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Recognizing the Signs: HRT Is Not Working

Is your hormone treatment under control one moment and a rollercoaster the next?

That's what a lot of women go through with Hormone Replacement Therapy (HRT). While HRT is currently the best-regarded solution for menopause symptoms, the truth about HRT is much more nuanced. Menopause is not simple.

Are you dealing with worse hot flashes/hot flushes, stomach aches you can't explain, or mood changes that catch you by surprise? These might be signs that your HRT isn't doing its job right.

In this article, Dr. Kay Bloom, founder of the Bloomer Brigade, takes you through the important signs to watch for. We'll talk about critical signs that suggest it's time to reassess your HRT plan, shedding light on issues such as the tricky balance of estradiol dosage, progesterone side effects, and HRT-related nausea, while offering insights into navigating these challenges. Let's dive in...


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when HRT isn't working


Have you ever wondered if your hormone replacement therapy (HRT) is truly helping you?

Let's dive into this important topic. As a menopause coach and a fellow woman journeying through the beautiful stage of life beyond 40, I understand the emotional and physical rollercoaster that hormonal imbalances can bring.

In this article, we'll explore the critical signs that indicate when HRT might not be working as expected to guide you towards better health and well-being.

Brief Overview of HRT and its Purpose

Hormone Replacement Therapy (HRT) is like a support system for women going through menopause.

During menopause, a woman's ovaries gradually reduce their production of two key hormones: estrogen and progesterone. Estrogen, particularly a type called estradiol, is important. Estrogen affects everything from your skin and bones to how your brain works.

As these hormone levels drop, they can cause all sorts of symptoms like hot flashes, mood swings, and trouble sleeping.

Common Side Effects of Estrogen

  • Hot Flashes

  • Bloating

  • Tender breasts

  • Nausea

  • Indigestion

  • Headaches

  • Mood Swings

  • Trouble Sleeping

Common Side Effects of Progesterone

  • Abdominal pain

  • Vaginal bleeding

  • Low mood

  • Acne

  • Headaches

  • Breast tenderness

  • Breast Fullness

This is WHY women take HRT.

It provides these hormones, especially estrogen, to your body to ease these symptoms.

Think of it as a way to balance things out during menopause, which is a natural part of aging. Keep your body feeling more like it used to when your ovaries were making more of these hormones.

Introduction to the Concept of HRT Not Working Effectively

But what happens when HRT seems to falter?

For some women in the Bloomer Brigade, they find HRT doesn't work as well as they hoped. This can happen for a few reasons.

Maybe the type or amount of hormones in the HRT isn't quite right for you. Everyone's body is different, so what works for one person might not work for another.

Recognizing that HRT might not be working effectively is important.

Your body might show signs that it's not getting the right balance it needs. This is where it gets a bit science-y.

If estrogen (estradiol) isn't at the right dosage, you might still have hot flashes or mood changes. If body identical progesterone is out of balance, it can cause weight gain, hair loss, or breast tenderness.

Understanding how HRT is supposed to work helps you and your doctor figure out what to do if it isn’t doing its job. It's all about finding the perfect match for your body's needs.

How HRT regulates estrogen in menopause

Understanding HRT and Its Expected Effects

Think of your body as an orchestra, each hormone an instrument playing its unique note.

What is HRT? (HRT Meaning)

Hormone Replacement Therapy (HRT) is the masterful conductor bringing balance and harmony. As women enter menopause, their ovaries gradually reduce producing essential hormones, primarily estrogen and progesterone.

HRT replenishes these hormones, especially estrogen, which is critical not just for reproductive health but for bones, skin, and even brain function.

This therapy often involves a combination of estrogen and progesterone, tailored to mimic the natural hormone levels your body used to produce.

benefits of HRT

Expected Benefits and Outcomes of HRT

The advantages of Hormone Replacement Therapy are numerous and impactful. Let's break down the key benefits:

  • Relief from Menopause Symptoms: HRT is the most effective treatment for reducing menopausal symptoms like hot flashes, night sweats, and vaginal dryness. By replacing diminishing hormones, it helps stabilize the body's internal thermostat and maintains vaginal health.

