HRT not working? The NHS says HRT can take up to 3 months to work fully, and that if you don’t feel better after that, your doctor may suggest changing your dose or switching to a different type. Some women don’t absorb oestrogen well through the skin. Getting HRT is the start of finding what works for you, not the end.
Key takeaways
- HRT not working yet? It can take up to 3 months to work fully. If you don’t feel better after that, the NHS says to speak to your doctor.
- Your doctor may change your dose or switch you to a different type of HRT. No one type suits everyone.
- Women’s Health Concern says a small percentage of women don’t absorb oestrogen well through the skin.
- Agree any change of dose or type with your doctor rather than adjusting it yourself. If you have a womb, you also need a progestogen to protect it.
- Women’s Health Concern says ‘the most effective way of monitoring HRT treatment is by having a regular review of symptoms’. A record makes that review easier.
How long does HRT take to work?
The NHS answer is that ‘it can take up to 3 months for hormone replacement therapy (HRT) to work fully in improving your symptoms’. It adds: ‘If you do not feel better after 3 months, speak to your doctor.’
NICE guidance says to review treatment for menopausal symptoms ‘at 3 months to assess efficacy and tolerability’, then once a year, or sooner if the treatment isn’t working or causes side effects. So if you’re asking ‘is my HRT working?’ a few weeks in, it may be too early to tell. Three months on, HRT not working is a fair thing to raise with your GP.
Still having symptoms on HRT?
Most of us hope that starting HRT will hugely improve our experience of perimenopause and menopause. In reality, it’s the start of a journey to get the type and dose right, as long as HRT suits you at all.
The NHS says ‘there is not 1 type of HRT that is suitable for everyone’, and that your doctor ‘may suggest changing your dose, or switching to a different type of HRT’. In my experience, HRT not working comes down to a few things: the dose, how it’s getting in, how consistently it’s going on, and what else is happening in your life.
My journey from patches to gel to spray
My journey with oestrogen started with patches: 50, then 75, then 100 micrograms. Every increase helped, then after a while my symptoms crept back. I was on the highest-strength patch for about three years, and I still had symptoms. If you’re on HRT and still not feeling like yourself, you might be wondering whether this is as good as it gets. I did.
By then Brent and I were building TALIA. I remember the first time I showed the app to my GP really clearly. After a chat, I pulled out my printed Doctor Report. She spent about two minutes looking at the data and said she was pretty confident I wasn’t absorbing my oestrogen properly through the patches. I’d also added notes about irritated, itchy skin under the patch site, which gave her even more confidence. She said that, for me, on that dose, she’d have expected my symptoms to be better controlled.
I walked out with a prescription for gel, and my tracking showed my symptoms really improving. The gel was great, but on my dose there was a lot of it, and lying there for nearly ten minutes every morning while it dried was having a real impact on my routine. So in September I asked about a spray, and she was totally open to it. I have very few symptoms now, and when they flare I can see why: illness, a busy or stressful patch, travel, my routine out of whack. It’s life, not my HRT letting me down.
HRT patches not working, or not absorbing oestrogen?
Women’s Health Concern, the patient arm of the British Menopause Society, says ‘a small percentage of women do not absorb estrogen well through the skin’, ‘because of many factors including site of application, skin irritation, skin type, ethnicity, age and level of hydration’.
The patient leaflet for Evorel, a patch that comes in 25, 50, 75 and 100 microgram strengths, lists ‘irritated, itchy skin and rash where the patch is applied’ as very common, affecting more than 1 in 10 people. The NHS says that if a rash or itchiness only affects the area where you apply the oestrogen, ‘talk to your doctor as you may need a different treatment’.
Gel and spray go through the skin too, so switching from patches to gel isn’t a guaranteed fix. It worked for me. Tablets are the type that doesn’t go through the skin at all, and the same factsheet says it’s better to try a different type of HRT than to check a blood level. If you use a combined patch, with the progestogen in it too, switching to gel or spray means taking a separate progestogen, so your doctor will look at both.
