Signs your HRT is not working for you
What's the lowdown?
Ensure that the symptoms you are experiencing are due to perimenopause and not another health condition or lifestyle factors
If you are on HRT and you have a recurrence of perimenopausal symptoms, you might need an increase in your dose of HRT or a change in the preparation or delivery method
HRT takes up to three months for its effects to be felt and the commonest side effects normally settle down by this time
If something doesn’t feel right and you just aren’t sure, talk to your doctor!
How do you know that your HRT isn’t working for you? Maybe a better first question is “how do I know my HRT is working?”.
In premenopausal women, oestrogen is produced largely by your ovaries and in smaller quantities, by fat cells, the lining of blood vessels and bones 1. The perimenopausal sleigh ride, during which time these levels can fluctuate wildly and eventually fall, can cause multiple physical and/or emotional symptoms.
While a lower level of oestrogen is the main change, the decrease in progesterone and testosterone can also contribute to the perimenopausal symptoms experienced 2. HRT seeks to replace the natural decline of these hormones and restore balance.
You know your HRT is working when the symptoms that drove you to talk to your doctor, be it troublesome night sweats, insomnia or hot flushes, become manageable or may even resolve. So, what should you do if your symptoms don’t disappear? Or worse still, reappear? Does that mean your HRT isn’t working?
When HRT is started, it is usually at a low dose and this is normally enough to top up dwindling levels of oestrogen for the majority of women 3. If suspected perimenopausal symptoms don’t improve with HRT, it is worth considering and exploring other health conditions and lifestyle issues that might be having an impact. Thyroid imbalance, fibroids, endometrial polyps, excess alcohol consumption, spicy food and stress are amongst the plethora of things that can contribute to and cause similar symptoms to those associated with perimenopause 2.
“My doctor and I have ruled out other problems, so what’s going on?”
As mentioned previously, over time, your body produces less oestrogen and the way in which the level falls is not linear. If your dose of HRT remains the same, it will have the same effect as always 4. However, for some women, doing the same thing just isn’t enough, and a recurrence of symptoms can occur. In such cases, a higher dose of HRT or a change in preparation and/or delivery method may be needed. Since we all have different experiences and absorb medications differently, it is essential to discuss your symptoms with an appropriate healthcare professional and work out if it’s time to try something new.
How quickly should you usually expect HRT to take to work?
It can take up to three months for HRT to work so patience should be exercised, though thankfully, symptom relief is often experienced before this 5. Factors that can lengthen the time to benefit include:
- if you take your medication perfectly or forget doses
- the type and dose of HRT
- how severe your symptoms are
- what other medications you are taking
- your medical history
Guidance from the British Menopause Society recommends you to have a review three months after starting HRT with annual reviews thereafter 6. Engaging in this process helps both you and your doctor assess if HRT treatment is working in the way it should and try and iron out any kinks.
How long should I wait for side effects of HRT to improve before changing the type?
Common side effects of HRT include nausea, irregular bleeding, headaches, heartburn, bloating, breast tenderness, leg cramps, rashes, and acne 7. It can take up to three months for HRT to show benefits, and the above symptoms usually settle within that time. This time also allows you to judge whether any negative side effects outweigh the benefit you’re getting from the HRT.
Of note, irregular bleeding can prompt a change in the dose of the progesterone component of HRT or a referral to a gynaecology clinic. If there is an increase in the heaviness or duration of your bleeding while using cyclical HRT, or if bleeding continues beyond six months of starting or changing HRT dose while using continuous combined HRT, further tests including a scan may be necessary 8.
Can HRT suddenly stop working?
In short, no. Just as it takes some time for it to start working, it takes time to notice the lack of benefit. This is usually because of an incorrect dosage or using a form of HRT that your body doesn’t absorb well.
Can HRT give me a new side effect?
You may experience different side effects if you change from one form of delivery to another, for example, a tablet and gel combination to a patch or increase your dose but this is not a certainty. If you suddenly develop a new side effect, this might be a sign of something else – so check it out with your healthcare professional.
How to tell if my dose is too low or too high?
If your original perimenopausal symptoms return, this could suggest your dose of HRT is too low. Extreme side effects or a particularly long duration of side effects could indicate your dose is too high. There is a medical term called “tachyphylaxis” which means that women feel their symptoms aren’t controlled so request higher and higher doses of oestrogen. In fact. These higher doses of oestrogen can mean that women still feel perimenopausal symptoms, and may even worsen symptoms. This is why HRT prescribing has to be so individualised to make sure you’re on the right dose to control your perimenopause, but not make things worse! Please talk through your symptoms with your doctor, or our specialists at Myla health.
Dr Helen Walker
Helen is a GP, wife and mum of one, working in South London with an interest in HIV, transplant and Women’s Health
Our medical review process
This article has been medically reviewed for factual and up to date information by a Lowdown doctor.
