Generally, most side-effects are due to the progestogen component of HRT.
Bleeding is one of the most important side-effects that cause poor update and continuation.
See appendix 8 for more details.
- Irregular/continuous bleeding
- Heavy periods
- Poor cycle control
- Oily skin
- Facial hair
A small amount of weight gain attributed to fluid retention can occur but weight gain is a side effect of the menopausal transition not of HRT.
It should be possible to determine whether the side-effects experience are estrogenic (ie. continuous) or only in the progestogen phase of the cycle. However, many women will not spontaneously volunteer side-effects as a potential problem, so it is very important to ask, especially within the first 3 months of commencing HRT.
- Fluid retention/bloating
- Breast tenderness/enlargement (more common when starting in older women)
- Leg cramps
- Nipple sensitivity
- Encourage perseverance – many will resolve over 2-3 months
- Reduce the dose
- Alternative estrogen
- Change route of delivery
- Skin irritation
- Poor adhesion
- Local sepsis/scars from implants
For information on heavy bleeding, see appendix 8.
Progestogen usually presents more problems than estrogen (related to the type and dose/duration of progestogen).
- Fluid retention
- Breast tenderness
- Mood changes/depression
- Lower abdominal pain
- Bleeding problems
- Encourage perserverance – many will resolve over 2-3 months
- Change progestogen
- Reduce dose, but not below recommended levels
- Reduce duration
- Consider continuous combined or Tibolone if 1 year post-menopause