  • Improved Sleep Quality: Menopause often disrupts sleep due to night sweats and mood changes. HRT can help restore more restful sleep patterns.

  • Boosted Mood and Energy Levels: Fluctuating hormone levels during menopause can lead to mood swings and a drop in energy. HRT can help even out these fluctuations, leading to improved mood and increased energy.

  • Reduced Risk of Osteoporosis: Estrogen plays a crucial role in maintaining bone density. With its decline during menopause, the risk of osteoporosis increases. HRT can help prevent bone loss, reducing the risk of fractures.

  • Lower Risk of Certain Cancers: Some studies suggest that HRT, especially estrogen-only therapy, may reduce the risk of colorectal cancer.

  • Prevention of Hair Loss: Menopause can lead to thinning hair due to lower estrogen levels. HRT can help in maintaining hair health.

  • Enhanced Skin Elasticity: Estrogen helps in maintaining skin collagen. HRT can aid in preserving skin elasticity and reducing wrinkles.

  • Cognitive Health Benefits: There is ongoing research on the impact of HRT on cognitive health, with some studies suggesting it may help in maintaining cognitive function if started at the onset of menopause.

Why women opt out of HRT

Despite its benefits, not all women choose or are advised to use HRT. The reasons vary:

  • History of Breast, Ovarian, or Uterine Cancer: Women with a personal or family history of certain cancers are often advised against HRT due to the potential risk of hormone-sensitive cancer growth.

  • Risk of Blood Clots or Stroke: HRT can increase the risk of blood clots and stroke, especially in women with a history of these conditions or certain health risk factors.

  • Heart Disease: Women with existing heart disease may be advised to avoid HRT due to potential risks.

  • Liver Disease: HRT can be harmful to women with liver disease, as it can affect liver function.

  • Migraines: Some women with a history of migraines find that HRT exacerbates their symptoms.

  • Personal Preference: Some women choose to avoid HRT due to concerns about side effects, preferring to manage menopause symptoms through lifestyle changes or alternative treatments.

In conclusion, while HRT offers a range of benefits that can significantly improve quality of life during menopause, it's not a one-size-fits-all solution.

Make an informed decision and consult with your healthcare provider.

Signs that HRT may not be working

Signs That Your HRT May Not Be Working

Overview of Common Signs and Symptoms

Recognizing the signs that HRT isn't working as intended is key.

Here's a quick list of symptoms that might suggest your HRT needs adjustment:

  • Persistent Hot Flashes

  • Increased Night Sweats

  • Mood Swings

  • Sleep Disturbances

  • Vaginal Dryness

  • Decreased Libido

  • Unexplained Fatigue

  • Memory Lapses

  • Body Aches

  • Breast Tenderness

  • Irregular Bleeding

If you're experiencing these symptoms, it's like your body is sending SOS signals. Your hormone dosage might not be aligned with what your body currently needs.

Detailed Exploration of Signs like Worsening Hot Flashes, Stomach Cramps, and Nausea

What if the symptoms get worse? Sometimes, the adjustment to HRT can lead to an increase in certain symptoms or the development of new ones:

  • Worsening Hot Flashes: If hot flashes become more frequent or intense, it can be a sign that the estrogen dosage in your HRT isn't right.

  • Stomach Cramps and Nausea: These symptoms can emerge as your body reacts to the hormonal changes introduced by HRT.

These intensified or new symptoms are your body's way of telling you something isn't quite right.

Listen to your body's signals!

Discuss symptoms with your healthcare provider. They can help decipher these signals and adjust your HRT dosage accordingly. Contact us if you need guidance on talking to your primary care provider (we are advocates for all our members).

Progesterone and Its Discomforts

Are you asking yourself, why does Progesterone make me feel awful?

You’re not alone!

How Progesterone Can Make You Feel Awful

Is progesterone a friend or a foe?

Progesterone, vital in many HRT formulas, plays a crucial role in balancing estrogen levels. But when its levels aren't just right, it can cause a stir. Imagine a seesaw – when balanced, it's smooth sailing, but an imbalance can lead to a bumpy ride.

