• 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 is prescribed to help women deal with hormonal fluctuations and menopause symptoms. It helps to offer some protection from the health risks which are associated with getting older and having lower oestrogen 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.

What are the signs hrt is not working?

If you’re reading this, you probably are already questioning why, despite being on a hrt treatment plan , 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 signs hrt is not working and that oestrogen patch or iud you've been using for the past few years is no longer meeting your needs.

Common menopausal symptoms

The effect of less hormonal support can also change the way the brain works causing 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.

Post menopause, many women experience symptoms of hormonal imbalances like hot flushes and night sweats for up to 8 years or longer.

More advanced symptoms, which can start to emerge when your hormone therapy hrt dose isn't doing it's job include vaginal dryness, itchy skin, hair loss and adult acne.

Why does HRT stop working

Your oestrogen supply steadily declines over time so your hormone supplementation needs to be reviewed over time.

Symptoms can start to reappear when your oestrogen levels or progesterone have dropped further and the level of hormones you're replacing with the hrt from your health provider just isn't enough to rectify your hormonal imbalance.

It's recommended you have your menopausal symptoms and hrt reviewed every twelve months by your GP or healthcare provider. The applies whether you're on synthetic or body identical hormone replacement.

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Low hormone symptoms


Supports brain health and cognitive function, blood flow to the brain, sexual desire, memory and stimulates serotonin production, your 'feel good' chemical.

Oestrogen supports collagen production - hair, skin and nails and helps to keep bones strong. Your very active oestrogen supply also supports your arteries, hair growth, supports metabolism and joints.

Common symptoms if oestrogen levels fall include tender breasts, drier skin, hot flashes, insomnia, fatigue, heart palpitations, headaches and migraines, loss of libido, vaginal dryness, more UTI's, a muffin top, a higher risk of poor cardiovascular health, higher cholesterol and weight gain.


Progesterone is a natural sedative, a calming hormone and helps the body and mind to relax. As peri menopause progresses this hormone declines.

When progesterone drops one of the most commonly recognised signs is missed periods or irregular periods. Sleep disturbances, anxiety, mood swings, anxiety, bloating and gaining weight are also signs your progesterone levels have become lower.

Oestrogen dominance

When progesterone levels are lower, its oestrogen balancing powers are limited which can lead to a period of too much oestrogen or unused hormones.

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 supports the maintenance of lean muscle mass, bone density, hair growth, is an exciter hormone which boosts libido as well as self confidence and energy.

Low testosterone symptoms include low sex drive, tiredness, lack of motivation, thinning hair, hair loss, weight gain and muscle weakness.

The NICE Menopause Guideline and the British Menopause Society do recognise that testosterone can be beneficial for many women sexual health issues such as a low sex drive but recommend that a trial of conventional HRT is given before testosterone supplementation is considered by her healthcare provider.

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Benefits of hormone replacement therapy

HRT can provide relief for 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.

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 HRT to work?

It can take around three months to adjust to hormonal medication. Many experience some side effects during these months. Headaches, migraines, tiredness, breast tenderness, bloating and bleeding are common as hormone levels increase. Consult with your healthcare provider if these persist.

What are the risks of HRT

The risks of taking 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 compared to combined HRT.

Which hrt regimen is best to treat menopause symptoms?

Changing your hrt is something that needs to be discussed with your health care provider. Taking HRT replaces the natural hormones you've lost with synthetic hrt or body identical hormones but your needs will change over time. Your medical or family history will also influence what your options are.

Systemic hormone replacement therapy hrt, takes many different forms, including patches, tablets, gels and sprays. Systemic means the hormones are absorbed into your system through your blood stream and need to be prescribed by a healthcare professional.

Other types of hormone replacement treatments include intrauterine devices which deliver a synthetic called progestin ( pretend progesterone) and oestrogen. There are also combined oestrogen/progestin patches which are applied to the skin to deliver hormones over a period of 2-4 days.

Over the counter products are available to improve hot flashes and vaginal dryness which don't need a prescription.

Combined HRT tablets can increase the risk of a blood clot and are less commonly prescribed as part of a hrt treatment plan.

What every woman can do to improve 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.

A balanced diet with high quality nutrition and regular exercise can go a long way towards helping you maintain a healthy weight, balance hormone levels, decrease serious health risks by reducing life limiting symptoms such as high blood pressure, cholesterol and fatal blood clots. This applies whether you're on hrt or not.

Vanilla meal replacement

Nutrition and lifestyle factors

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. 

50% of women will experience unexplained an increase in weight of 10kg between peri menopause and menopause phase.

Less tolerance to stress creates more stress hormone cortisol which is associated with an increase in belly fat. The decline of oestrogen and progesterone can also affect the way other hormones like ghrelin and leptin ( appetite hormones) and the stress hormone, cortisol operate.

Blood sugars are higher in women in menopause - excess sugar the body isn't using for energy is stored as fat.

Good nutrition and lifestyle changes can help to support weight loss and regulate hormones which can decrease symptoms.

Meal replacement shakes

There is significant evidence that low calorie meal replacements when used as a part of a calorie restricted diet promotes healthy weight and even help to reverse chronic health conditions like type 2 diabetes.

Eve Biology Meal Replacement Shakes replace breakfast and lunch and are high protein, made with prebiotic fibre and adaptogens to target menopausal symptoms and unexplained weight gain.

High Protein Low Carbohydrate Diets

Protein helps to boost metabolism and it also helps women build more muscle - super important as we age.    

Carbohydrates increase insulin (all carbs break down to glucose), insulin is a fat storage hormone, but also dramatically affects leptin and ghrelin, your appetite hormones.

By lowering carbs, especially avoiding processed foods and inflammatory seed oils, we help to balance the other hormones.

Manage your 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 in response to stress they cant produce your back up oestrogen to take the edge off symptoms.


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.