You're on HRT. You've been on it for months. Maybe years. And you still can't sleep, still can't think, still cry at adverts, still feel like a stranger in your own body.
And every time you say so, you get the same sentence back: "But you're on HRT."
Being on HRT and absorbing HRT are two completely different things. Nobody tells you that.
What happened to me
I had everything removed. Sent home with patches and a leaflet. Job done, as far as anyone was concerned.
For three years I got worse. Foggy, furious, exhausted, aching. And because the patches were physically on my skin, every conversation ended the same way — she's on HRT, so this must be something else. Stress. Age. Me.
It wasn't something else. I wasn't absorbing it. Three years of my life, gone to a box nobody thought to open.
The test almost nobody does
There's a blood test called an oestradiol level. It doesn't diagnose menopause — that's a different job, and if you're over 45 you shouldn't need a blood test to be diagnosed at all.
What an oestradiol level does is answer one question: is the oestrogen you're putting on actually getting into your blood?
That's the question that had never been asked about me.
Ask for it like this
"I'm on [patch/gel/spray] and I'm still symptomatic. Can we check my oestradiol level to see whether I'm absorbing it?"
Signs your HRT isn't doing what it should
- Symptoms come roaring back in the day or two before you change your patch
- You went up a dose and felt nothing at all — no better, no worse
- The flushes eased but the fog, rage and exhaustion never shifted
- You feel better for a fortnight after starting, then slide back
- You're on the starting dose and have been for a year, because nobody reviewed it
None of these mean HRT doesn't work for you. They usually mean the dose, the type or the absorption is wrong — and that's fixable.
Why patches sometimes don't absorb
Skin isn't the same on everybody. Some women absorb poorly through patches and do far better on a gel or a spray, or the other way round. Where you put it matters. Whether it's sticking properly matters. Heat and moisturisers matter.
And starting doses are exactly that — a starting point. Surgical menopause in particular often needs more than the standard opening dose, because you've lost the lot at once rather than tapering off over years.
The thing I most want you to hear
If you're on HRT and still feel awful, you are not a difficult patient and you're not imagining it.
You're on a treatment nobody has checked. That's a completely different problem, and it has a completely different answer.
How Do I Get the Right Help?
Exactly what to ask for, the words to use, and what to do when you're told no. Written by someone who lost three years to this. £19.
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This article is general information and lived experience, not medical advice, diagnosis or a treatment plan. Always speak to your GP or a menopause specialist about your symptoms and treatment. If you have any bleeding after menopause, or you're worried about your health, please see your GP.