Signs HRT Is Not Working: 8 Common Symptoms

Last updated 07.05.2024 | by Sabrina Johnson | 8 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.

Perimenopause and menopause stages surprise us (haha!) with a lot of unpleasant symptoms.

From hot flashes and night sweats to mood swings and vaginal dryness, there are a plethora of menopausal symptoms women go through in these years.

That’s why many women turn to Hormone Replacement Therapy (HRT) for relief [1].

It’s a medication used to replace female hormones your body stops producing during menopause. It is mainly used to relieve menopausal symptoms.

But what if, after months of taking HRT, those hot flashes and other symptoms are still hanging around?

HRT is a powerful tool, but it doesn’t always work like magic. In fact, studies show that up to 20% of women might not experience the full benefits of hormone replacement therapy.

Nothing to worry about, ladies! There are ways to identify if your HRT is not working or not. This article will help you! 

I will discuss common menopause symptoms, signs that HRT may not be working, factors affecting the therapy’s effectiveness, and more.

So, if your HRT is not working effectively or you are considering taking it, this guide has come to your rescue. Stay with me to know more!

Understanding Menopause Symptoms

Menopause is a natural transition that over half of the world’s population will experience.

It’s a process of hormonal shifts that can affect your body in many ways. Your hormones help to keep everything in perfect harmony. During menopause, they start to fluctuate wildly, resulting in a plethora of symptoms and health conditions.

The main reason behind these changes is a decline in estrogen production by the ovaries. Estrogen does a whole lot for our bodies, from keeping our vaginal tissues healthy to regulating our sleep cycles and mood. So, when its levels drop, it’s an indication of upcoming chaos in your body.

Let’s know about some common menopause symptoms:

Hot flashes and Night Sweats

According to research, up to 80% of women experience hot flashes and night sweats (vasomotor symptoms) during menopause.

They can feel like a sudden wave of heat radiating through your body, often accompanied by sweating and chills.

Vaginal dryness and discomfort

Estrogen plays a key role in keeping our vaginal tissues lubricated and healthy. With its decline, dryness, itching, and pain during sex can become a reality for some women.

Mild or severe vaginal dryness is experienced by almost all menopausal women [2].

Sleep disturbances

Ever feel like you’re constantly sleepy but never feel fully rested?

Yep, that can be menopause, too. Estrogen helps regulate sleep cycles, so its decline can lead to insomnia, restless sleep, and waking up frequently during the night.

Mood swings and irritability

Feeling like you could snap at any moment? Fluctuations in estrogen can also impact brain chemicals that affect mood, leading to irritability, anxiety, and even depression. 

Up to 20% of women experience depression during menopause [3].

Decreased libido

Estrogen plays a role in sexual desire, so it’s no surprise that some women experience a decrease in libido during menopause.

I remember experiencing hot flashes that would leave me drenched in sweat during work meetings. But the good news is, there are ways to manage these symptoms, and that’s where HRT comes in! However, its effectiveness differs and depends on various factors.

Signs That HRT May Not Be Working Effectively

So, you’ve started HRT, hoping that your menopausal symptoms will either vanish or reduce to some extent. But what if, after a few months, it feels like those symptoms are still lingering?

Don’t panic! Finding the right HRT dose and type can be a bit of a trial-and-error process. It takes time and patience.

This is how you can know that your HRT might not be working and requires some tweaking:

Menopause Symptoms Are Back

Remember those hot flashes that used to make you feel like a human radiator? Yeah, those. If they’ve returned in full force despite HRT, it could be a sign your current dosage isn’t strong enough. 

Don’t hesitate to talk to your doctor. They can adjust the dose or explore alternative HRT options.

But hot flashes aren’t the only symptom to keep an eye on. If all other symptoms of menopause, such as vaginal dryness, painful intercourse, sleep disturbance, mood swings, night sweats, headaches, etc., haven’t improved with HRT, it could be a sign it’s not working as effectively as it should.

I remember feeling so frustrated when my night sweats returned after a few months on HRT. I was tossing and turning again, feeling like I hadn’t slept a wink. That’s when I realized it was time to have an honest conversation with my doctor. We adjusted the dosage slightly, and thankfully, those sweaty nights became a distant memory.

Decreased in Libido

HRT can do wonders for women experiencing a decrease in libido due to menopause. But what if that spark hasn’t quite reignited? While some initial side effects like vaginal discharge or breast tenderness are common when starting HRT, they should subside after a few weeks. 

If these persist and are affecting your sex life, talk to your doctor. They can adjust the dose or explore alternative delivery methods (like patches instead of pills) that might be more comfortable. In rare cases, a specific type of HRT might not be ideal for your individual needs.

Unexpected Side Effects

It’s normal to experience some mild side effects when starting HRT, like headaches, nausea, or breast tenderness. But if these side effects are persistent, severe, or causing you significant distress, that’s a red flag. 

Remember, HRT should be improving your quality of life, not making it worse.

There are different types and delivery methods of HRT available. Your doctor can help you find the option that offers the most relief with the fewest side effects.

Feeling Off

If you’re constantly feeling off, it could also be a sign that your HRT isn’t working effectively. Maybe you just don’t quite feel like yourself. For instance, your mood is off, you’re experiencing unexplained fatigue, or your brain fog hasn’t lifted. These could all be signs that your current HRT needs some tweaking.

Unexpected Weight Gain

HRT, particularly some types of progesterone, can lead to a slight increase in water retention. However, significant, unexplained weight gain can be a sign that your HRT needs adjusting. 

This could be due to factors like increased appetite or a change in metabolism. Discussing any unexpected weight changes with your doctor is crucial to ensure your overall health and well-being.

Increased Cognitive Issues

Brain fog, forgetfulness, and difficulty concentrating are common complaints during menopause. While HRT can improve cognitive function for some women, in rare cases, certain types of HRT might exacerbate these issues. 

If you notice a worsening of memory problems after starting HRT, discuss it with your doctor. They can explore alternative options or adjust the dosage to minimize cognitive side effects.

Mood Swings Persist

HRT can significantly improve mood swings and irritability caused by hormonal fluctuations during menopause. However, if you’re still experiencing emotional volatility, it could indicate that your current HRT isn’t addressing the underlying imbalance. 

Sharing specific details about your mood swings with your doctor will help them refine your HRT plan for optimal emotional well-being.

Lack of Improvement in Bone Density

One of the significant benefits of HRT is its ability to help maintain bone density.  A healthy bone density reduces the risk of osteoporosis. 

If bone density does not improve after a reasonable amount of time on HRT, your doctor might explore further options. 

They may recommend additional supplements or adjustments to your HRT treatment to ensure it’s effectively protecting your bone health.

Factors Affecting HRT Effectiveness

While HRT can be a good option for managing menopause symptoms, several factors can influence how effectively HRT works for you.

Age and Health

Age, overall health, and even your individual response to hormones all play a role. For example, women who start HRT closer to the onset of menopause tend to experience greater benefits than those who start many years later [4].

My friend started HRT in her early 50s and saw a dramatic improvement in her hot flashes within a few weeks. However, it took me a bit longer to find the right dosage and delivery method that worked best for me.


Certain medications can interact with HRT, potentially reducing its effectiveness. Be sure to share a complete list of medications with your doctor when discussing HRT options.

Lifestyle Matters

Maintaining a healthy lifestyle can significantly enhance the benefits of HRT. Eating a balanced diet, getting regular exercise, and managing stress can all contribute to a more successful HRT experience.


How long does it take for HRT to work?

It can take several weeks to a few months to see the full effects of HRT. Be patient and communicate with your doctor if you don’t feel improvement after a reasonable timeframe.

Is there an age limit for starting HRT?

Age is just one factor. Generally, women who start HRT closer to menopause tend to experience greater benefits. Talk to your doctor to see if HRT is right for you at any stage.


Menopause is a natural transition, but that doesn’t mean you have to suffer through its symptoms. HRT can help you feel like yourself again. By understanding the signs that HRT might not be working effectively and communicating with your doctor, you can find the perfect solution to navigate menopause with confidence.


  • Sabrina Johnson

    Meet Sabrina Johnson, a compassionate author and a seasoned expert in Obstetrics and Gynecology. She is a driving force behind Simply Menopause, where her extensive medical knowledge and empathetic nature come together to empower women in their menopausal journey. Sabrina offers culturally sensitive guidance and support through her approachable writing, making her a trusted friend on the path to menopause wellness.

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