• Menopause Symptoms

Signs HRT is Not Working and What to Do Next

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  • Menopause Symptoms

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Hormone Replacement Therapy (HRT) is by far the most popular treatment for menopausal symptoms. In fact, according to gov.uk, more than one in 15% of women in the UK aged between 45 and 64 hrt hormones. But what if it isn’t working for you? Perhaps you’ve been taking hrt for a while, but recently started noticing some of your old menopause symptoms like hot flushes creeping up on you again. Could it be time to change tactics?

In this article, we’ll look at why taking hrt isn’t as clear-cut as you might think. Plus, we’ll go through the tell-tale signs that it’s time to review your gradually decreasing oestrogen levels and increase your hrt dose.Let’s begin!

What is menopause

If you’re reading this, you probably already know the answer to this question. But just to recap, menopause is the period in which a woman’s periods have stopped and have been absent for 12 months. This change is brought on by a drop in hormone levels – particularly oestrogen ( estrogen)

What are menopausal symptoms?

The responses in a woman's body when she no longer has her ovaries producing steady amounts of oestrogen are numerous and diverse but can differ from woman to woman, over time and also as she moves through the different stages of menopause. They can also change within a week depending on her hormones and which one dominates at the time.

When women start experiencing menopause symptoms these can include hot flushes, mood swings, leg cramps, breast tenderness, urinary symptoms, high blood pressure, anxiety, dry skin, night sweats, fluid retention, low energy levels and brain fog. Women in midlife are also at an increased risk of diabetes and heart disease. Menopause doesn't cause diabetes or heart disease, the risk is linked to an increase in body weight and blood pressure - which are affected by hormone levels.

What are the benefits of HRT?

Hormone replacement therapy hrt – is a treatment designed to replace the hormones lost during perimenopause and in menopause and relieve symptoms. The benefits of hrt include relief of symptoms and an increase in protection from diabetes and heart disease.

The two main hormones prescribed in HRT are oestrogen ( estrogen) and progesterone often referred to as combined hrt and oestrogen only hrt. Some hormone replacement therapy programmes can also include testosterone. Women are prescribed oestrogen-only HRT - if they don't have a womb lining because they've had a hysterectomy, otherwise you'll take a combination of both.

How do you take hrt?

Types of HRT gels

HRT takes many different forms, including tablets, patches, gels and sprays and inter uterine devices like the Mirena. These are called systemic hormone replacement therapy hrt, which simply means the hormones are absorbed into your system.

HRT can also be bought over the counter taken locally (vaginally) to treat vaginal atrophy menopausal symptoms, such as vaginal dryness, skin irritation, itching, painful sex, or urinary problems. Vaginal oestrogen can either be taken as a standalone treatment and include vaginal creams and in a pessary or alongside a systemic form.

Each form of HRT comes with its own list of benefits and potential side effects, but they all do pretty much the same job, making a woman more comfortable and helping to relieve menopausal symptoms.

How long does it take for HRT to work?

When you begin hrt It can take around three months for your body to adjust to taking hormonal medication, so if you’ve started HRT and the first few weeks feel awful, it’s probably just your body trying to get used to it. Things tend to settle down by the third month.

Why might HRT stop working?

As you move through the stages of perimenopause and into menopause, the oestrogen and progesterone levels in your body get lower and lower. So, if you want to keep the side effects of this at bay, you’ll need to increase your hormone dosage now and then.

Your doctor will usually recommend annual check-ups – treat these as your chance to tell them if you’ve noticed symptoms coming back, and they’ll be able to adjust your prescription in order to make you more comfortable. That’s not to say that you can’t speak to your doctor in-between check-ups, though, if you’re struggling.

How do you know hrt products need reviewing?

Oestrogen levels slowly decline during menopause and so symptoms can creep in over time but there are signs that your current does of hrt may no longer be serving you.

The return of your menopause symptoms

Most menopause symptoms are caused by declining levels of estrogen and progesterone. So, if you notice them creeping back up on you, it could be that it’s time to up your dosage. Hot flashes, headaches, poor quality sleep, heightened anxiety, night sweats and brain fog are well known culprits but there are 43 recognised symptoms!

Falling testosterone levels also have an effect. These include lower libido, brain fog, and trouble concentrating. Testosterone isn’t usually included in HRT but there are options if you ask. GPs will sometimes prescribe male testosterone for women. Some testosterone creams like Androfeme are privately available. We recommend speaking to your doctor about treatments but testosterone can be a game changer for some women.

If you’re taking HRT vaginally, remember that it will only treat symptoms like vaginal dryness, itching and urinary issues – any other symptoms will need to be treated with a different form of HRT, like transdermal patches, or gel.

Are There Any HRT side effects

As we mentioned earlier, it’s common to experience side effects when you first start taking HRT, but these should subside after a few months. In fact, most women notice an improvement in just a few weeks. Sometimes, however, bleeding, headaches and bloating can hang around for longer, leaving you frustrated and wondering whether you’re better off stopping your treatment.

Common side effects of hrt are bloating, headaches, nausea, breast tenderness, vaginal bleeding and indigestion. As for progesterone, it can cause low mood, acne, headaches, tender breasts and irregular bleeding.

The good news is that you don’t have to suffer from symptoms forever. Speak to your doctor about switching to a different form of HRT. HRT patches are the key to a much easier menopause for a lot of women and, like gels, tend to come with fewer side effects than an hrt tablet, for example. Alternatively, a lower hrt dose might help you feel better.

Are you taking your HRT correctly?

Taking HRT will be less effective if it’s not taken as prescribed. Are you remembering to take your tablet every day, or changing your patch frequently enough? If you use HRT gel, are you applying enough, and applying it correctly? It may be worth double-checking if you’re unsure. And if you’re taking your HRT as prescribed and it’s still not working for you, it could be time to speak to your doctor.

The bottom line

HRT is an effective treatment for menopause symptoms, which is why it’s so commonly prescribed to women around the globe. As you get older, your hormone levels continue to fall, so it’s important to regularly get reviews with your doctor if you're taking hrt to make sure you're on the right dose in order to stop your symptoms from coming back.


How long after starting HRT do you feel a difference?

It usually takes a few weeks for HRT to start working. Your doctor will usually recommend trying treatment for at least three months, by which time any side effects should have also subsided.

Does HRT cause weight gain?

There’s no evidence that suggests HRT causes you to gain weight. Many women put on weight as they approach menopause, regardless of whether or not they take HRT. The best way to prevent weight gain is to eat a healthy diet and exercise regularly.

Can you get HRT over the counter?

Combined HRT or oestrogen only is not currently available to buy over the counter, so if you want to try it, you’ll need to speak to a doctor and obtain a prescription first. Local oestrogen for vaginal dryness is available over the counter, as are vaginal creams