Book a consultation

What to expect when you start HRT

It’s useful to know what to expect when you start HRT, so you’re prepared to give the medication a chance to work in your body.

There’s an easy way of remembering common side effects for those first few weeks when you start, and that’s to learn the 4 Bs:


This could be brown discharge, light spotting or sometimes more like a heavy period and may come and go or last for a few weeks. Any bleeding usually settles after a few weeks. Contact your healthcare professional if it has been more than 3 months and you’re still bleeding.


Your breasts may become tender, be quite painful, and be more sensitive around the nipples. This can last for several weeks but usually settles with time. Wearing a good-fitting and supportive bra can usually help.


You may feel bloated and uncomfortable like having trapped wind. This can be due to the progesterone and usually settles with time.

The Blues

You might feel lower, or more emotional in the first few weeks if you’re taking progesterone such as Utrogestan.

Give it time

All these symptoms usually settle down within 3 months of taking your HRT, so if it has only been a week or two, try and stick with it and wait and see. If you’re still troubled by side effects after 3 months, discuss it with your healthcare professional.

Try something else

There are many different types and ways to take HRT. If you don’t feel your HRT has bought you the benefits you were hoping for after 3 months, discuss whether you can change the dose or the way you take the medication with your doctor or nurse.

Your healthcare professional may have given you a range within which to manage the dose yourself, for example stating ‘1-3 pumps’ of estrogen gel. You can alter the dose yourself within the range prescribed for you, just remember your body can take a few weeks to respond to any changes you make.

Warning about packaging misinformation

The information inserts with your HRT are out of date and not accurate. The MHRA (Medicines and Healthcare products Regulatory Agency) are working to change and update them in line with the evidence that shows that HRT is safe and effective.

What to expect when you start HRT
Dr Louise Newson

Written by
Dr Louise Newson

Dr Louise Newson is a GP and pioneering Menopause Specialist who is passionate about increasing awareness and knowledge of the perimenopause and menopause, and campaigns for better menopause care for all people.

Looking for Menopause Doctor? You’re in the right place!

  1. We’ve moved to a bigger home at balance for Dr Louise Newson to host all her content.

You can browse all our evidence-based and unbiased information in the Menopause Library.