HRT (menopause)

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HRT side effects

HRT side effects

Menopause affects all women at some point in their lives, and it can be mentally and physically taxing. To help you to tackle the symptoms of menopause, clinicians will often prescribe HRT: a type of medication that balances your body’s hormone levels. But like with most medications, HRT can come with associated risks and side effects.

Some of the most common side effects of HRT include breast tenderness, bloating, digestive issues and mood swings. But each type and form of HRT comes with a different list of possible side effects.

We’ll take you through the possible side effects of oestrogen-only and combined HRT, as well as specific problems associated with HRT tablets, gels, implants and patches. We’ll also demystify a few common misconceptions for you - that way you can make an informed decision on what you want to take and how.

Daniel Atkinson
Medically reviewed by
Daniel Atkinson, GP Clinical Lead
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Medically reviewed by
Dr Daniel Atkinson
GP Clinical Lead
on August 02, 2022.
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Common side effects of HRT

Each type of HRT can have different side effects, whether it be oestrogen-only or combined treatment, or the way it’s taken (tablets, patch, implant, or gel). But HRT is prescribed to women who are experiencing unpleasant menopause symptoms, which can be worse for you than any possible side effects caused by HRT if left untreated. HRT can also help to prevent any further complications from menopause, such as osteoporosis.

Sometimes HRT can have some serious side effects, but many women have little to no issues at all when taking HRT, so long as they find a dose and form that works for them.

Some of the common side effects of HRT can include bloating, breast tenderness, indigestion, headaches, mood swings and leg cramps.

Depression is usually only linked to combined HRT, so if you’re prescribed oestrogen-only HRT, you’re unlikely to experience depression as a side effect of your treatment.

One of the symptoms of menopause is mood changes, and in most cases it manifests as increased feelings of anxiety and depression. So if you’re experiencing symptoms of depression when you’re taking HRT, it can be hard to know whether it’s due to the medication or the menopause. Studies show that certain types of HRT can improve symptoms of anxiety and depression in menopausal women .

HRT can often cause digestive issues, but more commonly with oestrogen-only HRT than combined treatment. This can include nausea, indigestion, bloating, and general feelings of sickness. Using a patch or gel instead of pills can sometimes avoid these issues.

There’s no evidence to suggest that weight gain is a side effect of HRT. [popovern id=ref3] But weight gain is a known menopause symptom, so you might still experience a shift in your weight in this phase, it just won’t usually be because of hormone replacement therapy.

It’s not unusual for hair loss to occur during menopause. It can happen because of the lowering levels of hormones in your body – so HRT, by replacing these hormones, can work to replenish your hair if you’re losing it through menopause.

Do different forms of HRT cause different side effects?

medically-reviewedThere are four main forms of HRT: patches, gels, tablets, and implants. Each of these will have different risks and side effects associated with them. Some are more convenient to take, and others last longer so you don’t need to take them routinely. Also, some are oestrogen-only, so you might need to take progesterone separately, too, in some cases.

Ultimately, there’s no HRT with the least side effects, each has its pros and cons and it’s up to you to decide which one you prefer.

Skin patches are a common way of taking HRT, and they’re quite straightforward to use. You’ll usually apply it to your skin and after a few days replace it with another. This option can be easier for you if you’re not used to taking tablets every day and would prefer not to take them. Since you only need to replace the patch about twice a week, it’s easier to commit to it than to a daily tablet.

HRT patches are available in both oestrogen-only, and as an oestrogen and progesterone combination. And since the hormones are absorbed through your skin, you can avoid some side effects that you would get from the tablets (like indigestion) and decrease your risk of blood clots, stroke, or heart attacks.

The specific side effect of HRT patches is usually irritation and redness of the skin in the area where you apply the patch, but this doesn’t happen to everyone. If this happens to you, your clinician might recommend a different patch, or for you to try an alternative form of HRT.

