You may have been asked whether you needed Hormone Replacement Therapy (HRT) if you have menopausal, perimenopausal, or simply hormonal imbalance-related signs and symptoms. One starts with questions on the type of symptoms experienced, such as hot flashes, night sweats, mood changes or unstable emotional states, difficulty sleeping, and dryness in the vagina. When starting HRT, a woman is supposed to know what will happen when she starts treatment for the first time. HRT is more individualized than standardized because it is approached through the biopsychosocial lens of the patient’s medical history, age, hormone levels, lifestyle choices, and risk factors.
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How Long Does It Take for HRT to Work?
HRT will take 3 months to reduce symptoms of menopause once you commence treatment. However, most will ease at some point during this period, while some less noticeable improvements will only be seen on reflection and with the benefit of viewing one’s circumstances in hindsight.
If you have not felt any improvement after 3 months, then a treatment reassessment should be done. Your doctor may have advised you on how to modify the doses. For example, you may have started by taking one pump of Oestrogel a day, but your doctor might recommend increasing the dose to two pumps. Your doctor may also suggest alternative methods for taking HRT.
You may not need to wait 3 months to adjust your dose if your quality of life is being affected by symptoms. If you can, I suggest waiting for four to six weeks so that the changes are noticeable after HRT settles down. Consider booking an appointment with your doctor at this point to discuss your symptoms.
What Can I Expect in Terms of Side Effects?
When starting HRT, the first thing you will notice is a feeling of discombobulation, an impression of being out of sorts, or just feeling nauseated or sick, with possible breast tenderness or some bloating. Headaches may make this feeling even worse. Below is a complete list of harms associated with HRT products.
Bloating from HRT or estrogen is bothersome clinically; however, in most cases will resolve gradually. Visit your GP if the bloating persists or causes pain, if you urinate more frequently, notice changes in bowel movements, or experience unscheduled bleeding along with the bloating.
Normally, you’ll expect to find side effects disappearing within the first three months of treatment, but sometimes they last longer than that. If they remain and aren’t improving within that time, kindly schedule a repeat appointment with your physician. You might need an alternative HRT with a different dosage.
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Progestogens in HRT
Women may experience increased side effects with progestogens in HRT. These bloating headaches or irritability might just be premenstrual symptoms in some women. Some of these women will experience side effects with the progestogens, and some will not. You may feel better using an HRT that includes Utrogestan, a micronized progesterone that many people tolerate well with all forms of estrogen.
Side Effects of Utrogestan
On its own, Utrogestan may make you feel slightly low at the beginning, with a thick cloud hanging over your head. Usually, this will get better within about three months or about three cycles of the sequential use of Utrogestan. Namely, if it were taken in the evening, you might wake up feeling a little bit foggy the next morning. Usually, this side effect improves after a period of a few weeks.
If you feel foggy in the morning, take Utrogestan in the evening. Talk to your doctor if you are feeling ill or do not feel your side effects have settled down. If you are unable to tolerate Utrogestan, then a change in the way you take it may be required.
Unscheduled Bleeding
It is relatively common to experience some unscheduled bleeding after starting HRT, even if you have not bled for years. The bleeding would usually stop within 3 to 6 months if it had no interference with your dosing. If you do not comply with the HRT therapy, bleeding is more likely.
Bleeding on a No-Bleed Combined Continuous HRT
You can expect bleeding during the first three to six months after starting continuous no-bleed HRT. The bleeding may appear as spotting or a smear when wiping after urination. It may be either light or heavy, similar to a period. It is possible to have old, dark blood or bright, shiny blood. If the bleeding is heavy, associated with pain, caused by sexual intercourse, or does not resolve after three months, consult your doctor.
Bleeding During a Type of HRT with Sequential Bleeding
When on an HRT that is sequential and expects a monthly cycle, expect the unexpected. It is possible that bleeding could be irregular for the first three months, but may settle into a new rhythm thereafter. The bleeding may be heavier or lighter than normal, shorter or longer than normal. It may start with dark, sludgy blood, or maybe end with it.
Try to contact your doctor about a confirmed follow-up beyond 6 months if the bleeding stays heavy or painful, happens between scheduled periods, or starts after sexual activity.
Summing Up!
Usually, you can wait for the side effects to get better after starting HRT. If you are on a sequential bleed regime, keep a journal recording every side effect that occurs. It will let you know if the side effects only occur during the days you are on the progestogen.
If you are in doubt regarding follow-up, you may seek the doctor’s opinion. Alternatively, you can also check out our FAQ page here at Dvida Med Spa.
If, three months later, the side effects remain intolerable, it’s time to reconsider your HRT. This would be an appropriate time to book another follow-up for the doctor to discuss your feelings, expectations, and best next steps.
Here at Dvida Medical Spa in Raleigh and Wake Forest, NC, we offer the solution to regaining your strength and authority regardless of age.
