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Hormone Replacement Therapy (HRT) Side Effects

Side effects can occur with any medication, including HRT. In fact, side effects with HRT are very common, though not inevitable. However, as with many things HRT, they will be different for every woman.

While side effects can be uncomfortable, they generally settle over 8-12 weeks. However, if symptoms are particularly severe, persistent or worrisome, it’s important to speak with your prescriber for guidance. Don’t suffer unnecessarily.

HRT side effects can occur with any new or change to HRT regime, so patience is key as your body adjusts. Side effects can also be similar with oestrogen and progesterone so again patience is needed as you work through options with your prescriber. There’s no one size fits all with HRT.

Common side effects | Oestrogen

The following side effects are most commonly experienced with oestrogen replacement therapy. The list is by no means exhaustive, and any side effect that is particularly troublesome should be discussed with your prescriber.

  • Bloating and swelling
  • Breast tenderness
  • Changes to bleeding patterns
  • Headaches or migraines
  • Indigestion
  • Leg cramps
  • Mood changes
  • Nausea
  • Nipple sensitivity
  • Skin irritation

Common side effects | Progesterone

The following side effects are most commonly experienced with progesterone replacement therapy:

  • Abdominal discomfort
  • Acne
  • Backache
  • Bloating and swelling
  • Breast tenderness
  • Changes to bleeding patterns
  • Fatigue
  • Headaches
  • Indigestion
  • Mood changes
  • Nausea
  • PMS

Testosterone side effects

Side effects are uncommon with testosterone replacement therapy if testosterone levels are maintained within the female physiological range. If side effects do occur they are generally reversible with reduction in dosage or discontinuation of testosterone replacement therapy.

Managing side effects | Prescriber led

If side effects don’t settle, there are many options available to your prescriber, so don’t be disheartened. As previously mentioned, there’s no one size fits all with HRT, and finding the right individualised combination can take time. Options may include:

  • A change to HRT dose, which may be up or down
  • A change to HRT application type e.g. gel to patch, spray or tablet
  • A change to HRT brand e.g. Evorel to Estradot patches
  • A change to HRT regime e.g. from cyclical to continuous combined
  • A change to the type of hormone e.g. from synthetic to body identical progesterone
  • A change to how you use your HRT e.g. switching from oral to vaginal use of Utrogestan

Where necessary, investigations may also be necessary to rule out other causes of side effects, such as bleeding.

Managing side effects | Patient led

Self-help measures may also be worth trying, and can include:

  • A change to the time of day you apply HRT e.g. using progesterone at night to benefit from sleep effects, or using oestrogen gel in the morning if it’s energising
  • Using evening primrose oil and starflower oil supplements to ease breast tenderness
  • Switching patch application sites to minimise skin irritation or to test patch absorption and adhesion
  • Switching gel application sites to test if absorption is better at one site or another
  • Splitting a gel dose (morning and evening) if that maintains a more constant oestrogen level for you

Weight gain

Despite popular myth, the results of many accurate scientific studies show that HRT does not cause weight gain, and many women will gain weight with menopause due to a perfect storm of hormonal, metabolic and social changes.

HRT side effects such as bloating and breast tenderness may feel like weight gain, but once these have settled, it’s more likely that HRT will act as a catalyst for weight loss – boosting energy levels, activity levels and feelings of wellness.


Side effects of HRT are a common occurrence for many women. However, time, patience and a knowledgeable HRT prescriber can help find an HRT option that is right for you.

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