My HRT isn't working...

For some women in their golden years, it's natural to seek comfort and relief during menopause. Hormone replacement therapy (HRT) promises this, but what if it doesn't seem to work as expected? Leading consultant gynaecologist Mr Mahantesh Karoshi invites us to unravel this together.

Understanding the timeline of HRT

Patience is key when starting HRT. Immediate results are rare; it often takes several weeks, sometimes up to three months, for your body to adjust and symptoms to ease.

This is the reason why specialists will typically re-evaluate your progress after this period.

If you're in the early stages, hang in there! It's crucial to give your body time to respond before considering changes to your treatment.

Is your HRT dose just right?

If you've been on HRT for months with no relief, it's worth reviewing your dosage, especially the amount of oestrogen. Menopause symptoms stem from declining hormone levels. HRT replenishes oestrogen, but finding the perfect dose can be a balancing act. A higher dose might better manage symptoms, while a lower dose might reduce side effects. Dosage adjustments vary, whether you're using pills, patches, gels, or sprays.

Considering a dose increase

Sometimes, what worked initially might need tweaking as you progress through menopause. Your body's hormone requirements can change, necessitating a higher oestrogen dose to keep symptoms at bay.

Choosing the right type of HRT

It's not just about how much, but also about what type of HRT you're using. Systemic HRT, which distributes hormones throughout your body, is great for general menopause symptoms like hot flushes and mood swings. This includes tablets, patches, gels and sprays. However, for issues specific to the genital area, like dryness or pain during intercourse (known as genitourinary syndrome of menopause), vaginal HRT might be more appropriate. Sometimes, using both systemic and vaginal HRT together provides the best relief.

Are you using HRT correctly?

It's also important to ensure you're using HRT as prescribed. Are you replacing patches on time, applying gels correctly, or remembering your daily tablets? If you find the method challenging, discuss alternatives with your doctor. HRT comes in various forms, and it's crucial to find one that fits seamlessly into your life.

Reassessing your symptoms

If HRT isn't bringing the relief you expected, it's worth considering whether your symptoms are menopause-related. Many issues attributed to menopause can stem from other causes, like thyroid disorders or infections. A detailed discussion with your specialist can help uncover other potential causes and treatment options.

A holistic approach

Beyond HRT, lifestyle changes can significantly impact your menopause experience. Diet, exercise, and habits like smoking all play a role. Sometimes, a holistic approach, combining lifestyle adjustments with HRT, offers the most comprehensive relief.

In summary, if your HRT journey feels rocky, don't lose hope. Often, the solution lies in a bit of patience, a dosage tweak, or a different type of therapy. Remember, your doctor is your partner in this journey, and together, you can find the best path forward. Plus, embracing positive lifestyle changes can enhance your overall well-being during these transformative years.

Do you require expert advice regarding HRT? Arrange a consultation with Mr Karoshi via his Top Doctors profile.