Hormone replacement therapy (HRT) is one of the most common treatments for menopausal symptoms. But what if it isn’t working for you? Perhaps you’ve been taking HRT for a while and have noticed some old symptoms creeping back, like hot flushes or night sweats. Could it be time to change tactics?
In this article, we’ll look at why taking HRT isn’t always straightforward. We’ll also go through the tell-tale signs that it’s time to review your oestrogen levels and discuss next steps if your current HRT plan isn’t doing the job.
What is menopause?
Menopause is confirmed when a woman has had no periods for 12 consecutive months. This natural transition is driven by falling hormone levels — particularly oestrogen (estrogen).
What are menopausal symptoms?
As the ovaries produce less oestrogen, a wide range of symptoms can appear, vary in intensity, and change across the different stages of menopause. They can even fluctuate week to week.
Common symptoms include hot flushes, night sweats, mood changes, anxiety, sleep disturbance, vaginal dryness, urinary symptoms, breast tenderness, headaches, dry skin, fluid retention, low energy and brain fog. Women in midlife are also at higher risk of menopausal weight gain and increased blood pressure, which can influence cardiometabolic health.
What are the benefits of HRT?
Hormone replacement therapy (HRT) replaces hormones lost during perimenopause and menopause to relieve symptoms. The two main hormones used are oestrogen and progesterone (combined HRT), while some women without a womb may use oestrogen-only HRT. In certain cases, testosterone may be added. Many women experience significant symptom relief and additional health benefits when appropriately prescribed and reviewed.
How do you take HRT?
HRT comes in several forms, including tablets, patches, gels, sprays and intrauterine devices (IUD). These are called systemic HRT because hormones enter the bloodstream.
Vaginal oestrogen (creams, pessaries, rings) is used locally to treat symptoms such as vaginal dryness, itching, painful sex and some urinary problems. Local treatment can be used alone or alongside systemic HRT.
How long does it take for HRT to work?
It can take around three months for your body to adjust to hormonal medication. Early side effects are common but often settle by the third month. If you’re struggling or symptoms persist, speak to your doctor rather than stopping suddenly.
Why HRT might stop working over time
As you move through perimenopause into menopause, levels of oestrogen and progesterone generally continue to decline. Over time, a dose that once worked may become less effective. Medication interactions, absorption, route of administration, weight changes, lifestyle factors and new health conditions can also influence how well HRT works.
How to tell if your HRT needs adjusting
There are several signs it may be time to review your HRT:
- The return or persistence of symptoms such as hot flushes, night sweats, poor sleep, anxiety, headaches and brain fog (there are more than 40 recognised symptoms).
- Testosterone-related changes (e.g., low libido, difficulty concentrating). Testosterone isn’t routinely included in HRT, but there are options — discuss with your clinician.
- Using local (vaginal) oestrogen only will not address whole-body symptoms; systemic HRT may be needed for those.
What to do if your HRT side effects don’t settle
Side effects such as bloating, headaches, nausea, breast tenderness, vaginal bleeding and indigestion can occur early on. Progesterone may also cause low mood, acne or irregular bleeding in some women. If side effects persist beyond a few months or feel unmanageable, speak to your doctor. A different route (e.g., patches or gel), a different preparation, or dose adjustments can often help.
Are you taking your HRT correctly?
HRT is less effective if not taken as prescribed. Check you are:
- Taking tablets daily or changing patches on schedule.
- Applying the correct amount of gel and using the right application technique.
- Following your clinician’s guidance for combined or cyclical regimens.
If you’re confident you’re using HRT correctly and symptoms persist, book a review rather than waiting for your annual check-up.
When to speak to your doctor about your HRT
Contact your GP or menopause specialist if you experience:
- New, worsening or returning symptoms after initial improvement.
- Side effects that don’t settle after ~3 months.
- Unscheduled or heavy bleeding, chest pain, severe headaches, or any red-flag symptoms.
How nutrition can help your HRT work better
Even well-balanced HRT isn’t a cure-all. Diet, lifestyle and nutrient intake materially influence how your body responds to treatment. Many women find that fatigue, brain fog, sleep issues and weight gain linger — not always because HRT isn’t working, but because the body needs extra nutritional support.
That’s where Eve Biology’s meal replacement shakes can help. Designed for women in midlife, they provide targeted nutrition to:
- Support steady blood-sugar and sustained energy — helping to reduce mood swings and cravings.
- Deliver key nutrients (e.g., plant protein, vitamins B6, B12 and D, and phytoestrogens) that complement hormone balance.
- Offer a convenient way to nourish your body when appetite or time is low.
- Help maintain a healthy weight — often harder as oestrogen levels fall.
Tip: If you’re still experiencing symptoms despite being on HRT, try supporting your body nutritionally for a few weeks. A daily Eve Biology shake, alongside a balanced diet and regular movement, can make a noticeable difference.
The bottom line
HRT can be highly effective for menopause symptoms, but your needs may change over time. Review your treatment regularly with your clinician, ensure you’re using it correctly, consider route and dose adjustments, and support your body with nutrition and lifestyle.
FAQs
How long after starting HRT do you feel a difference?
Many women notice improvements within a few weeks. Clinicians often recommend trying treatment for at least three months to allow benefits to establish and early side effects to settle.
Does HRT cause weight gain?
There’s no clear evidence that HRT directly causes weight gain. Weight changes around menopause are common due to age-related and hormonal factors. A balanced diet, regular movement and adequate protein can help.
Can you get HRT over the counter?
Systemic combined or oestrogen-only HRT typically requires a prescription. Some local vaginal oestrogen products may be available over the counter. Always follow medical advice.
