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Hormone replacement therapy (HRT): possible side effects of treatment

Updated: Feb 26

What to expect when starting HRT


Hormone Replacement Therapy (HRT) is a medical treatment aimed at replenishing hormones that the body no longer produces sufficiently. For most women, HRT is considered a safe and effective approach to managing the symptoms of perimenopause or menopause, offering potential benefits such as lowering the risk of cardiovascular disease, osteoporosis, and potentially diabetes and cognitive decline.



Lady holding HRT medication
HRT risks vs benefits

Side effects of HRT


Predicting potential side effects upon commencing HRT can be challenging. This often hinges on factors such as when one starts HRT—during perimenopause or post-menopause—and personal hormonal sensitivity. The occurrence of side effects may vary based on variables like hormone type, dosage, the individual's health status, and the method of administration (e.g., oral pills, patches, gels).


Using body-identical HRT is often considered less likely to be associated with adverse effects due to the medication being bio-identical to the hormones naturally produced by our ovaries and brain.


It's essential to note that while some individuals may experience side effects, others might encounter none at all. Additionally, most side effects are typically temporary and tend to dissipate as the body adapts to the new hormone levels.


Anticipating the HRT Experience:

When we prescribe HRT within our menopause or PMS clinic, we engage in a thorough discussion about the potential for side effects. For the majority of women, these effects are mild and fleeting, seldom persisting beyond a few weeks. In instances where side effects prove difficult to manage or extend beyond three months from the initiation of HRT or any change in dosage or type, we encourage contacting us for a discussion about available options.


HRT Side Effects


Oestrogen-Related Effects:

• Breast tenderness or enlargement—often manageable with evening primrose oil or short-term use of ibuprofen gel.

• Irregular bleeding or spotting—typically resolves after a few cycles; do consult if prolonged beyond three months.

• Nausea

• Headaches

• Mood swings


Progesterone-Related Effects:

• Bloating

• Breast tenderness

• Mood changes, encompassing anxiety, low mood, and irritability

• Potential elevated risk of blood clots—depending on progestogen type used; generally not associated with body-identical micronised progesterone


Navigating Progesterone Intolerance:

Progesterone intolerance, while not universally recognised in medical terminology, is a genuine adverse reaction experienced by a subset of women using progesterone. Importantly, individual reactions to progesterone can significantly vary. Some women exhibit heightened sensitivity to hormones, leading to undesirable effects.


Symptoms of Progesterone Intolerance:

  1. Mood Changes: Mood swings, irritability, anxiety, or depression might arise with progesterone use.

  2. Breast Tenderness: Some individuals might experience tender or sore breast tissue.

  3. Bloating: Progesterone may result in fluid retention and bloating.

  4. Gastrointestinal Symptoms: Nausea, indigestion, or changes in bowel habits could manifest.

  5. Headaches: Hormonal fluctuations, including those linked to progesterone, could trigger headaches.

  6. Fatigue: Certain individuals may experience fatigue or changes in energy levels.

  7. Skin Changes: Progesterone might contribute to skin changes, such as acne or oily skin.

  8. Menstrual Changes: For those with menstrual cycles, progesterone intolerance might entail irregular periods, heavy bleeding, or other menstrual shifts.

Communication with a healthcare professional is pivotal when addressing symptoms or concerns. If adverse effects related to progesterone-containing medications are suspected, we can assist in identifying the cause of intolerance, exploring alternative treatments, adjusting dosages, or suggesting other strategies to manage symptoms. For most women, it's about finding a tolerated progesterone or progestogen, whether that's the Mirena Coil, Utrogestan, Provera, or other options.


It's also noteworthy that individual responses to hormones can be intricate, influenced by diverse factors like overall health, hormone levels, genetics, and pre-existing medical conditions.


Testosterone replacement: potential side effects

It's important to discuss the potential benefits and risks of testosterone therapy when thinking about starting testosterone HRT with your clinician. We can help determine whether testosterone therapy is appropriate for your individual situation, monitor your response to the treatment, and manage any side effects that may arise. Regular follow-up appointments and monitoring are crucial when undergoing hormone therapy.


Testosterone can be prescribed as a component of Hormone Replacement Therapy (HRT) for women who exhibit low levels of this hormone. It is utilised to address diminished libido. However, within clinical practice, women also report heightened energy levels and enhanced cognitive functioning.


Nevertheless, akin to any medication, testosterone therapy for women carries potential side effects. It is crucial to note that responses to testosterone therapy can diverge among individuals, and not all women will encounter the same side effects.


The British Menopause Society recommends conducting blood tests to assess testosterone levels before initiating treatment and again after 6-12 weeks when prescribing testosterone to alleviate symptoms of perimenopause or menopause. This procedure ensures precise dosing within the physiological range suitable for females. Under this premise, testosterone treatment is safe and side effects are infrequent.


Notwithstanding, here are several conceivable side effects of testosterone therapy in women:


  1. Hair Growth: Hair growth may manifest at the application site. We suggest alternating the application site daily to mitigate this occurrence.

  2. Acne and Oily Skin: Some women might experience heightened acne and skin oiliness due to testosterone therapy.

  3. Hair Loss: While testosterone therapy can lead to escalated body hair growth, paradoxically, it can also rarely contribute to scalp hair loss, known as androgenic alopecia.

  4. Clitoral Enlargement: Testosterone therapy can prompt clitoral enlargement, albeit this effect is generally reversible upon discontinuation of therapy.

  5. Changes in Libido: Testosterone is often linked to heightened libido. Certain women may undergo shifts in sexual desire while undergoing testosterone therapy.

  6. Mood Changes: Mood changes, including irritability, mood swings, or heightened aggression, may be encountered by certain women. However, the impact on mood can substantially differ among individuals.

  7. Cholesterol Levels: Testosterone therapy might influence cholesterol levels, potentially elevating "bad" cholesterol (LDL) levels and diminishing "good" cholesterol (HDL) levels. We conduct annual blood tests for testosterone levels and recommend monitoring liver and cholesterol function.

  8. Menstrual Irregularities: Testosterone therapy can occasionally result in alterations in menstrual cycles, potentially causing irregular or absent periods.

When considering the initiation of testosterone HRT, it is imperative to discuss with your clinician the conceivable benefits and risks of such therapy. We can aid in assessing whether testosterone therapy is beneficial to your particular circumstances, oversee your response to the treatment, and address any potential side effects. Sustained follow-up appointments and monitoring are pivotal facets of hormone therapy.








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