What to expect when you start HRT

Your questions about starting hormone replacement therapy answered

HRT is usually the first line treatment for the management of menopausal symptoms
But with so many different types available, it’s common to feel a little daunted
Balance’s guide to starting HRT, including timings, potential side effects – and what to do if you aren’t feeling the benefits

You’ve seen a healthcare professional, talked about hormone replacement therapy (HRT) and collected your first prescription – now what?

With so many different brands, types and doses, starting HRT can feel a little daunting, and you’ll no doubt have lots of questions including how and when to take it, and any initial side effects that may occur.

Here, balance looks common questions women have when they start HRT.

How long after starting HRT will it take for my symptoms to improve?

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

When it comes to symptom relief every woman is different: symptoms like hot flushes and night sweats should 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 resolve.

What sort of side effects can occur when starting HRT?

Here are some common, temporary side effects that can happen in the first few weeks after starting HRT, known as the four Bs:

Bleeding

This could be brown discharge, light spotting or sometimes more like a heavy period and may come and go or last for a few weeks.

If you are perimenopausal when you start HRT (and so are still having periods), bleeding patterns may alter initially and may take three to six months to settle into a regular pattern. If you are menopausal when you start HRT (and are no longer having periods), bleeding may occur, but this usually settles within three to six months.

If bleeding is persistent and/or heavy or you have other symptoms with the bleeding then you should contact a healthcare professional for an examination and/or further investigations.

It’s also important to point out that after you have any change in the dose or type of HRT you use, bleeding can occur and take three to six months to settle.

Breasts

Your breasts may become tender, painful and more sensitive. This can last for several weeks, but usually settles. Wearing a well-fitting, supportive bra can also help if you’re experiencing this symptom.

Bloating

If your HRT regimen includes progesterone or a synthetic progestogen, you may experience an uncomfortable, bloating feeling. This should settle within time.

Blues

You may find that your mood is affected, or you feel more emotional than usual in the first few weeks after starting HRT, but this should improve with time.

Women often mistake these temporary side effects after starting HRT as a sign their treatment isn’t working. However, it’s important to remember to give your treatment time to take effect: every woman’s response is slightly different, but initial side effects should settle, often as symptoms start to improve.

Do I need to take my HRT at the same time every day?

It’s helpful to get into a routine so you remember to take/apply your HRT as directed. How this fits into your daily routine is up to you: you may have more time in the evening to apply your gel, cream or patches, or you might find it works better when getting ready in the morning.

If micronised progesterone is part of your HRT regime, you may find taking this in the evening works best, as it has a mild sedative effect – and ideally needs to be taken on an empty stomach.

Where can I find tips on how to apply my HRT?

You can find lots of helpful articles and videos on using HRT patches, sprays, gels and creams in the HRT section of the balance website by clicking here.

I’ve missed a dose. What should I do?

It’s best to take/use your HRT at the same time each day, but the odd hour’s difference here or there won’t matter – what’s important is that you are taking the amount prescribed for you, as directed by your healthcare professional, on a consistent basis.

If you have forgotten, or were unable to take your HRT one day, just continue with your normal dose on the next day. Doubling up on the dose may can lead to side effects, such as headache or breast tenderness.

I don’t feel any different after starting HRT, or I’m feeling worse – 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 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.

There are many different types and ways to take HRT, so if you don’t feel your HRT has bought you the benefits you were hoping for after three months, you can discuss alternatives with your healthcare professional, including changing your HRT type or dose.

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: HRT doses explained

It’s also helpful to track the type, frequency and severity of symptoms before and while taking HRT. You can download the free balance app to do this and create a health report to take to healthcare appointments.

How to have the best possible perimenopause and menopause

A good perimenopause menopause goes beyond HRT. In addition to replacing your hormones, use this time to optimise your nutrition by eating a balanced diet, exercising regularly and making time for relaxation and to reduce any stress.