A higher dose is the other option the NHS names, and it has limits. The British Menopause Society says ‘some women may require higher doses of estrogen, outside the licensing guidelines’, but that this ‘should not be regarded as standard practice’. If you still have your womb, the NHS says ‘you’ll need to also take a progestogen medicine to protect your womb’. Whether or not you do, change your dose or type with your doctor, never on your own.
Symptoms coming back on HRT: what else to check
In my experience, consistency matters too. One of the things women told us most in our beta was that they were taking their HRT more consistently. Nobody misses a dose on purpose. Life just gets in the way. The NHS says to use gel and spray ‘at the same time each day’.
I still forget my spray some mornings without a nudge, so TALIA reminds me at the time I’ve set. If you do miss a dose, follow your product’s leaflet, and there’s more on what to do if you forget your HRT.
Then there’s life. For me, illness, stress, travel and a routine thrown out of shape all bring symptoms back on HRT, and that doesn’t always mean HRT has stopped working. Before you put it down to HRT not working, a record of what else was going on helps you and your doctor tell the difference.
What to take to your GP about HRT not working
Your doctor will want to know what’s happened, when, and how it’s changed over time. Before your appointment, note:
- your symptoms, how bad they are and how often
- when you took or applied your HRT, and any doses you missed
- where you put your patches, gel or spray, and any itching or rash there
- what else was going on: illness, stress, travel, a change in routine
If changes to your treatment aren’t helping, NICE says to ‘refer women to a healthcare professional with expertise in menopause if treatments do not improve their menopausal symptoms or they have ongoing troublesome side effects’. It’s fair to ask your GP about that. Outside the UK, your own doctor and local guidance apply.
TALIA logs each dose of your HRT, whether it’s a patch, gel, spray or tablet, and reminds you when it’s due. When your doctor changes your dose or type, TALIA records the change and shows how your symptoms looked in the week before and after. You can turn it all into a Doctor Report to take to your appointment, and there’s more on tracking HRT patches, gels and sprays. TALIA can’t tell you whether your dose is right. That’s your doctor’s call, and the record helps them make it. Download TALIA for iPhone or Android.
Frequently asked questions
How long does HRT take to work?
The NHS says it can take up to 3 months for HRT to work fully. If you don’t feel better after 3 months, speak to your doctor, who may suggest changing your dose or switching to a different type. NICE guidance also recommends a review at 3 months.
Is it normal to still have symptoms on HRT?
It can be, especially in the first few months. The NHS says there is not one type of HRT that suits everyone, and finding the right type and dose can take time. If symptoms carry on or come back, keep a record and take it to your doctor.
Can I switch from patches to gel?
Yes, if your doctor agrees. The NHS lists switching to a different type of HRT as one option when it isn’t working. Gel is used once a day and the NHS says to wait up to 5 minutes for it to dry before getting dressed; a spray takes up to 2 minutes. If you use a combined patch, you’ll need a separate progestogen with gel or spray.
What if the highest-strength patch isn’t working?
Women’s Health Concern says a small percentage of women don’t absorb oestrogen well through the skin, so a different type may suit you better. The British Menopause Society says some women may need higher doses outside the licensing guidelines, but that this should not be regarded as standard practice. If treatments aren’t helping, NICE says your GP should refer you to someone with expertise in menopause.
Can a blood test show if I’m absorbing my HRT?
Not usually. Women’s Health Concern says blood tests are ‘not usually an accurate way of determining exactly how well you are absorbing HRT’, and that it is better to try a different type of HRT and talk through your symptoms with a healthcare professional than to check an oestrogen blood level.
If your HRT isn’t doing what you’d hoped, try and find out why before you decide it’s not for you. TALIA keeps the record of how you feel and when you took or applied it, privately on your phone. Download TALIA for iPhone or Android.
