Like all medications, HT can have side effects. These vary from person to person and can depend on the dose and type of HT used. Read on to find out more about the side effects of HT, and what can be done to minimize them.
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What is HT?
Hormone therapy (HT) is a treatment for menopause symptoms. It comes in the form of pills, patches, creams, and gels among others. It has been consistently proven to be the most effective treatment for a range of menopause symptoms such as mood changes, hot flashes, painful sex, and bladder symptoms.
It’s important that you discuss any symptoms with your healthcare provider to be sure of your diagnosis before you consider HT treatment. Other medical issues can mimic menopause symptoms.
Likewise, HT may not be suitable for you because of your medical history or you may just prefer not to take it. That’s ok, HT isn’t for everyone – there are alternative, non-hormonal medications, and lifestyle change can help too. Your healthcare provider will help you make an informed decision.
HT, HRT, and MHT – what’s the difference?
Research and self-education can improve your menopause experience and speed up the process of finding the right treatment for you. Confusing terminology can get in the way of this! We want to clear things up if you have come across the terms HRT, HT, or MHT and you’re not sure what they mean. The truth is, there is little difference between these abbreviations.
- HRT stands for hormone replacement therapy. Many symptoms of menopause are caused by a dramatic reduction in levels of certain hormones such as estrogen. This name suggests that the medication works by replacing the hormones that are no longer produced by your body during menopause
- HT, or hormone therapy, is a term that is growing in popularity as the way to describe this type of treatment, as HT does not technically ‘replace’ hormones. It is more accurate to say that the hormones in HT safely and effectively treat symptoms caused by changes in your body during menopause
- MHT, or menopausal hormone therapy, is a more precise phrase than HT. Hormones are used in lots of different medical treatments, so MHT is used to specifically describe HT for menopause and is often preferred by research scientists for this reason. You may see this phrase used in scientific research papers
What are side effects?
All medications have some side effects. These are unwanted symptoms or other effects that you could experience when taking a new medicine. It’s difficult to predict who will experience side effects and who won’t. It is important that you ask your healthcare provider and read about the possible side effects of any new medicine. Also, read the information that comes with your medicine, including which side effects are most common or are an indication of a serious reaction.
Often, side effects will stop after a short time as your body adjusts to the new medication. If you do get side effects, and they’re relatively mild, track them to make sure they don’t get worse. If you experience severe or persistent side effects on a new medication, speak to a healthcare professional.
The side effects of HT
HT, like other medications, does have some side effects and these are thought to be quite common. One study of just under 5,000 HT users found that 43% were affected.
Side effects from HT depend on several factors:
- Hormones taken – estrogen or progesterone
- Dose
- Route – systemic, transdermal, or vaginal
- Your own body’s response
Side effects are least common with vaginal HT because the hormones used are absorbed only into the vagina and nearest tissues, rather than into the bloodstream as with systemic HT. But vaginal HT only treats vaginal symptoms of menopause and will not help with more general symptoms like hot flashes, sleep problems, and mood changes.
What are the side effects of estrogen?
Estrogen is a key component of HT and most of the symptoms of menopause are caused by decreased levels of this hormone. HT supplies estrogen that your body no longer makes for itself, and therefore helps to improve your symptoms.
Estrogen can be taken as:
- Systemically – distributed throughout the body
- Vaginally – hormones are applied to and stay in the genital area, resulting in fewer side effects
Common side effects of systemic estrogen (pills, patches, sprays, and gels) include:
- Bloating
- Swelling
- Breast tenderness or swelling and nipple sensitivity
- Nausea
- Leg cramps
- Headaches
- Indigestion
- Vaginal bleeding
What are the side effects of progesterone?
You only need to take progesterone as part of your HT regimen if you still have your uterus. If this is the case, progesterone is important as it protects the uterus lining (endometrium) from the effects of estrogen. If estrogen is taken alone, it can cause abnormal thickening and even cancer of the uterus lining. Taking progesterone alongside it removes this risk.
Common side effects of progesterone HT include:
- Tender breasts
- Fluid retention
- Headaches
- Mood swings
- Depression
- Breakouts and acne
- Abdominal pain
- Backache
- Vaginal bleeding
What are the side effects of vaginal HT?
