Hormone replacement therapy is prescribed to help women deal with menopause symptoms and offers some protection from the health risks which are associated with having lower oestogen levels. The common signs hrt is not working is when symptoms start to return or new symptoms emerge which start to make life a bit more uncomfortable or interfere with your quality of life.
In this article, we’ll look at the way menopausal symptoms progress and what your options are when it comes to symptom relief. Changing your HRT regime, increasing your hrt dose, increasing your nutritional support and lifestyle factors can all help to support the pesky symptoms which arrive as your oestrogen levels fall. Let’s begin!
What are the signs hrt is not working?
If you’re reading this, you probably are already questioning why, despite being on hrt, you are beginning to feel crappy again. The return of menopause symptoms like hot flushes, mood swings, poor sleep quality, night sweats, joint pain and fatigue can be one of the signs hrt is not working and that oestrogen patch you've been using for the past two years is no longer meeting your needs.
Your oestrogen supply steadily declines over time. Your hormone supplementation needs to be reviewed over time. Symptoms can start to reappear when your oestrogen levels have dropped further and the level of hormones you're replacing just isn't enough to rectify your hormonal imbalance.
It's recommended this is done every twelve months by your GP or healthcare professional.
Why does hrt stop working?
It doesn't stop working - it's a question of it not working for your needs because they've changed. Oestrogen, progesterone and testosterone hormone levels fluctuate and change before steadily declining.Hormonal balance changes and evolves which causes changes in symptoms.
Hormonal imbalances and menopausal symptoms
Oestrogen affects your health
Oestrogen, as well as being the hormone which gives a woman her curves and regulates the menstrual cycle to support fertility also plays a role in keeping a woman healthy.
Oestrogen helps to regulate a woman's cholesterol levels, and protect her cardiovascular health by helping to keep blood vessels flexible and free from fatty plaque.
Oestrogen supports collagen production so hair, skin and nails and helps to keep bones strong. Oestrogen supports brain health and cognitive function, blood flow to the brain, sexual desire, memory and stimulates serotonin production, your 'feel good' chemical. When levels start to drop you're going to feel the effects!
Progesterone is produced during the second half of your period. As you hit perimenopause progesterone drops and levels are less reliable. Missed periods or irregular periods is one of the most common signs of low progesterone.
Sleep disturbances anxiety and mood swings are also a sign your progesterone levels have become lower. Progesterone is a natural sedative, a calming hormone and helps the body and mind to relax.
When progesterone levels are lower, its oestrogen balancing powers are limited which can lead to a period of oestrogen dominance. When oestrogen is higher you can experience symptoms like breast tenderness, hot flashes, bloating, unstable blood sugars and insulin resistance which can lead to persistent fatigue.
Testosterone is important to women too
Androgens, including testosterone, are key to the development and maintenance of female sexual anatomy and physiology, and modulation of sexual behaviour. Testosterone supports the maintenance of lean muscle mass, bone density, boosts libido, self confidence and energy.
The NICE Menopause Guideline and the British Menopause Society do recognise that testosterone can be beneficial for sexual health issues such as a low sex drive but recommend that a trial of conventional HRT is given before testosterone supplementation is considered.
Perimenopause is a time of fluctuating hormones, a woman is still ovulating - though less regularly and she can still get pregnant although it will be harder. Oestrogen levels can spike when the balancing power of progesterone is lower than normal which can cause extra intense symptoms.
Confusingly things can then return to normal for a few months which makes the start of perimenopause difficult to pinpoint. Why you don't need a perimenopause test
Weight gain and hrt
On average a woman gains 10kg by the time she reaches menopause. When the body has less oestrogen it can release more stress hormone - more cortisol is associated with an increase in belly fat.
The decline of oestrogen and progesterone hormone levels can affect the way other hormones like ghrelin, leptin, and the stress hormone, cortisol operate. This can change the way you eat ( more snacking ) , your emotions, how your body manages blood sugars, burns calories and stores fat which can result in unexplained weight gain.
There is no evidence to suggest hrt causes weight gain. Not maintaining a healthy weight contributes to your risk of chronic disease so keeping weight gain down should be on your to do list.
As peri menopause progresses some women's symptoms - brain fog, night sweats, intense mood swings, anxiety, sleep disturbances, unexplained weight gain and hot flushes will carry on through to her menopause phase.
When periods have stopped altogether, a woman is in menopause which lasts 12 months. After 12 months but she in post menopause but can experience symptoms for up to 8 years.
The effect of less hormonal support can also change the way the brain works causing the return of debilitating symptoms like brain fog, low moods, irritability, tiredness, loss of confidence, sleep disturbances, night sweats, hot flushes and anxiety which can make day to day life challenging.
