HRT Risk-Benefit Calculator — Personalized Assessment
Primary Question
Is HRT likely to be a good option for me, given my personal health history and symptom burden?
Computes a personalized risk score (0-100) and benefit score (0-100) based on your health history and symptoms, then maps the combined profile to one of six risk-benefit categories.
Who This Is For
- ✓Women in perimenopause or post-menopause experiencing vasomotor or other menopause symptoms
- ✓Women who want to understand their personal HRT risk-benefit profile before a doctor visit
- ✓Women who have heard conflicting information about HRT safety and want evidence-based guidance
- ✓Women who want to prepare for an informed conversation with their healthcare provider
Not For
- —Women who have already been advised by a specialist to avoid HRT — follow that advice
- —Women seeking a diagnosis — this tool does not diagnose any medical condition
- —Women with current hormone-sensitive cancer — this calculator will flag this as high risk, but clinical guidance from your oncologist takes precedence
- —Women who are pregnant or breastfeeding
Your age
How this calculator works
Purpose: Estimates a personalized risk-benefit profile for hormone replacement therapy (HRT) based on your self-reported health history, lifestyle, and symptoms. Helps you have an informed conversation with your doctor.
Who it's for: Women considering HRT who want to understand their personal risk-benefit balance before discussing with a healthcare provider.
What information is considered
The tool asks 18 questions covering your age, years since last period, 12 medical diagnoses, 4 family history items, smoking status, BMI, activity level, alcohol consumption, quality of life impact, 6 symptom severity ratings, DEXA scan results, cardiovascular risk factors, and prior HRT experience.
How the information contributes to the result
Risk points: breast cancer (+40), blood clots (+35), stroke/TIA (+35), liver disease (+35), unexplained bleeding (+30), endometrial cancer (+15), gallbladder disease (+10), migraine with aura (+10), heart disease (+10), family history of breast cancer (+15-20), smoking (+8-15), high BMI (+15), multiple cardiovascular risk factors (+15). Protective factors: no smoking (-5), healthy BMI (-5), very active (-10), recent menopause (-10), no family history (-5). Benefit points: severe QoL impact (+25), significant (+18), noticeable (+12), high symptom count (+12-20), age 45-54 (+15), osteoporosis (+20), osteopenia (+15), prior successful HRT (+20), cardiovascular risk factors (+10). Both scores are capped at 0-100.
Research and guideline basis
Risk factors are based on contraindications and cautions identified in The Menopause Society 2022 Position Statement and NICE Guideline NG23. The timing hypothesis and WHI study critique are based on published literature including the Women's Health Initiative (WHI) trial data and subsequent reanalyses. The scoring weights are custom estimates, not derived from a validated risk stratification tool.
What this calculator cannot determine
This tool is NOT a medical risk assessment. The scoring is a custom heuristic, not a validated clinical risk model (it is not the Gail model, FRAX, or ASCVD risk calculator). It cannot replace a clinical evaluation. Many factors a doctor would consider (blood pressure, lipid panel, personal cancer risk, medication interactions) are not captured. The "High Risk" output does not mean HRT is definitely unsafe — it means you should discuss your specific situation with a specialist.
When professional medical evaluation may be appropriate
If your results suggest moderate or higher symptom burden, or if you are considering prescription treatment, a conversation with a qualified healthcare provider is recommended. This tool is decision support, not a diagnosis.
Methodology version 1.0 · Last reviewed 2026-09-27
Understanding your possible results
These are the result categories this calculator may produce. You do not need to complete the calculator to understand what each result means.
Low Risk
What it means: Based on your self-reported history, your risk factors for HRT appear low. HRT may help — discuss with your GP as one option among several.
Factors considered: Risk score below 20 with moderate or lower benefit score.
Limitations: Low risk does not mean no risk. Your doctor may identify factors not captured by this self-assessment.
Common next steps: Discuss HRT as one option with your GP. Ask about transdermal vs oral forms and the timing hypothesis.
Low Risk / High Benefit
What it means: Based on your self-reported history, your risk factors appear low and the potential benefit appears significant. HRT may be worth a serious conversation with your doctor.
Factors considered: Risk score below 20 with benefit score of 60 or higher.
Limitations: Even with a favorable profile, only a healthcare provider can determine if HRT is appropriate for you.
Common next steps: Schedule a conversation with your GP or a menopause specialist. Bring your results to discuss.
Moderate Risk
What it means: Based on your self-reported history, you have some risk factors to consider. Natural approaches may be worth trying first, then reassess with a specialist.
Factors considered: Risk score 20-39 with moderate or lower benefit score.
Limitations: Moderate risk factors may or may not affect HRT appropriateness — a specialist can help weigh them.
Common next steps: Consider evidence-based non-hormonal approaches first. Schedule a specialist consultation to discuss whether HRT is still an option.
Moderate Risk / High Benefit
What it means: Based on your self-reported history, you have some risk factors but also significant potential benefit. Transdermal HRT may offer good benefit with lower risk — discuss with a specialist.
Factors considered: Risk score 20-39 with benefit score of 60 or higher.
Limitations: Transdermal HRT has lower clot risk than oral, but other risks may still apply. Only a specialist can assess this.
Common next steps: Specialist consultation recommended. Ask specifically about transdermal options and the timing hypothesis.
Elevated Risk
What it means: Based on your self-reported history, HRT may need careful specialist assessment before considering. Effective non-hormonal alternatives exist.
Factors considered: Risk score 40-59.
Limitations: Elevated risk does not mean HRT is impossible — it means specialist evaluation is essential.
Common next steps: Schedule a specialist consultation. Discuss non-hormonal alternatives. Bring your full medical history.
High Risk
What it means: Based on your self-reported history, HRT may not be appropriate for your profile. Effective alternatives exist and should be explored with your doctor.
Factors considered: Risk score of 60 or higher.
Limitations: This is a self-assessment estimate, not a clinical determination. Some women with high risk scores may still be candidates for certain HRT forms under specialist supervision.
Common next steps: Discuss non-hormonal alternatives with your doctor. A specialist may still evaluate whether specific HRT forms (e.g., local estrogen for GSM) are appropriate.