Hormone replacement therapy

Hormone replacement therapy (HRT) is treatment with oestrogen, often with a progestin, given to replace hormones that drop sharply at menopause. Research going back to the Women's Health Initiative trial shows it reliably reduces fractures, including hip fractures, in postmenopausal women — the clearest and least disputed finding from that study, even though the trial became known for other reasons. The decision to start, stop, or change HRT always belongs to you and your prescriber, who can weigh it against your personal history.

HRT works by telling your skeleton to stop breaking down bone so fast — it restores a more protective hormonal environment. But it doesn't supply the mechanical signal that tells bone where to build; that comes from loading. The two address different problems, which is why they're often described as working together rather than as substitutes for each other.

An honest limitation: bone density gained during HRT is largely lost in the years after stopping, and fracture protection fades with it, so it's something you maintain rather than something that banks permanent bone. There's also no credible evidence that supplements or over-the-counter products replicate what hormone therapy does for bone, so claims of 'natural HRT' are worth treating with suspicion. If you're near menopause or in a higher-risk group — early menopause, androgen deprivation therapy, aromatase inhibitors, long-term steroid use — the window to have this conversation with a prescriber matters, so it's worth not putting off.