Many women will develop other menopausal symptoms as their oestrogen supply steadily ebbs away. There are 43 recognised menopause symptoms! More advanced symptoms, which can start to emerge when your hormone therapy hrt dose isn't doing it's job include
- Dry skin, more lines
- Thinning hair
- A thickening waist
- Hair loss
- High blood pressure
- Joint pain
- Digestive issues
- Dental and gum problems
- Bone fractures
- Low libido (sex drive)
- Dry vagina
Which hrt regimen is best to treat menopause symptoms?
Ahhh if only we could give you the magic answer. You'll need to work with your doctor to find out which combination of hormones work for your symptoms. This will need to be reviewed regularly.
HRT replaces natural hormones with synthetic hrt or body identical hormones. Body identical hormones are natural and regulated - they've been rigorously tested and are widely prescribed.
Hormone replacement therapy hrt, takes many different forms, and includes patches, tablets, gels and sprays. They are systemic which means the hormones are absorbed into your system through your blood stream.
IUDs and hormone patches
Other types of hormone replacement treatments include intrauterine devices which deliver progestin ( progesterone). Oestrogen and combined oestrogen/progestin patches are applied to the skin to deliver hormones over a period of 2-4 days. The strength of these can easily be increased or decreased
Combined HRT tablets can increase the risk of a fatal blood clot and are less commonly prescribed as part of a hrt treatment plan.
Over the counter hrt products
HRT can also be taken locally (vaginally) to treat vaginal atrophy symptoms such as skin irritation, itching, vaginal dryness, painful sex, or urinary problems.
Vaginal oestrogen can either be taken as a standalone treatment and includes vaginal creams and in a pessary form and is available over the counter.
In a British Menopause Society survey 35% of women said they had experienced vaginal dryness with 18% saying it was unexpected.
Menopause symptoms change over time and a HRT regimen can use any combination of treatments based on your individual needs. Menopause and peri menopause symptoms aren't the same for every woman and you'll need to discover which treatments are best for you and when to use them.
What are the benefits of hormone replacement therapy hrt?
Relief of persistent symptoms
Oestrogen, testosterone and progesterone hormones are essential for brain health. Low levels can contribute to persistent symptoms which include mood swings and disordered sleep patterns, chronic fatigue and brain fog
Brain fog includes memory, motivation, concentration levels and language. Many women find they start to lose words and their ability to retain information is impacted. Along with hot flushes and irregular bleeding, this can be disastrous for confidence, especially at work.
Hrt has been shown to decrease chronic health risks
As well as managing menopausal symptoms due to hormonal imbalances, hormone replacement therapy hrt increases your protection from brittle bones, diabetes, heart disease and some studies suggest it also protects against dementia.
How long does it take for a new HRT regime to work?
It can take around three months to adjust to hormonal medication. It's common to experience some side effects during these months until your body gets used to it. Headaches, migraines, tiredness, breast tenderness, bloating and bleeding are common symptoms of a new regime. Consult with your healthcare provider if these persist.
What are the risks of HRT treatment?
The risks of HRT include a slight increased risk of breast cancer. There are about 5 extra cases of breast cancer in every 1000 women who take a HRT combination pill ( oestrogen and progesterone ) for 5 years. The longer you take HRT and the older you are, the risk increases.
Your risk falls again after you stop taking it. Oestrogen-only HRT has a lower risk of breast cancer from oestrogen-only HRT.
What every woman can do to to manage symptoms
Your hormones can affect gut health, your appetite, your energy levels, mood and your metabolism. As you mature you'll naturally lose lean muscle mass and store more fat, your body shape will start to change. It is easy, when you feel out of control, to slide into a sedentary lifestyle with an unhealthy diet. Resentment is a common feeling - you're not alone. In the long run it just makes things worse.
A balanced diet with high quality nutrition and regular exercise can go a long way towards helping you maintain a healthy weight, decrease serious health risks and feel better through hormonal changes. This applies whether you're on hrt or not. Why you should drop the weight NOW
Learn to manage stress
Stress management is super important during this time as your adrenal glands produce your back up oestrogen supply when your ovaries cut their output. If they are busy producing cortisol and adrenaline they cant produce oestrogen. We know this is easier said than done in midlife with career, family and parental care responsibilities. Increased abdominal fat is associated with prolonged and elevated stress levels. Exercise reduces stress.
The bottom line
Common menopausal symptoms like persistent mood swings, hot flushes, night sweats and vaginal dryness can reappear when the hrt regimen you have been on is no longer effective. Hormone levels decrease over time and symptoms change so your hrt needs to be reviewed every 12 months. Whether you're on hrt or not a balanced diet with quality nutrition and regular exercise goes a long way to helping you manage symptoms.