Here's a short list of discomforts caused by unbalanced progesterone:

  • Mood Swings

  • Bloating

  • Headaches

  • Fatigue

  • Breast Tenderness

Each of these symptoms can be a signal from your body that the progesterone levels might be off. Progesterone works in tandem with estrogen, and its balance is key for overall well-being.

Progesterone-Related Mood Swings

Progesterone can send your emotions on a rollercoaster ride!

Progesterone naturally fluctuates during the menstrual cycle, affecting mood and emotional well-being. Getting the balance right is crucial. Too much progesterone can amplify mood swings, making you feel like you're on an emotional pendulum – happy one moment and inexplicably upset the next.

This happens because progesterone can influence neurotransmitters in the brain, like serotonin, which regulate mood.

Progesterone-Related Physical Discomfort

But it's not just your emotions that progesterone affects.

Physical discomforts are also part of the package when progesterone is unbalanced. You might experience bloating, a feeling of fullness or tightness in the abdomen, which can be quite uncomfortable. Headaches and fatigue are other common issues.

These physical symptoms occur because progesterone can cause water retention and impact blood vessels and energy levels.

In summary, while progesterone is essential to many HRT regimens, getting its levels right is crucial.

If you're experiencing these symptoms, it's a sign to talk to your healthcare provider. Adjusting progesterone levels can be the key to restoring harmony and comfort in your HRT journey.

Evaluating HRT Dosage and Types

Importance of the Right HRT Dose (Estradiol Patch Dose Too Low/High)

Our bodies are complex machines, using hormones as the fuel. Just the right amount keeps everything running smoothly.

Estradiol, a form of estrogen used in HRT, is especially important. If the dose is too low, your menopause symptoms like hot flashes or mood swings might continue as if there's not enough fuel. But if it's too high, it can lead to side effects like breast tenderness or headaches.

It’s all about balance. Each one of us responds differently to HRT. Finding your right dose is a personalized process, often requiring adjustments.

Different Types of HRT and Their Effects

HRT comes in different forms, each with its pros and cons. Let's explore the types:


  • Pros: Easy to use; options for different hormone combinations.

  • Cons: Can be associated with a higher risk of blood clots; not suitable for women with certain health conditions like liver disease.


  • Pros: Direct absorption into the bloodstream, bypassing the liver; consistent hormone levels.

  • Cons: Can cause skin irritation; need to remember to change them regularly.

Gels and Creams

  • Pros: Easy application; can be good for localized symptoms like vaginal dryness.

  • Cons: Risk of transferring hormones to others through skin contact; dose can be harder to measure.

Vaginal Rings, Tablets, or Creams

  • Pros: Targeted relief for vaginal symptoms; lower doses with fewer systemic effects.

  • Cons: Primarily helpful only for vaginal symptoms; may require comfortable insertion.

Bioidentical Hormones

  • Pros: Custom-compounded to match individual needs; may be more natural feeling.

  • Cons: Less regulated; not enough large-scale studies to compare safety and effectiveness with traditional HRT.

Choosing the right type of HRT is like finding the best fit for your unique body and needs.

Discussing the options with your healthcare provider is important, considering factors like your specific symptoms, medical history, and personal preferences. They can help you navigate the choices, ensuring you find the HRT that works best for you.

Side Effects of HRT

Stepping into the world of HRT is like starting a new dance – it takes time to learn the steps.

Let's explore this adjustment period and why your body might react the way it does.

Comprehensive Look at HRT Side Effects

Ever wondered why HRT has such a range of side effects? It all comes down to how your body responds to the balance of hormones. Here's a quick rundown of side effects based on hormone levels:

When Estrogen is Too High:

  • Breast Tenderness

  • Headaches

  • Nausea

  • Leg Cramps

When Estrogen is Too Low:

  • Hot Flashes

  • Mood Swings

  • Fatigue

  • Vaginal Dryness

When Estrogen Dominance Occurs:

  • Weight Gain

  • Bloating

  • Irritability

  • Hair Loss

Estrogen and progesterone need to work in harmony.

When this balance is off, either due to too much estrogen, too little, or an imbalance with progesterone (known as estrogen dominance), your body reacts, leading to these various side effects.

