Signs HRT might not be working

Published: 07/03/2023

Have you been prescribed HRT but haven’t noticed much improvement?

HRT, as with any medication, does not suit or work for everyone. Some women will have amazing benefits from taking HRT whilst others don’t feel any real benefit at all.  

It can take up to 3 months to feel the benefits from initially starting HRT and it’s recommended that you use it for this length of time before changing HRTs or giving up on it completely.  

During this time, any side effects should have settled and you should be getting the maximum benefit from the medication.  If you are feeling really unwell when you start HRT, then contact your GP.

When starting on HRT it’s always good to consider which way you want to take it, via the skin or via a tablet. Some people have digestive problems which may affect the absorption of swallowing medications, others have skin conditions that can impact the absorption of transdermal HRT.  

Correct application of transdermal HRT

If you have chosen a patch, gel, or spray as the oestrogen component, make sure you are applying it to the correct area of the skin as described in the instructions.  Make sure your skin is clean, dry, and free of any creams, moisturisers, etc so absorption can take place.  

Make sure that you do not dress or get into bed within 10 minutes of the application of a gel or spray, the product will rub off.  Do not shower within 2 hours of application, the product will wash off before adequate absorption has taken place.

Check patches are still in place and haven’t come off.  Some women have difficulty getting patches to stick adequately which interferes with absorption.

Have you been prescribed HRT but haven’t noticed much improvement?

More often than not, you will start HRT on a low dose, this is because the lowest dose is used to effectively treat symptoms. Each person is different, some need more than others.

If you have noticed some improvement in your symptoms but your symptoms are still there, or some symptoms have improved but others haven’t, then it’s worth speaking to your GP about increasing the oestrogen in your HRT.  It might be that the oestrogen is being absorbed and is working somewhat, but you need a higher dose.

If you haven’t noticed any improvement whatsoever, it could be that you need a higher dose or it could mean that you are not absorbing adequately via the route you are taking it.  It is always worth increasing the dose first, rather than changing route as more often than not this can solve the issue.

If you are using gels or sprays it is quite easy to increase the dose.  You should ideally up the dosage by 1 measured dose and re-assess symptoms at around 4-6 weeks’ time to see if there has been any improvement.  This can be done until you are using the maximum dose in consultation with your GP.

With tablets, your GP can increase the dose from 1mg to 2mg depending on which brand you are given.  If there isn’t a higher dose in the brand you are using, a different brand will be required with a higher dose.

Patches also come in different strengths, again these can be changed to a higher dose or a different brand. Some patches can be cut in half, and 1.5 patches applied.  Again check with your GP or pharmacist to check if your patch can be cut.

What if I still don’t have any improvement in my symptoms?

If you have reached the maximum dose and you haven’t noticed any improvement in your symptoms, it is probably because you are not absorbing the medication.

If you are taking tablets then ask your GP to change your prescription to a transdermal preparation. Again, give it some time to work, it may take up to 3 months to have any benefit when changing the route.

If you are using gels/sprays/patches ask your GP to change your prescription to a tablet.  

If you are not able to take oral HRT, ask your GP if you can try a different brand or change from a gel to a patch, or patch to a spray etc.  Sometimes GPs will prescribe more than the maximum dose as some women require a much higher dose than others.  The dose of progestogens may also be increased as well.

If you have tried both tablets and transdermal HRT without any control of your symptoms,  it may be worth considering an implant. 

This is usually used as a last resort in women whose symptoms cannot be managed.  Implants are not widely available and need to be inserted at a specialist menopause service, some private practices offer them too but are costly.  Your GP will need to refer you if you choose not to go private.

Implants are only the oestrogen component of HRT, so If you still have your womb, you will need to have a tablet or Mirena coil for the progestogen part.

If HRT does not work for you, speak to your GP.  There are prescribable alternatives that may help.  Look at what lifestyle changes you could make.  Complementary and alternative therapies are helpful for some women.

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