While HRT is sometimes referred to as something of a wonder drug, the truth is often much more complex. Hormone replacement therapy (HRT) is the most effective treatment available for menopause. You may even think it’s something of a wonder drug, but the truth is that it can be complex. You might notice signs HRT is not working for you, such as bothersome side effects and symptoms that aren’t improving. Dr Lucy Wilkinson, clinical advisor at Vira Health, explains what to do if this happens to you and how to get help.
FIND WHAT YOU NEED QUICKLY
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How long have you been taking HRT?
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Are you struggling with HRT side effects?
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Are you taking the right dose of HRT?
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Are you taking the right type of HRT?
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Are you taking your HRT correctly?
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Do you have a clear picture of your menopause symptoms?
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Are your symptoms really caused by menopause?
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Final word
Start your free online menopause assessment to see if HRT is right for you
How long have you been taking HRT?
Don’t lose faith if you don’t see an immediate improvement after starting HRT. It can take several weeks for your symptoms to settle, and sometimes up to three months. This is why your doctor will usually wait until three months have passed before checking in to see how things are going.
If you are in the early days and weeks of HRT treatment, hang in there! It really is worth persevering before stopping or changing your prescription.
However if you have recently started HRT and feel awful, contact your doctor before your three-month follow-up. This is especially important if you have heavy vaginal bleeding or have noticed any breast lumps or changes.
Get medical help urgently if you have any signs of:
- A blood clot like deep vein thrombosis (DVT)
- Pulmonary embolism (PE), including chest pain, leg swelling or shortness of breath
- Stroke
- Other serious concerns
Are you struggling with HRT side effects?
HRT does come with certain side effects, which tend to be most pronounced in the first few weeks and months of use. If you are unlucky, you may even find that HRT can make you feel worse before you feel better.
Common side effects of oestrogen include bloating, nausea, indigestion, tender breasts, vaginal bleeding and headaches.
Side effects of progesterone include abdominal pain, low mood, acne, headaches, breast tenderness and vaginal bleeding.
These all tend to settle after a few weeks. However, if they are particularly bad or do not improve, speak to your doctor. They may be able to change your prescription to ease the side effects. For example, side effects tend to be milder with HRT patches compared to pills. Likewise, your doctor may be able to reduce your dose or suggest another approach to your treatment.
Common side effects of oestrogen
- Bloating
- Nausea
- Indigestion
- Tender breasts
- Vaginal bleeding
- Headaches
Side effects of progesterone
- Abdominal pain
- Low mood
- Acne
- Headaches
- Breast tenderness
- Vaginal bleeding
These side effects tend to settle after a few weeks. However, if they are particularly bad or do not improve, it could be a sign that HRT is not working for you and you need to speak to your doctor.
Your doctor may be able to change your prescription to ease the side effects. For example, side effects tend to be milder with HRT patches compared to pills. Alternatively, a lower dose or different approach to treatment may work better.
Find out more about the risks and benefits of HRT.
Are you taking the right dose of HRT?
If several months have passed and you are seeing no improvement in your menopause symptoms, it could be one of the signs that HRT is not working for you. You might need to increase your dose of HRT, specifically the oestrogen you are taking.
Menopause symptoms are caused by falling hormone levels, and HRT works by providing your body with the oestrogen that it no longer produces.
Many HRT products come with a range of oestrogen doses, and it can be trial and error to find the correct one for you. A higher dose may help manage menopause symptoms more efficiently, while a lower dose may make side effects more tolerable.
- If you are taking a pill or patch, your doctor may prescribe a different strength
- If you are taking a gel or spray, you may be advised to apply more or less
Increasing your HRT dose
You may also want to think about an increase in dose if your once-brilliant HRT seems to have stopped working. As your body proceeds through menopause, your hormone requirements sometimes increase, meaning that you may need to take more oestrogen to keep your symptoms under control.
Are you taking the right type of HRT?
This is an important question, especially when it comes to vaginal HRT.
HRT can be taken systemically, meaning that the hormones enter your bloodstream and are distributed throughout your body. This is an effective way to treat general menopause symptoms, including hot flushes and low mood among others. Preparations include tablets, patches, gels and sprays.
Read more about the different types of HRT.
HRT can also be used vaginally, meaning that oestrogens are applied only to your genital area. This treats the genitourinary syndrome of menopause (GSM), which can cause itching, burning, pain, tightness, painful sex and urinary symptoms. With this approach, hormones are not absorbed into your bloodstream and stay in your genital area only.
While systemic HRT can help with GSM, some users may need to take both systemic and vaginal HRT together to improve symptoms.
Likewise if you are taking vaginal HRT to treat GSM, you will not see an improvement in any other menopause symptoms. If this is the case, ask your doctor about changing your prescription.
Start your free online menopause assessment to see if HRT is right for you
Are you taking your HRT correctly?
If you are concerned that your HRT isn’t working or is making you feel worse, read the instructions on your medication pack.
HRT medicines can be complicated to take, and it is worth checking that you are taking the right dose at the right times. Ask yourself if you are:
- Replacing your patch often enough?
- Applying the gel correctly?
- Remembering to take your tablets every day?
If you find your HRT difficult to take, ask your doctor for an alternative. It is common to switch from one type to another and it is important to find a type of HRT which works well for you. For example, if you have arthritis in your hands you may find it difficult to use a pump or apply a patch. Or, if you have a hectic lifestyle, you may struggle to remember a daily pill and a twice-weekly patch might work better.
Do you have a clear picture of your menopause symptoms?
It can be tricky to get a handle on your menopause symptoms, especially if you are trying to monitor them over a long period of time. While it can be easy to count hot flushes, how can you possibly keep tabs on your mood, weight, energy levels or aches and pains all at the same time?
One way to get a useful overview is to use our Stella app which allows you to track your progress. It will allow you to see how your symptoms have changed over time, and whether there has been any improvement. You can share this information with your doctor who will be able to use it to inform your treatment plan.
Are your symptoms really caused by menopause?
If you have been taking HRT but it is not working, it might be time to re-evaluate your symptoms.
Many problems commonly put down to menopause can also be caused by completely unrelated issues. This means that they will not improve with HRT and a different approach is required.
For example, while hot flushes are common during menopause they can be caused by a host of other medical issues, from thyroid problems to infections.
If it seems like your HRT is not working, take the opportunity to check in with your doctor. They may be able to investigate further and find an alternative cause for your symptoms.
This may also be a good time to think generally about your lifestyle. Are there any other changes you could make to improve your symptoms? You may decide to think about your diet, exercise, weight, smoking history and daily routine among others.
Final word
If your HRT doesn’t seem to be helping, don’t lose heart! Many common issues can be solved with a little time or a minor adjustment to your prescription. Speak to your doctor if you feel like HRT isn’t working for you to figure out what your next steps should be.
Remember too that lifestyle changes can complement your HRT treatment and are proven to help with many menopause symptoms.