Of all the different types of HT, vaginal HT has the lowest number of side effects. This is because the hormones used stay in and around your vaginal and genital areas, rather than being distributed throughout your body as with systemic HT.
Vaginal HT is useful and effective for treating symptoms of menopause that are specific to your vagina and urinary tract including pain, itching, dryness, painful sex, and recurrent UTIs. These are collectively known as the genitourinary syndrome of menopause (GSM) although you might also hear them referred to as vaginal atrophy or atrophic vaginitis.
Side effects are most common in the first few weeks of use as some of the hormones are absorbed into the bloodstream through the dry and damaged vaginal wall. However, this often stops as soon as the vaginal HT starts working and the vaginal tissues become healthier.
Some side effects include:
- Breast tenderness
- Increased vaginal discharge, bleeding, or spotting
- Irritation or itching of the skin in or around your vagina
- Headaches
- Stomach pain or feeling sick
- Flu-like symptoms
How long do HT side effects last?
HT side effects generally get better within three months of starting the medication. This happens as your body adjusts to the hormones contained in your HT.
Some lucky people will have few or no side effects, and many find that side effects settle within a few days or weeks. However, if you’re still having side effects by the three-month mark, let your healthcare provider know in case they can suggest other treatments.
How can I reduce HT side effects?
If you have side effects that are bothering you, there are a few different approaches you can take to improve them.
If you take your HT as a pill, try:
- Taking it with food to reduce any nausea or digestive side effects
- Taking it at a different time of day, such as before bed
General measures include:
- Exercising regularly and gentle stretching if leg cramping is an issue
- Putting your feet up if you’ve noticed leg swelling
- Eating a healthy, balanced diet
If you’re still struggling, your healthcare provider may recommend a change to your HT prescription. They may consider:
- Switching the way your HT is delivered, for example, from a pill to a patch
- Reducing your estrogen dose
- Changing the type of hormone in your HT, such as switching from a synthetic form of progesterone to micronized progesterone
- If you’re on cyclical HT – which gives you regular period-like bleeds – changing how much progesterone you take in each cycle
Read more about the different types of HT.
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When should you see a healthcare provider?
It can sometimes be tricky to decide whether your symptoms are side effects of HT or signs of another medical problem. If you’re unsure, worried, or suffering from severe symptoms, see your healthcare provider.
See a healthcare provider urgently if you have any:
- Vaginal bleeding if it has been over 1 year since your last period (known as postmenopausal bleeding)
- Bleeding after sex
- New breast lumps or other changes – learn how to check your breasts
- Any severe pain
- Any new or severe headaches, headaches that wake you from sleep, or headaches with any other associated symptoms – including vision changes, balance problems, and weakness
- Leg swelling, tenderness, or redness – these could be signs of deep vein thrombosis, known as DVT
- Chest pain or breathlessness – these could be signs of a pulmonary embolism, known as PE
- Depression with thoughts about harming yourself or others
- Any other persistent, severe, or worrying symptoms
There are many rare side effects which might cause a problem for you. For a full list of what to look out for, check the patient information brochure in your HT pack.
Final word
While side effects of HT are common initially, it’s worth persevering. For most people, these side effects pass within a few weeks or months. If you’re struggling, see your healthcare provider for further advice.
Find out more about menopause on our blog or in our symptoms library.
- Cleveland Clinic, Hormone therapy for menopause symptoms
- Hillard, T. et al (2017). Management of the Menopause. ed. London: British Menopause Society, pp. 59-62, 73-76 and 88
- Mayoclinic.org. n.d. Estrogen (Vaginal Route) Side Effects – Mayo Clinic. [online] Kjersti Bakken, Anne Elise Eggen & Eiliv Lund (2004) Side-effects of hormone replacement therapy and influence on pattern of use among women aged 45-64 years. The Norwegian Women and Cancer (NOWAC) study 1997, Acta Obstetricia et Gynecologica Scandinavica, 83:9, 850-856, DOI: 10.1080/j.0001-6349.2004.00560.x
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