Hormone replacement therapy (HRT) is one of the most effective ways to ease menopause symptoms like hot flushes, night sweats, mood swings, and brain fog. But what happens when it doesn’t seem to be helping
Here’s how to recognise when HRT isn’t working as expected, what might be going on behind the scenes, and the steps you can take to feel better.
How long does it take for HRT to work?
For some women, HRT brings relief from symptoms within a few weeks. For others, it takes longer for the full benefits to show. Doctors usually recommend giving your prescribed HRT a three-month trial before deciding whether it’s the right fit. It’s about recognising that your body may need time to settle as your hormone levels rebalance.
If after three months your symptoms haven’t improved, or new issues have cropped up, it’s time to check in with your GP or a menopause specialist to review your options.
Why am I feeling worse since starting HRT?
It can feel discouraging when the treatment you hoped would bring relief makes things harder at first. Some people do experience short-term side effects when starting HRT, such as
- Headaches
- Nausea
- Breast pain or tenderness
- Mild rash or itching
- Mood changes
- Unexpected vaginal spotting or bleeding
- Diarrhoea
- Acne
- Leg cramps
- Dizziness
These symptoms are usually short term, and improve as your body adapts. But if they don’t, it doesn’t mean HRT isn’t right for you. It often just means a tweak is needed, such as adjusting the dose, changing the type of oestrogen or progesterone, or switching to a different delivery method (like patches instead of tablets).
It’s also worth remembering that menopause symptoms and HRT side effects can sometimes overlap, making it tricky to tell what’s causing what. That’s why regular check-ins with your doctor are so important.
Why do I still have menopause symptoms on HRT?
So how do you know if things aren’t on track? HRT is meant to ease menopause symptoms, but if you’re still experiencing hot flushes, night sweats, vaginal dryness, low mood, anxiety, poor sleep, low sex drive, or joint pain, it could mean that something isn’t quite right with your current treatment routine.
It might be a simple fix, such as needing a higher dose of medication, or another form of HRT being more appropriate for you.
Can HRT make you more tired?
Another common menstrual frustration is fatigue. Many women do feel their energy return once they’re on the right HRT. But if you’re more tired than before, a few things could be at play:
- Your body is still adjusting to hormonal changes.
- The dose of progesterone is too high (particularly with oral tablets).
- The balance of oestrogen and progesterone isn’t quite right.
- Another health issue, like thyroid problems or anaemia, is involved.
If you find your energy levels are lower after starting HRT, it may just take a little patience while your body adjusts. But if tiredness is weighing you down, it’s not something you just have to “push through”. Speak with your doctor about tweaking your prescription or running some checks for other possible causes.
Why do I feel better after stopping HRT?
It’s understandable to want to stop treatment altogether if you don’t think it’s helping. Sometimes, women do notice they feel better after coming off HRT. But this usually means that the original treatment plan wasn't the right match, not that HRT itself can’t help menopausal symptoms.
With different types of oestrogens or progesterones, and different ways of taking them (from gels and sprays to patches and tablets), there are lots of options to explore.
It’s also possible for symptoms to ease naturally over time, making HRT feel less necessary. Your doctor can help you distinguish between the two.
It’s important to know that stopping HRT “cold turkey” can trigger symptoms like hot flushes and headaches to come back abruptly. So even if you’ve decided HRT isn’t right for you, and you’d prefer to come off treatment, it’s best to reduce your dose gradually over three to six months.
What else might affect how well HRT works?
Sometimes HRT seems less effective because other factors are contributing, such as:
Smoking
Research shows that cigarette smoking can reduce or completely cancel out the effect of oral oestrogens used in HRT. If you smoke, it might be worth looking into local NHS stop smoking services, which can boost your chances of quitting for good.
Medications and supplements
Certain medications and supplements, like St John’s wort, can also reduce HRT’s effect. So always let your doctor know about supplements you’re taking if you’re prescribed HRT.
Medical conditions
Sometimes HRT seems ineffective because symptoms of menopause can overlap with those of other conditions, such as pregnancy, thyroid conditions, anaemia, anxiety, sleep apnoea, and rheumatoid arthritis.
This is why a personalised approach, like Voy’s Menopause programme, matters so much. Your treatment should take into account your whole health, not just your hormone levels.
What to do if HRT isn’t working for you
If you feel your HRT isn’t doing what you hoped, it doesn’t mean you’re out of options. Here are some steps to take that can make you feel more in control:
- Stick with it for three months (if your side effects are tolerable): This gives your body time to adjust.
- Review your treatment plan with your clinician: A small change, such as a different dose, delivery method, or adding testosterone, can make a big difference.
- Rule out other causes for your symptoms: Simple blood tests can uncover issues like thyroid problems or low iron.
- Look holistically: Nutrition, movement, sleep, and stress management all support hormone balance.
- Discuss other medications with your doctor: For example, antidepressants can be prescribed for mood swings or anxiety, while non-hormonal medications, such as clonidine, gabapentin, oxybutynin, can treat symptoms like hot flushes and night sweats.
Find a menopause plan that works for you
When HRT doesn’t seem to be working, it’s natural to feel frustrated or even defeated. But it doesn’t mean relief isn’t possible. With the right support and adjustments, most women find a way forward that helps them feel more like themselves again.
At Voy, we recognise that every woman is unique and that her menopause care needs to be too. Our specialists work with you to tailor your treatment plan to suit your specific symptoms, medical history and goals. Book an appointment with a menopause specialist today.
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