Hormone therapy (HT) is the most effective treatment available for some of the most disruptive symptoms of menopause like hot flashes and bone loss. You may even think it’s something of a wonder drug, but the truth is that it can be complex. You might notice signs HT is not working for you. Maybe you experience negative side effects or your symptoms don’t improve. In this article, we explain what to do if this happens to you and how to get help.
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How long have you been taking HT?
Don’t lose faith if you don’t see an immediate improvement after starting HT. It can take several weeks for your symptoms to settle, and sometimes up to three months. This is why your healthcare provider will usually wait until three months have passed before checking in to see how things are going.
If you are in the early days and weeks of HT treatment, hang in there! It is worth persevering before stopping or changing your prescription right away.
If you have recently started HT and feel awful or are having troublesome side effects, don’t wait to contact your healthcare provider. This is especially important if you have heavy or abnormal vaginal bleeding or have noticed any breast lumps or breast skin changes.
Get medical help urgently if you have any signs of:
- A blood clot like deep vein thrombosis (DVT)
- Pulmonary embolism (PE), including chest pain, leg swelling, or shortness of breath
- Other serious concerns
Are you struggling with HT side effects?
HT does come with certain side effects, which tend to be most pronounced in the first few weeks and months of use. You may even find that HT can make you feel worse before you feel better.
Common side effects of estrogen
- Tender breasts
- Vaginal bleeding
Side effects of progesterone
- Abdominal pain
- Feeling sad
- Breast tenderness
- Vaginal bleeding
These side effects tend to settle after a few weeks. However, if they are particularly bad or do not improve, it could be a sign that HT is not working for you and you need to speak to your healthcare provider.
Your healthcare provider may be able to change your prescription to ease the side effects. For example, side effects tend to be milder with HT patches compared to pills. Alternatively, a lower dose or different approach to treatment may work better.
Find out more about the risks and benefits of HT.
Are you taking the right dose?
If several months have passed and you are seeing little or no improvement in your menopause symptoms, then HT is not working for you. You might need to increase your dose or change the medicine or route of delivery of your HT, such as using a patch instead of a pill for the estrogen.
Menopause symptoms are caused by falling hormone levels, and HT works by providing your body with the estrogen that it no longer produces or produces less of.
Many HT products come with a range of estrogen doses, and it can be trial and error to find the correct one for you. A higher dose may help manage menopause symptoms more efficiently, while a lower dose may make side effects more tolerable.
- If you are taking a pill or patch, your healthcare provider may prescribe a different strength
- If you are taking a gel or spray, you may be advised to apply more or less
Increasing your HT dose
You may also want to think about an increase in dose if your once-helpful HT seems to have stopped working. As your body proceeds through menopause, your hormone requirements sometimes increase, meaning that you may need to take more estrogen to keep your symptoms under control.
Are you taking the right type of HT?
This is an important question, especially when it comes to vaginal HT.
HT can be taken systemically, meaning that the hormones enter your bloodstream and are distributed throughout your body. This is an effective way to treat general menopause symptoms, including hot flashes and low mood among others. Types of HT include tablets, patches, gels, and sprays.
Read more about the different types of HT.
HT can also be used vaginally, meaning that estrogens are applied only to your genital area. This treats the genitourinary syndrome of menopause (GSM), which can cause itching, burning, pain, tightness, painful sex, and urinary symptoms. With this approach, a small amount of hormones are absorbed into your bloodstream and most stay in your genital area only.
While systemic HT can help with GSM, some users may need to take both systemic and vaginal HT together to improve symptoms.
If you are taking vaginal HT to treat GSM, you will not likely see an improvement in any other menopause symptoms. If this is the case, ask your healthcare provider about adding systemic therapy to your prescription.
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Are you taking your HT correctly?
If you are concerned that your HT isn’t working or is making you feel worse, read the instructions on your medication packaging.
HT medicines can be complicated to take, and it is worth checking that you are taking the right dose at the right times. Ask yourself:
- Are you replacing your patch often enough?
- Are applying the gel correctly?
- Are you remembering to take your tablets every day?
If you find your HT difficult to take, ask your healthcare provider for an alternative. It is common to switch from one type to another and it is important to find a type of HT that works well for you. For example, if you have arthritis in your hands you may find it difficult to use a pump or apply a patch. Or, if you have a hectic lifestyle, you may struggle to remember a daily pill and a twice-weekly patch might work better.
Do you have a clear picture of your menopause symptoms?
It can be tricky to get a handle on your menopause symptoms, especially if you are trying to monitor them over a long time. While it can be easy to count hot flashes, how can you possibly keep tabs on your mood, weight, energy levels, or aches and pains all at the same time?
Are your symptoms really caused by menopause?
If you have been taking HT but it is not working, it might be time to re-evaluate your symptoms.
Many problems commonly blamed on menopause can also be caused by completely unrelated issues. This means that they will not improve with HT and a different approach is required.
For example, while hot flashes are common during menopause they can be caused by a host of other medical issues, from thyroid problems to infections.
If it seems like your HT is not working, take the opportunity to check in with your healthcare provider. They may be able to investigate further and find an alternative cause for your symptoms.
This may also be a good time to think generally about your lifestyle. Are there any other changes you could make to improve your symptoms? You may decide to think about your diet, exercise, weight, smoking and/or vaping history, and daily routine among others.
If your HT doesn’t seem to be helping, don’t lose heart! Many common issues can be solved with a little time or a minor adjustment to your prescription. Speak to your healthcare provider if you feel like HT isn’t working for you to figure out what your next steps should be.
Remember too that lifestyle changes can complement your HT treatment and are proven to help with many menopause symptoms.