4 Risks of Not Taking HRT

 




Doctors and menopausal women still base their judgements of HRT risks on the Women’s Health Initiative.

This results in decreasing HRT application yearly by 0.23%.

Menopausal (1.8 %) and postmenopausal (4.7%) women posted a decrease in use of hormone replacement therapy. According to Stephanie S. Faubion (MD, MBA, NCMP, IF, Mayo Clinic Center for Women’s Health director and The Menopause Society medical director), misinformation is the top reason why women are hesitant in taking HRT.


Recent evidence showed that HRT risks are relatively low and its benefits usually outweigh the risks.

1. Osteoporosis and Fractures

Research shows that during and after menopause, up to 20% of bone mass can be lost and 1 in 10 women over 60 are affected by osteoporosis. 

Bone thickness starts decreasing as estrogen levels fluctuate during menopause. On average, women lose 10% of bone density in the first years after menopause. 

HRT replenishes decreasing estrogen levels (important in maintaining bone density and strength). Some studies and clinical reviews noted the positive effects of HRT in menopausal women’s bone health. 

A 2019 randomized controlled trial investigated the impact of HRT on Chinese women's bone health. 123 early postmenopausal women were divided into three groups receiving different doses of conjugated equine estrogen (CEE) combined with micronized progesterone or dydrogesterone. 

Results showed a significant increase in bone mineral density (BMD) at the lumbar spine across all treatment groups. The highest gain was the group receiving standard-dose CEE and dydrogesterone. 

Additionally, one group experienced improvements in femoral neck and Ward’s triangle bone mineral density. The study concluded that low and standard-dose HRT effectively support bone health in early postmenopausal women.

2. Cardiovascular Disease

According to Cheng-Han Chen, MD (a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, California), decreasing estrogen leads to increased artery plaque buildup, increased cholesterol, and increased blood pressure. This all contributes to higher heart disease risks.

To counter these issues, women are advised to take estrogen replacement therapy to renew blood vessels’ elasticity, reduce LDL (low-density lipoprotein), and promote HDL (high-density lipoprotein).

A study led by Penn State Hershey Medical Center researchers showed that estrogen-based hormone therapy has a positive long-term effect on almost all markers of cardiovascular health. Participants (in 2 groups) were on conjugated equine estrogen, and another group was taking conjugated equine estrogens with medroxyprogesterone acetate.

The researchers found that the conjugated equine estrogen group (taking it for at least 1 year) had a 13% increase in high-density lipoprotein cholesterol (HDL-C, good cholesterol). Those taking conjugated equine estrogens plus medroxyprogesterone acetate saw a 7% increase in HDL-C measures.

3. Cognitive Health

When estrogen falls, it stops supporting the growth of new cells. This reduces brain energy levels and triggers hot flashes, night sweats, mood swings, and brain fog. Women with early or surgical menopause not treated with HRT have higher risks of Alzheimer’s disease and cognitive decline.

A 2025 study published in Frontiers in Dementia examined the impact of hormone replacement therapy (HRT) on postmenopausal women's cognitive function. Researchers used data from the Cognitive Function and Aging Study Wales (CFAS Wales). 

It included 615 women with an average age of 73. They were 20 years post-menopause and about 42% had a history of HRT use. The study found that HRT use, later age at menopause, higher education levels, moderate alcohol consumption, and following a healthy diet were linked with better cognitive performance at a single follow-up point. 

Additionally, KEEPS (Kronos Early Estrogen Prevention Study) noted that transdermal estrogen is good for younger women’s sleep and cognition ability in their postmenopausal years (women aged 42-58 years who are within 36 months of their final menstrual period).

4. Hot Flashes and Night Sweats

Many women shared their experiences on Reddit and menopause-focused forums about how the absence of HRT intensified their menopausal symptoms (particularly hot flashes and night sweats. 

For example, in a SELF article, a woman recounted that her night sweats became less frequent and severe after starting progesterone and using an estrogen patch. This suggests that prior to HRT these symptoms were more pronounced.

The combined clinical studies of Gynecology, Obstetrics, and Neonatology institutes and universities in Spain showed that a dose of 0.025 mg/day reduced hot flashes frequency by 84%. Additionally, transdermal estradiol increased the bone mineral density at the spine and hip. However, experts don’t recommend this therapy for osteoporosis prevention. 


Sources


Menopause and Osteoporosis


Heart Declines Rapidly After Menopause


Brain Fog


HRT, Menopausal Age and Lifestyle Variables



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