Menopause Myths And Facts
By Dr Ellie Cannon • 17, Mar 2025
In this article, I will look at common misconceptions and myths around menopause using the available fact-based science and years of experience as a GP.
All women will need Hormone Replacement Therapy
Many women don’t need Hormone Replacement Therapy (HRT) because they are not having menopausal symptoms and, therefore, don’t warrant it. If you don’t have symptoms or particular osteoporosis concerns, taking HRT means your risks from the medication outweigh your personal benefits, and doctors would not recommend it.
Along the spectrum of menopausal symptoms, for some women, they are mild or moderate enough that it isn’t worth thinking about taking a medication. The benefits are negligible for someone with no or only mild symptoms that don’t impact their day-to-day functioning and quality of life.
Choosing to take any medication is a balancing act of downsides and benefits, and if there aren’t great benefits to be had, the balance doesn’t swing in favour of taking something.
Also, HRT is not going to help all women. Many women are doing very well with their menopause symptoms using alternatives to HRT, whether natural or prescribed. And some women are having symptoms that in fact, are not from menopause but are due to another issue that has crept up around menopause time, so they should be taking something entirely different.
You have to stop HRT at a certain age
We used to tell women they had to stop HRT at a certain time; now we don’t. The individual approach to prescribing HRT has led to there being no time limit on how long a woman takes it.
There is no specific age for when you have to stop HRT. In fact, you can also choose to start at any age if you are having menopausal symptoms or if you need it for osteoporosis.
The age to stop HRT will be up to you as an individual with your own specific medical history, family history and wishes.
The longer you stay on HRT, the more the risks of taking it increase. Importantly, the risks, such as breast cancer and stroke, still remain small in an average woman (especially under the age of 60), but it is essential to know that they do increase.
But for any of us, those risks are being weighed up against the benefits, and for some women, the value of stopping distressing menopausal symptoms remains so great that it outweighs the risks.
We can generalise and say many women take HRT for around two to five years and stop when they feel their symptoms have gone. But it very much depends on your preferences, your symptoms and your medical history. We always want people to take medication at the lowest effective dose for the shortest time possible because of side effects and risks. As you get older, you can reduce the risks by taking low doses and using lower-risk types like patches or vaginal oestrogen only.
In the UK, there are women taking HRT for decades, after discussions about their risks and because they value the improvements in their quality of life from HRT. As long as you are aware of all of the information, this is perfectly acceptable. As I have seen in the clinic, menopausal symptoms can be hugely debilitating, and to have those cured is worth the risks for many women. Choosing to start HRT is based on how you feel and your symptoms. Choosing to stop is exactly the same.
If you are using vaginal oestrogen, you do not need to think about stopping it because it is considered safe for long-term use. This means how long you use it only depends on how long you feel you need to use it, and it helps, and nothing else.
Hormone Replacement Therapy prevents ageing
There is a view among some people that you should take HRT even if you have no symptoms because it helps you to look and feel younger. I think this has been falsely sold to women as an idea as if HRT is an anti-ageing magic elixir. It isn’t and has never been proven to be so.
The science behind HRT has been studied closely and is constantly evolving. We can say very clearly what it can and can’t do. It doesn’t stop you from ageing, but it does improve menopausal symptoms and reduce bone thinning. However, it has never been proven to make you look and feel younger.
Many of the symptoms of menopause make us feel old, such as poor sex drive, brain fog and aches and pains. Of course, taking HRT, which can reduce those symptoms, will help us feel younger and brighter. But you shouldn’t take HRT unless your menopausal symptoms are bad enough for you that you need treatment. It isn’t an anti-ageing potion that you take ‘just in case’. That’s because it comes with risks and side effects, and these have to be balanced by big benefits to you.
Dementia is something we are all afraid of and is a frightening aspect of ageing. Since we know HRT helps to reduce menopausal brain fog and concentration, people assume that it must, therefore, help to prevent dementia or age-related memory issues. But that isn’t the case. Science has shown so far that HRT both prevents but also causes dementia – in truth, no one is sure at this stage.
What we do know if we look sensibly at the whole thing is that HRT can improve your quality of life around menopause and allow you to do things like exercising, working and socialising that may keep memory problems and ageing at bay.
All women need testosterone HRT
Testosterone is a hormone. At the age of about 40, a woman’s testosterone level is 50 per cent what it was when she was in her teenage years.
In women, testosterone plays a key role in your sex life and libido, as well as your sexual feelings, such as your ability to orgasm and how much you enjoy and feel like having sex. When the testosterone levels drop, this is all impacted. Lubrication is also really important around menopause, as the whole vulva and vaginal area can feel drier because of the drop in oestrogen levels. Less testosterone just adds to the issue for some women – so there are two dips in hormones that negatively impact sex at this age.
Testosterone is prescribed during menopause to improve sexual function. Although testosterone has other roles in a woman and is involved in heart health, energy levels and brain health, it is only prescribed for sexual issues because it is only proven to work for that. For example, there is no proven link that shows that taking testosterone HRT is the answer to preventing dementia or boosting your energy.