HRT tablets are one of the most common forms of HRT. You usually only need to take one tablet a day, so many women take this route if it’s the easiest for them, especially if they have been taking birth control for a long time, and are used to the routine of having to take a tablet every day. HRT tablets are also available in oestrogen-only or combined HRT, so all you ever need is one pill.

Compared to other forms of HRT, the tablets will put you at a higher risk of developing blood clots, but the risk is very small so you shouldn’t have to worry too much about it.

Some of the most common HRT tablet side effects include: digestive issues, vomiting, indigestion, and stomach pain, dizziness, headaches, low libido, and PMS symptoms. But these can often also be attributed to menopause, so you might need to assess whether you feel better with or without HRT.

HRT gel, commonly known as oestrogen gel, is becoming one of the most popular forms of HRT. To apply it, you rub it onto a small area of skin of your arm or thigh once a day. Since the substance is absorbed through the skin, the risk of developing blood clots lowers significantly compared to when you take HRT tablets.

The side effects of HRT gel can include digestive issues, swollen and tender breasts, vaginal dryness, low libido, headaches, mood changes, and dizziness. But many of these are also menopause symptoms, so it can sometimes be hard to pinpoint what’s exactly causing these.

Some people have suggested that HRT gel will make you gain weight, but there’s no evidence that suggests that it does. Weight gain is, however, one of the symptoms of menopause, so the belief might stem from there.

HRT gel is oestrogen-only, so unless you’ve had a hysterectomy you’ll need to take progesterone separately as well – otherwise it can increase your risk of developing cancer.

The implant is a slow-release pellet that’s placed just under your skin. The biggest pro of the implant is that it lasts for a long time, and you don’t need to remember to take a tablet, change a patch, or apply any gel. This is perfect if you don’t want to worry about regularly taking or applying your treatment.

Shortly after having the implant inserted, there are a few risks to take into account. Your body might reject the implant, and if that happens, the pellet will find its way out of your skin. This is rare, but if it happens you should see a doctor as soon as possible. Aside from that, you might experience some pain and bruising in the area for a few days after the procedure.

HRT implants are oestrogen-only, so you’ll need to take progesterone separately if you need to use combined HRT.

HRT types and side effects

Whether or not you should take oestrogen-only, or what kind of combined HRT you take, will depend on what stage of the menopause you’re in and whether or not you’ve had a hysterectomy.

Oestrogen-only HRT is usually only prescribed to women who’ve had a total hysterectomy. The main downside of this type of HRT is an association with endometrial cancer.

Combined HRT can be prescribed to any woman who hasn’t had a hysterectomy. The progesterone in it will lower your chances of developing endometrial cancer. Within this category, there are two types of HRT: cyclical combined HRT and continuous combined HRT.

The cyclical combined HRT is prescribed to women who have menopause symptoms already, but they are still getting periods. The continuous combined HRT is recommended for women who are postmenopausal.

Combined HRT contains progesterone, which can come with its own set of side effects. But in the long run, taking combined HRT reduces your risk of developing endometrial cancer (which is higher when you take oestrogen-only HRT) so the combined HRT side effects are often seen as a risk worth taking.

The side effects of combined HRT can include: stomach upset, dizziness, headaches, breast tenderness, dry eyes, low libido, acne, bloating, leg cramps, mood changes, and weight changes.

If you’re experiencing unpleasant side effects from your combined HRT, speak to your clinician. They might decide to reassess your prescription and find you a better solution.

If your oestrogen levels climb too high above your progesterone levels, you might develop some symptoms due to what’s known as “oestrogen dominance”. Your breasts might get tender, you may get bloating, leg cramps, headaches, indigestion, swelling, and a feeling of sickness. High levels of oestrogen can increase your risk of stroke and blood clots, as well as thyroid dysfunction. Oestrogen-only HRT has also been linked to cancer of the endometrium lining .

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This page was medically reviewed by Dr Daniel Atkinson, GP Clinical Lead on August 02, 2022. Next review due on August 01, 2024.

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