Few subjects in women's health are as charged — or as muddled — as HRT. So let's separate what the evidence says from what fear and headlines have made of it. (One important note: this is education, not medical advice. HRT is an individual decision to make with a clinician who knows your history.)

How we got here. Around 2002, early findings from a large study (the Women's Health Initiative) were reported in a way that made HRT sound dangerous, and prescriptions fell off a cliff worldwide. In the years since, researchers have re-analysed that data and run further studies — and the conclusions have shifted considerably. A key realisation: the original headline lumped together women of widely different ages and used specific older formulations, which skewed the picture.

What the evidence broadly shows today:

• Timing matters — a lot. For most healthy women who start HRT around the menopause transition (roughly under 60, or within ten years of their last period), the benefits tend to outweigh the risks. Starting many years later changes that balance.
• It's highly effective for symptoms. HRT remains the most effective treatment for hot flushes and night sweats, and it helps with many other symptoms — and it protects bone density, lowering fracture risk.
• Type and route matter. Modern body-identical oestrogen, and oestrogen taken through the skin (patches or gels) rather than as tablets, carry a different — generally more favourable — risk profile than the older oral formulations studied decades ago.
• The risks are real but often smaller and more specific than feared. They depend on your personal and family history, your age, and the exact type and dose. This is precisely why it's an individual decision, not a blanket yes or no.

The honest bottom line. HRT is neither the miracle nor the menace it's been painted as at different times. For many women with troublesome symptoms it is safe and life-changing; for some it isn't the right choice. What's changed is that the conversation can now be based on current evidence rather than a twenty-year-old headline.

If symptoms are affecting your life, you deserve an up-to-date, individual discussion with a clinician who keeps current with the research — not a flat "you'll be fine" or a fearful "absolutely not." Armed with the real picture, that conversation is one you can lead.

Common questions

Is HRT safe?

For many healthy women starting around menopause, the benefits tend to outweigh the risks — but it's an individual decision to make with your doctor.

When is the best time to start HRT?

Generally around the menopause transition — roughly under 60, or within ten years of your last period.

Keep reading: Hot flushes & night sweats: what helps · How long do menopause symptoms last? · Take the free Hormone Quiz