And even when we prescribe it for sexual issues, it is not always the first choice: testosterone is only used for the sex side of things once we’ve sorted out the oestrogen prescriptions, as we know, oestrogen plays such a significant role in a healthy sex life too.
What this means in reality is that you would try a higher dose of oestrogen or adding in vaginal oestrogen first when trying to fix sexual issues. It is unlikely everyone will need testosterone without first getting things sorted with oestrogen and even tinkering with oestrogen doses and regimes.
Testosterone can be very valuable around menopause for dealing with sexual symptoms, but that does not mean every woman needs to take it. HRT should certainly not be started until after, and only after it has been adequately trialled first. It is not something to be taken ‘just in case’.
Only the highest-dose HRT will help symptoms
For all the types of HRT, there are dose ranges from ultra-low to high. These doses have been studied and tested first to see if they work to improve symptoms and, crucially, to be safe. At higher doses, there is a higher chance of side effects from oestrogen, such as headaches. There is also a higher chance of risks like endometrial cancer and blood clots. Prescribing outside of the regulated dose ranges is dangerous.
Women’s health experts always recommend that women use the lowest dose of HRT that controls symptoms to keep the risks and side effects at bay.
If a woman finds her HRT is not working, she is absolutely right to trial an increase in dose within the known safe levels. Or the HRT can be changed to a different type or regime. It is also possibly worth looking at alternatives to HRT and thinking about non-menopausal causes of her symptoms.
HRT will make me fat
There has always been a concern about the contraceptive pill that it can make some women gain weight. (In fact, most women do not gain weight on the pill, and it depends on which one you use.)
Since HRT also contains hormones, the misconception has grown that HRT can also make women gain weight. Hormones around our period are often associated with feeling fatter, so I can understand where this myth arises.
In fact, HRT is not proven to make women gain weight. Menopause and ageing are associated with weight gain. This is a natural change in our metabolism and hormones, and fat distribution often shifts to the tummy area. Weight gain at this time of life is also associated with ‘life’ – people exercise less, eat more and can be in demanding professional and personal roles that do not allow the time for a healthy lifestyle.
If anything, being on HRT can help to reduce this expected mid-life and menopausal weight gain, as it can improve energy levels and mood and reduce joint aches. All of this means you are more likely to exercise more and lose weight.
The side effects of HRT include fluid retention and bloating, which can make women feel they have gained weight. Side effects often pass in the first few weeks of taking HRT.
Antidepressants are not for menopause
Not every woman wants or needs to take HRT for menopause. Other options, whether pharmaceutical or natural, are perfectly valid and important. And other routes are helping plenty of women at a difficult time during their overall menopause journey.
Using an antidepressant for menopausal symptoms does not mean women are being dismissed or considered mentally ill or that their menopause is being invalidated. It does not mean healthcare professionals think symptoms are in your head. They are not offered as an option in any way to belittle women and their physical symptoms. They are offered because there is science behind their use and effectiveness in menopause, even including the physical symptoms.
Antidepressants have always been used for issues other than depression, particularly for pain, as well as anxiety and OCD.
The types of antidepressants used in menopause work by increasing the levels of chemicals in the brain and this is thought to improve mood and emotion[ld2] al regulation. These chemicals are not just responsible for mood, but also pain and other functions in the body like temperature control: this could explain why they work for hot flushes and night sweats.
One antidepressant, paroxetine, is especially used because the US medicines regulatory body, the FDA, has approved it for use for hot flushes. Research shows antidepressants can improve quality of life during menopause in some women. Unfortunately, antidepressants will not help everyone and we cannot tell who they will help. But it is wrong to dismiss them outright.
HRT causes breast cancer
Hormone Replacement Therapy does not cause breast cancer. Taking some forms of HRT may increase your risk of getting breast cancer. There is a difference between these two things. This was always one of the big historical worries about HRT and is something the science has swung backwards and forwards on.
There are two types of HRT that do not increase your risk of breast cancer: vaginal oestrogen and oestrogen-only HRT.
Taking combined HRT – with oestrogen and a progestogen – can be linked to an increased risk of breast cancer. The important thing to know is that this is related to how long you take HRT, and the risks reduces again, albeit slowly, after you stop HRT. This is one of the reasons we always suggest you use the lowest dose of HRT for the shortest time. Also, if micronised progesterone or dydrogesterone is used for combined HRT, the risks are considered lower.
Your increased chances of breast cancer from HRT are considered low in scientific and statistical terms. In the UK, about 2 per cent of breast cancer cases are thought to be linked to the use of HRT. Remember when thinking about breast cancer that there are also a whole host of other breast cancer risk factors, such as weight, alcohol intake and your family history. Looking at the figures tells us that the risk from HRT is less than the risks from being obese or drinking alcohol every day.
If you found this post helpful, check out our Menopause Health Check to learn more about how our expert GPs can help you stay on top of your health.
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