It's like a delicate dance, and the whole routine can be affected when the steps are off.

How Long Do HRT Side Effects Last?

Are you wondering how long you'll be dancing with these side effects?

The good news is that many of them are usually temporary. Your body is like a finely tuned instrument, and it can take time to adjust to the new levels of hormones introduced by HRT.

This adjustment period typically lasts a few weeks to a few months.

You might experience these side effects during this time as your body tries to find its new equilibrium.

But what if the music doesn't settle, and the side effects worsen? That's your cue to have a chat with your healthcare provider. They're like the conductor, able to tweak the composition (your HRT regimen) to suit the orchestra (your body) better. Just like in music, the goal is harmony – in this case, between your body and the hormones it's receiving.

Remember, you're not alone on this journey; there's guidance and support available to help you find the right balance. We even invite you to join our menopause community and facebook group.

Adjusting to HRT: Time and Patience

Embarking on HRT? Brace yourself for a journey of adaptation. Your body is about to embark on an incredible transformation journey, and like all great journeys, it requires time and patience.

Understanding the Adjustment Period for HRT

Did you know your body needs time to get acquainted with HRT?

Starting HRT is like introducing a new character into the story of your body. At first, there's an adjustment period as your body acquaints itself with the new hormone levels. This is a phase of adaptation, a pivotal time for your body to recalibrate and find its new normal.

Remember, this period is as unique as you are – some may breeze through it, while others may need more time.

Can HRT Make You Feel Worse Before Better?

Ever feel like things are getting worse before they get better?

That's not uncommon with HRT. Initially, as your body adjusts, HRT might intensify existing symptoms or bring about new ones. It's a bit like gardening – sometimes, when you plant a new seed, the soil needs to be unsettled before the plant can flourish.

But don't lose heart. This phase is often temporary, a mere stepping stone on your path to better well-being.

When to Consider Changing Your HRT Plan

Navigating HRT is like steering a ship – sometimes, you must adjust your course. Recognizing when to change your HRT regimen is crucial for smooth sailing.

Signs of Too Much Bioidentical Progesterone

Are you getting more progesterone than you need?

Your body will send signals. Here's a list to help you spot the signs:

  • Bloating

  • Mood Swings

  • Drowsiness

  • Libido Changes

These symptoms are your body's way of waving a flag, indicating that the levels of bioidentical progesterone might be higher than what it comfortably handles.

How to Know if Your HRT Dose is Too High

How can you tell if your HRT dose has crossed the line? Look out for these tell-tale signs:

  • Breast Tenderness

  • Frequent Headaches

  • Emotional Overdrive

  • Weight Gain

These symptoms can be red flags, signaling that your HRT dosage might be too high.

It's about finding that perfect balance, where your body feels at ease and the symptoms of menopause are effectively managed. Remember, the goal of HRT is to make your journey through menopause smoother, not rockier.

If you're experiencing these signs, discussing them with your healthcare provider and considering adjusting your HRT plan is a good idea.

Lifestyle Considerations and Natural Alternatives

Natural Replacements for Estrogen

Did you know that your kitchen could be a treasure trove of natural estrogen boosters?

As women journey through menopause, the body's estrogen production dwindles. But nature offers a helping hand through phytoestrogens – plant-based compounds that mimic estrogen in the body.

Here's how they work: phytoestrogens bind to the same receptors in your body as estrogen.

While they're not as strong as the estrogen your body makes or the kind found in HRT, they can help provide a gentle, natural balance. Some great sources include:

  • Soy: Think tofu, soy milk, and edamame. Soybeans are rich in isoflavones, a type of phytoestrogen.

  • Flaxseeds: These tiny seeds pack a punch with lignans, another form of phytoestrogens.

  • Fruits and Vegetables: Particularly those rich in fiber, as they can help modulate estrogen levels in the body.

Incorporating these foods into your diet can be a delicious and natural way to support your hormone health during menopause.

The Role of Lifestyle in Managing Menopause Symptoms

Are you aligning your lifestyle with your body's needs during menopause?

