What to do if HRT seems to have stopped working for you

Advice on what to do if you don’t think your HRT is working as well as it used to

• Hormone replacement therapy (HRT) is usually the first line treatment for the management of perimenopausal and menopausal symptoms
• However, your HRT prescription may need adjusting over time
• Always speak to a healthcare professional if you don’t think your treatment is as effective as it once was, or you are considering stopping treatment

HRT is usually the first-line treatment to improve symptoms of perimenopause and menopause [1].

When it comes to HRT, there is no one size fits all approach. The type and dose of HRT is prescribed according to your symptoms, medical history and personal preference.

In terms of symptom relief, every woman is different: symptoms such as hot flushes and night sweats usually subside within a few weeks of starting HRT, while other symptoms, such as low mood, muscle and joint pains and vaginal dryness, may take longer to improve.

But what should you do if your HRT doesn’t seem to be as effective as it once was?

Is it common to have to change my HRT prescription?

Many women need their HRT treatment regime altered over time.

When you start HRT for the first time, there may be a noticeable improvement initially but then not as much as you were hoping for, or there may be a return of some symptoms. This may be because you own hormone levels are reducing with time so you may need more to replace the amount of hormones that are missing in your body.

My symptoms have returned. What should I do?

Your healthcare professional may have given you a range within which to manage the dose yourself (for example, one to three pumps of oestrogen gel). You can usually alter the dose yourself within the range prescribed for you if you aren’t feeling the benefits of HRT, but just remember it can take a few weeks or months to respond to any changes you make.

RELATED: HRT doses explained

If you are experiencing a recurrence of symptoms, the first step is to talk to the healthcare professional who prescribed your HRT. It may be that you need your dose or type altering: you may need to change from a gel to a patch for example or you might benefit from adding in testosterone, as well as oestrogen (and progestogen if you are taking this). Whatever the reason, discuss it with your health professional if you think your HRT needs changing.

Blood tests may be recommended to determine how well you are absorbing oestrogen through your skin and to look at other causes of your symptoms, such as vitamin deficiencies or an underlying thyroid disorder.

RELATED: Understanding hormones levels in your blood

What about alternatives?

Another option your healthcare professional may discuss with is trying a different method of HRT, or a different brand.

Hayley Berry, pharmacist with Newson Health, says: ‘Remember that we have lots of different types and brands of HRT, so we can usually find a very similar product to the one that you’re using.’

For example, two pumps of Oestrogel is roughly equal to 2-3 sprays of Lenzetto, a 50mcg patch, 1mg oestrogen-only tablet or one sachet of 1mg Sandrena gel.

RELATED: HRT supply: what should I do if I can’t get my usual prescription

If you don’t feel a treatment is working as effectively as you’d like, don’t just come off it, as it could cause a return of symptoms. Always speak to your healthcare professional first.

‘Healthcare professionals will work with you to find a suitable alternative for you,’ says Ms Berry.

References

1. National Institute of Health and Care Excellence (NICE) ‘Menopause: identification and management’