3 signs your HRT isn’t working for you

3 signs your HRT isn’t working for you

Navigating menopause can be a minefield. Many women are determined to go the ‘natural’ route but end up with such life-limiting symptoms they find themselves in front of their GP being given hormone replacement therapy (HRT).

For some, HRT is a life saver. For others, however, it is just a continuation of the misery that led them to taking it in the first place. Here we discuss what is happening in the body during menopause and the three main signs that your HRT isn’t working for you.

During menopause, peri to post menopause, massive changes occur in the levels of our three hormones: oestrogen, progesterone and testosterone.

  • Oestrogen is an exciter hormone. It gives us energy and promotes healthy weight, boosts libido, ensures ovulation, boosts mood and protects our heart.
  • Progesterone is a calming hormone. It lines the uterus to hold a pregnancy, it is important in fertility, it regulates our cycle and it helps with mood.
  • Testosterone is also an exciter hormone. It is responsible for libido, energy, and also lovely thick hair!

The first real symptoms start in perimenopause when progesterone drops, and oestrogen levels are ‘higher’ than progesterone. This is called ‘oestrogen dominance’.

These symptoms can be difficult to spot and include anything from disturbed sleep, lack of libido, lack of energy, weight gain and mood swings to name but a few.

As perimenopause progresses, other symptoms start including itchy scalp, confusion, memory loss, lack of confidence, increased food intolerances, headaches and period irregularities, followed by some of the more physiological symptoms such as insomnia, hot flushes, night sweats and vaginal dryness.

It is usually when these symptoms make life difficult that women end up seeking help from the GP, and are prescribed one of the current HRT offerings such as the Mirena coil, the oestrogen patch or gel or a combination pill.

What are the signs your HRT isn’t working for you?

1. You are tired ALL the time. 

And not just tired: you are exhausted and feel like you are dragging yourself around.

This is often because the oestrogen used in HRT is the most active form of oestrogen and it’s also a pretty big dose of it. This oestrogen is very stimulating. If we have already been dealing with quite a lot of stress, our nervous system can struggle to deal with this much stimulation.

This is compounded with the fact that during menopause our liver begins to struggle to remove the unused hormones from our body and we start to get a build-up. With the high doses of this very active oestrogen that can happen quickly, and our body can become overwhelmed.

This toxicity is also seen by the body as a ‘stressor’. In response to any stress our body produces the hormone ‘cortisol’. Cortisol is designed to get us out of danger by switching on our ‘fight-or-flight’ mode but being in this mode 24/7 leads us to become utterly exhausted.

2. You are experiencing problems with your sleep 

For some women this is a huge issue. It usually has three causes.

The first cause is that we are in that ‘fight-or-flight’ mode mentioned above which hugely affects our sleep.

The second cause is due to imbalanced blood sugars, which in turn creates more stress hormone to be produced.

The third cause is really important to know because it’s actually the cause of MANY issues with synthetic HRT. Not only do we have the oestrogen dominance issue mentioned above, we are also having to deal with ‘pretend’ progesterone in most HRT at a time when we need real progesterone. But why is this a problem?

Pretend progesterone

The progesterone in most HRT isn’t really progesterone. It’s a synthetic called ‘progestin’ (also called drospirenone, levonorgestrel, or medroxyprogesterone).

Chemically these are totally different. Levonorgestrel is actually more similar to testosterone than progesterone, which means we end up overstimulated and ‘tired but wired’.

This pretend progesterone also affects the body differently.


  • beneficial for cardiovascular health
  • stimulates hair growth
  • calms mood and promotes sleep
  • prevents breast cancer.


  • increases the risk of fatal blood clots
  • can cause hair loss (due to its similarity to testosterone)
  • may cause anxiety and depression
  • increases the risk of breast cancer.

There is, however, a natural (body-identical) progesterone available from your GP.

3. You are struggling with your weight despite doing everything ‘right’

The problem with most mainstream approaches to diet is that ‘calories in/calories out’ is the answer; this is really flawed science.

Today’s diets are very carb heavy, leading to unstable blood sugars. Even if your diet is ideal, most of us are navigating stressful lives so we are overproducing the stress hormone cortisol. Combined with overstimulation from the wrong HRT, this leads to major hormone imbalances which can lead to weight gain.

So, what can I do?

    1. Work with an experienced practitioner
    2. Speak to your GP
    3. Find a specialist Doctor
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