Once established on the “right” HRT preparation for you, its often presumed that menopause symptoms will be suppressed for as long as the HRT is taken…Unfortunately that’s not always the case.
Many factors can affect how well HRT works - from health and lifestyle changes to human error and bad habits.....
Some health conditions can mimic menopause symptoms – for example high blood pressure, type 2 diabetes, thyroid and heart conditions. If significant symptoms are occurring see your GP for a check-up.
New health related conditions can also affect HRT – bowel disorders, particularly frequent diarrhoea/loose bowels, can affect tablet HRT effectiveness. If you have noticed a change to bowel function seek your GPs advice about it – as well as discussing HRT requirements. Skin conditions requiring emollients/steroid creams may affect transdermal (through the skin) HRT absorption.
Many women find that their HRT can seem to be less effective after a few years use. During perimenopause and early post menopause, the ovaries continue to produce some oestrogen, also, small amounts of oestrogen stored throughout the body in areas of fat continue to circulate in the bloodstream, helping to treat menopause symptoms. Over time, these reserves run out and this can lead to menopausal symptoms feeling worse. Reviewing HRT and possibly increasing dose/changing route will often help symptom control.
It’s easy to get into bad habits when taking any regular medication – forgetting to take tablet HRT can cause break-through symptoms. Poor technique when applying gels can prevent good absorption – remember to apply to normal temperature skin and allow to air-dry well before dressing. Fake tans and body lotions can affect absorption for some women. Patches need to stick well, not irritate, and be changed on the correct days.
Simple prescribing mistakes can happen – if you notice a change in symptom control, double check the product you are using – particularly the oestrogen dose. If you think it’s different to your usual prescription, ask your Pharmacist to investigate.
Occasionally due to supply issues a different brand of HRT may be issued. Sometimes this is unavoidable. It's possible that the progestogen component (in combined products) may differ, however the dose of oestrogen should remain unchanged.
Some women feel they respond best to a particular brand of gel or patch. If so, it might be useful to talk to your Pharmacist about the possibility of arranging a continuous supply of the particular brand you respond best to.
Generally, best symptom control is usually achieved with transdermal rather than tablet oestrogen. For women with resistant symptoms, swapping to transdermal preparations is recommended.
Lifestyle factors including weight gain, unhealthy diet, increased alcohol and caffeine consumption and smoking can all trigger an increase in menopause symptoms. Stress will always make menopause symptoms feel worse - and can lead to all of the above spiralling - Recognising and starting to address these triggers will improve menopause symptoms – simply increasing Oestrogen may well not.