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Hormone Replacement Therapy (HRT) comes with a lot of benefits, but, like any medical treatment, there are some side effects to watch out for.
To make sure you're in the know about HRT side effects, you should read up on what they are, how to recognise them, what to do about them, and how to avoid them, as well as any long-term health risks from using HRT.
It depends on what medication you’re taking – there are different types of hormones that you can take in hormone replacement therapy (HRT). The side effects are slightly different depending on whether you are taking oestrogen or progesterone.
Possible side effects if your medication contains oestrogen
Possible side effects if your medication contains progesterone
Side effects are usually short-lived – generally, people experience side effects when they start HRT, switch the method of using HRT, or switch to a different hormone. They normally last a few weeks until your body becomes more used to them.
Speak to your GP if you're having problems – some people find that these side effects don’t really affect their day to day life, whereas for others they can become inconvenient. We recommend that you speak to your GP if you are struggling with the side effects of HRT.
How can you tell if you are having HRT side effects?
It's not always easy to tell – some side effects of hormone replacement therapy (HRT) (such as swelling in the ankles) are easy to pick out. Others (such as mood changes) can be hard to distinguish from symptoms of menopause.
Timing is a good indication – generally, if you start experiencing symptoms after you start or change HRT it could be a side effect of treatment. If these symptoms improve when you stop or change HRT treatment, it’s quite likely that what you experienced was a side effect.
There could be other causes – other underlying conditions can cause some of the symptoms listed above. For example, heart or liver problems can cause swelling of the ankles and mental health conditions can cause mood changes. We recommend that you speak to a doctor if any of these symptoms bother you.
What to do about HRT side effects?
Decide whether you can put up with them – you will need to decide yourself whether the benefits of HRT outweigh the disadvantages. People who experience mild side effects find that they would rather put up with symptoms of menopause, whereas others would prefer to take HRT even if it causes some unpleasant side effects.
Wating a few months could work – it is a good idea to stick to your current prescription of HRT for at least three months rather than making changes after a short period of time. Side effects may go away or become less severe as your body starts to get used to them.
Talk to a doctor for confirmation – to confirm whether you are having a side effect of HRT, you can speak to a doctor face-to-face. They can assess the type of HRT that you are on to see whether you are likely to be experiencing a side effect.
If you want to stop treatment – if you feel that you want to stop treatment, speak to a doctor face-to-face. They will be able to advise you on the safest way to stop HRT treatment. Do not stop or change medication without speaking to a doctor beforehand.
Things that can help – there are some things that you can do at home to manage side effects whilst you’re taking HRT treatment:
Take oral HRT with food
Do gentle stretches or exercise to relieve cramping
If managing your side effects doesn't work – if side effects still bother you after you try to manage them at home, make an appointment to see your doctor.
Reporting side effects – below is a video about how to report side effects using the UK government's YellowCard scheme:
How do you avoid side effects?
There isn't much you can do to prevent side effects – sometimes, there’s not a lot that you can do to prevent side effects from happening. There are a few things that you can do to reduce the likelihood of getting side effects or the severity of symptoms, such as taking oral hormone replacement therapy (HRT) with food or doing gentle stretches to relieve pain.
Alternative treatments – if you do not want to take HRT, there are alternatives available:
Deciding to quit smoking, eating a healthy diet, and regular exercise can help reduce symptoms of menopause. Also, you can avoid foods or drinks that trigger hot flushes or use a vagnial lubricant to improve dryness. Some women find that they don’t need medication after they make some of these lifestyle changes
Some antidepressants can be used to improve hot flushes, although they are not licensed for this use. Speak to your GP to find out more about this treatment for menopausal symptoms
These are hormones which are made from plant products which mimic the body’s natural hormones and the hormones used in HRT. However, we do not recommend this type of treatment as they are not regulated and it’s not yet clear how safe they are
No treatment – Many women choose not to take any treatment for their menopausal symptoms. This is an option if you feel that you can put up with the symptoms. The advantage is that there is no risk of side effects with no treatment. Also, some women feel that there is no need to treat symptoms which naturally happens in everyone.
Does HRT have any long term health risks?
Yes, this is something to consider – research have found that taking hormone replacement therapy (HRT) is associated with a slightly higher incidence of some conditions. Because of this, it’s important for you to be aware of the health risks so that you can make an informed decision on taking HRT.
Breast cancer – combined HRT (containing both oestrogen and progesterone) is associated with both a higher incidence of breast cancer and a higher mortality rate from it. You should tell your doctor if there is a history of breast cancer in yourself or your family before you start taking HRT. However, taking HRT results in only one extra case of breast cancer per every 1,000 women every year, so the risk is very slight.
Endometrial cancer – oestrogen HRT is associated with a higher rate of endometrial cancer in women who have not had their womb removed. You can lower this risk by using a cycle of 14 days on oestrogen and 10 days on progesterone or by using combined HRT. You should tell your doctor if there is a history of endometrial cancer in yourself or your family.
Ovarian cancer – data from research on whether there is a link between HRT and ovarian cancer is currently conflicted. Speak to your doctor if you are worried about the risk of ovarian cancer.
Clots – HRT that is taken by mouth carries a higher risk of developing blood clots. People who have an obese BMI, smoke, have previously had a clot, or are bed-bound are also at a higher risk of developing clots and taking oral HRT may not be suitable for them.
Stroke – oral HRT and combined HRT slightly increase your risk of having a stroke. This risk increases with the dose, so if you are worried about this you can speak to your doctor about decreasing the dose of medicine.
These risks are usually low overall – although the consequences of developing the conditions listed above are severe, the risk of it happening is very small. Some people consider that the relief from menopausal symptoms is worth the risk associated with it.
These risks are checked during your assessment – if you order online, your online doctor will take some of these long term health risks into account when you fill in your health questionnaire to get your supply of HRT. If you have a specific worry, however, it may be worth speaking to a doctor face-to-face.
Can I reduce my risk? – there are things that you can do to keep the risk of developing these conditions as low as possible. You could: