Menopause is a transition that all women will go through. As a result of menopause symptoms, such as night sweats, hot flushes, skin changes and joint stiffness, many women take the step of starting hormone replacement therapy (HRT) in a bid to alleviate discomfort and improve their overall well-being.
However, the effectiveness of HRT does vary between individuals, both in how long it takes to work and the symptoms that it addresses. Understanding how HRT works and what to expect can help manage expectations when you start treatment.
How long does HRT normally take to work?
This varies from one person to another. Some women may find that HRT starts working for them instantly. For others, changes can be more subtle and take a little time as the HRT restores hormones to an effective level and reverses the physical changes caused by months, or sometimes years, of depleted oestrogen and progesterone.
Signs that HRT might not be working
Every woman is unique and will respond differently to different HRT types and regimens, so an individualised approach is essential when determining whether HRT is working for you.
Ultimately, HRT is supposed to help reduce menopause symptoms. Therefore, a predominant indication that HRT is not working as intended is the prevalence of:
- Night sweats
- Hot flushes
- Anxiety
- Low mood and/or depression
- Brain fog
- Difficulty concentrating
- Vaginal dryness, itching and/or discomfort
- Decreased libido
- Sleep disturbances
- Headaches
Side effects of HRT
As with most medicines, HRT can cause side effects. However, not all women will experience side effects and those that do often only encounter mild ones. In some instances, it can be difficult to tell how well HRT is working at managing menopause symptoms as it generates similar undesirable side effects of its own. However, most side effects improve with time, so it’s recommended to carry on with HRT for at least three months to allow everything to stabilise. Side effects of HRT include:
- Acne
- Breast pain or tenderness
- Changes to your period
- Diarrhoea
- Dizziness
- Feeling sick (nausea)
- Hair loss
- Headaches
- Leg cramps
- Mild rash, itching or skin irritation
- Mood changes
- Stomach or pelvic pain
- Tiredness
- Thrush
- Unusual hair growth
- Vaginal bleeding or spotting
- Vaginal discharge
- Weight gain
Why HRT can sometimes not work
While HRT is an effective treatment for menopause symptoms, it doesn’t work for everyone. Your medical history, health, lifestyle and a range of other factors can have an impact on how it works.
Incorrect HRT dosage
Hormone replacement therapy comes in various forms and strengths, and one size does not fit all. Women’s bodies respond differently to hormones like oestrogen and progesterone, and finding the optimal balance is key to relieving symptoms.
For instance, too little oestrogen may not alleviate symptoms like hot flushes, while too much can cause side effects like bloating or headaches. Some women may also need testosterone supplementation if their symptoms include fatigue or low libido.
Incorrect type of HRT
There are several ways to deliver HRT including pills, patches, gels, and sprays. Each of these methods has different absorption rates and effects on the body. Some women may not respond well to one form but find relief with another.
For example, oral oestrogen has to go through the digestive system and liver and can lead to side effects like nausea. Transdermal methods (patches, gels or spray) bypass the liver, delivering hormones directly into the bloodstream, which may be more effective for some women and can be effective at lower doses.
Hormone sensitivity
Women have varying sensitivities to hormones and their fluctuations. Some women may be more sensitive to small changes in hormone levels, making it harder to find the right balance with HRT.
Others don’t deal with progesterone very well and may have had adverse reactions to contraceptive pills in the past as a result. Side effects of progesterone can include fatigue, bloating and mood disturbances. If you experience such side effects, you may be advised to take the lowest effective dose for the shortest time possible or there may be careful adjustments that can be made by a specialist such as at Menopause Care which allows you to gain the benefits in spite of your sensitivity.
Underlying health conditions
Pre-existing health conditions such as thyroid disorders can affect how the body processes hormones.
For example, women with hypothyroidism may experience symptoms like fatigue and weight gain, which could be mistaken for menopause-related symptoms. If these underlying conditions are not addressed, HRT may not have the desired effect because the body’s entire endocrine system is out of balance.
Bowel disorders can also affect how well oral HRT is absorbed into the body. In these instances, switching to a transdermal form of HRT which is absorbed through the skin, may be recommended.
Lifestyle factors
Lifestyle factors may influence the efficacy of HRT. Smoking, for instance, has been shown to reduce or completely cancel the effect of oral oestrogens.
Other factors, such as poor diet, alcohol and caffeine, and lack of exercise can exacerbate menopause symptoms, which could potentially mask the impact that HRT is having.
Medications and supplements
Taking HRT with certain medications and supplements can cause the medications or HRT to become less effective. For example, some HRT can interfere with epilepsy medication, making the condition less well-controlled.
Medications such as Modafinil, Rifampicin and Bosentan are predicted to decrease the effects of HRT as is the popular supplement, St John’s wort.
Misdiagnosis of symptoms
Not all symptoms commonly associated with menopause are necessarily caused by hormonal changes.
For instance, fatigue, mood swings, and depression could be related to mental health conditions, sleep disorders, or other medical issues. If these are misdiagnosed as menopause-related, HRT might be prescribed but won’t provide relief because the true underlying cause is not being treated.
Why you shouldn’t stop HRT suddenly
HRT doesn’t always offer immediate relief, and it’s normal if you feel frustrated when you first start taking it if you don't experience a drastic improvement in your well-being. However, it’s important to remember that while HRT has a valuable place in managing symptoms, it isn't the remedy for all life's problems. Stabilising your hormones using HRT can leave you feeling better positioned to address the other issues that are contributing to your quality of life. Therefore, it’s vital to not discontinue HRT before it has even had time to fully work.
In addition, stopping HRT abruptly may cause unpleasant temporary withdrawal symptoms akin to menopause symptoms due to the drastic decrease in oestrogen.
If you want to stop taking HRT, it’s recommended that you come off it slowly in consultation with a doctor. Gradually decreasing your dosage can mean that menopausal symptoms return more slowly than when going cold turkey.
What to do next
If you feel HRT is not working after three months, it’s a good idea to talk to someone about your options, such as altering the type of HRT you are using, changing your dose or exploring holistic therapies, lifestyle changes and herbal remedies for menopause. Having HRT blood tests can provide further insight into how your body is reacting to treatment and help inform the next steps.
At Menopause Care, we take a person-centred approach where we work with you to help you navigate this life stage, empowering you to make the right choice for yourself based on evidence and tailored advice. To get started, book a consultation with a menopause doctor.
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