This phase of life can be challenging, but your daily habits can play a significant role in how you feel. It's not just about what you eat; it's about an overall lifestyle that supports your well-being:

  • Regular Exercise: Staying active is key. It helps in managing weight, reduces the risk of osteoporosis, and can improve your mood. Even gentle activities like walking or yoga can make a big difference.

  • Balanced Diet: A diet rich in fruits, vegetables, whole grains, and lean proteins can help manage menopause symptoms and support overall health.

  • Stress Reduction: Menopause can be a stressor both mentally and physically. Techniques like meditation, deep breathing, or even a hobby can help in keeping stress levels in check.

  • Adequate Sleep: Quality sleep can be elusive during menopause, thanks to night sweats and hormonal changes. Creating a bedtime routine and making your bedroom a comfortable sleep environment can help.

By focusing on these lifestyle elements, you're not just managing symptoms; you're investing in a healthier, more vibrant version of yourself.

Remember, menopause isn't just about midlife; it's a transition to a new, potentially wonderful phase of life. Embracing this change with positive lifestyle choices can make this journey smoother and more enjoyable.


Recognizing the signs when HRT isn't working, understanding the side effects, and knowing when to adjust your plan are crucial steps in managing your health during menopause. Remember, each woman's experience is unique.

Your health journey is personal and precious. Consulting with healthcare providers for a personalized treatment plan is essential. They can guide you through the nuances of HRT, ensuring that your path to wellness is as individual as you are. Remember, embracing this stage of life with knowledge and support can turn it into a journey of empowerment and well-being.

Feeling overwhelmed or isolated in this journey?

You're not alone!

Imagine a supportive community where wisdom meets warmth, and experience becomes empowerment.

In the Bloomer Brigade, we understand the challenges and triumphs of navigating menopause and HRT. Our LifeBloom program offers not just answers but also a sisterhood of support, helping you transition from confusion to clarity, from struggle to strength.

Let us be your compass in the complex world of menopause and HRT, guiding you towards a path of well-being and inner beauty.

I invite you to apply in the link below.

Hormone Replacement Therapy (HRT) FAQs

FAQ Section: Understanding Hormone Replacement Therapy (HRT)

How do you know if HRT is not working?

If you're on HRT and still experiencing symptoms like hot flashes, mood swings, or sleep disturbances, it might not be working effectively. Every woman's body reacts differently, so if your symptoms persist or worsen, it's essential to talk to your healthcare provider. They can reassess your treatment plan and make necessary adjustments.

How do I know if my HRT dosage is too high?

Signs that your HRT dosage might be too high include breast tenderness, headaches, nausea, or mood swings. It's crucial to monitor any unusual symptoms and report them to your doctor. They can adjust your dosage to find a balance that alleviates your menopausal symptoms without causing side effects. Learn More at WebMD

How do you know when to stop taking HRT?

The decision to stop HRT should be made in consultation with your healthcare provider, as it varies for each individual. Generally, it's recommended to use the lowest effective dose for the shortest possible time. If you feel your menopausal symptoms have subsided, discuss with your doctor whether it's time to taper off HRT. Read More on WebMD

What symptoms does HRT get rid of?

HRT is effective in alleviating many menopausal symptoms like hot flashes, night sweats, vaginal dryness, mood swings, and sleep problems. It can also help in preventing bone loss and fractures. However, the effectiveness can vary, so it's important to have regular check-ups with your doctor. Detailed Information from Mayo Clinic

What are permanent effects of HRT?

Most effects of HRT are reversible once you stop the treatment. However, there are concerns about long-term risks such as an increased risk of certain types of cancer and cardiovascular issues. Discuss with your healthcare provider the risks and benefits of HRT for your specific situation. Understanding the Risks on WebMD

What is the best natural replacement for estrogen?

Some natural alternatives to estrogen include phytoestrogens found in soy products, flaxseeds, and certain herbs like black cohosh. However, their effectiveness can vary, and they are not regulated as strictly as conventional medications. Before trying natural alternatives, it’s important to consult with your healthcare provider.

Everything on this page is for general informational purposes and should not replace professional medical advice. Always consult with a healthcare provider for personal medical advice.


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