Considering Hormone Replacement Therapy to Help With Perimenopause & Menopause Symptoms? Doctors Explain Common HRT Side Effects and Potential Remedies

Hormone replacement therapy (HRT) is a relatively complex topic. There are various treatment methods, proven benefits, potential side effects and quite a few personal considerations to take when deciding whether it’s a plausible option for you personally. Hormone replacement therapy side effects, in particular, can be particularly daunting when you’re not sure what to expect or how to handle them, but doctors say you can find easy relief for most. 

What is HRT? 

HRT is a type of hormone therapy medication used to treat menopausal symptoms brought on by changes in hormone levels such as hot flashes, night sweats and many other symptoms that can come with perimenopause and menopause, explains Mindy Goldman, MD, Chief Clinical Officer for Midi Health and clinical professor emeritus of obstetrics at UC San Francisco.  

“It works by releasing estrogen into the bloodstream or vaginal tissue, and is available in many forms, including pills, patches, vaginal rings, and topical creams and gels,” she says. “To protect the uterus (in patients who have one), doctors add progesterone or progestin to estrogen, which reduces any risk of uterine cancer.”

Technically, Dr. Goldman says, the terminology of HRT is misleading, because  the hormones your body stops producing during the natural menopause transition are not being fully replaced. In fact, the medications add back just a small percentage of the hormones your body makes during your fertile years. Still, she says, the benefits are numerous. 

“HRT is the most effective treatment for relieving menopausal hot flashes, night sweats, vaginal dryness and recurrent urinary tract infections, according to the most recent guidelines from The North American Menopause Society (NAMS),” notes Dr. Goldman. “Clinically, hormone replacement therapy has also been shown to be highly effective in relieving symptoms of insomnia, mood changes and brain fog.” 

Additionally, she points to more recent research that shows that women who start hormone replacement therapy within 10 years of their last period experience significant relief from symptoms of menopause and may have a lower risk of heart disease and bone loss.

HRT risks and benefits

More severe but rare effects might include a very slight increased risk of breast cancer, uterine cancer and cardiovascular events such as risk of blood clot and stroke, notes Alyssa Dweck, MD FACOG, Chief Medical Officer of Bonafide Health. This is why HRT is best prescribed while taking one’s personal medical history and risk profile into account to minimize these potential side effects and adverse events, she says. However, many HRT side effects resolve on their own over time and can be mitigated from home. 

1. Breast tenderness

“This is more often associated with the estrogen component of HRT and often just happens when women first start hormones,” explains Dr. Goldman. “As your body adjusts, tenderness tends to go away.” 

Potential treatments: A well-fitting or tighter bra may help, says. Dr. Goldman, as well as using anti-inflammatory medication like ibuprofen. There are also some dietary and lifestyle changes that may help, she adds. For example, some women find that certain foods such as those containing high levels of salt or chocolate may aggravate breast tenderness, so limiting consumption may ease soreness. 

“For breast tenderness, evening primrose oil or flaxseed oil supplements can help,” offers Mark Anton, MD, FACS, Founder of OC Breast Surgery. “They provide essential fatty acids that reduce inflammation and relieve soreness.”

You can also try a gentle breast massage with warm olive oil infused with lavender essential oil, Dr. Anton says. The heat and massage increase circulation, while lavender acts as an anti-inflammatory.

2. Bleeding 

Light and unexpected irregular vaginal bleeding is common when women first start HRT, Dr. Goldman explains. It typically resolves after a few weeks to a few months, she says,  but if it is still going on after four to six months or if the bleeding is heavy, you should see your healthcare provider. 

Potential treatments: “To reduce spotting, increase your intake of vitamin C and bioflavonoids, found in citrus fruits,” suggests Dr. Anton. “They help strengthen blood vessel walls. You can also use progesterone cream, which helps regulate the uterine lining. Apply it directly to your skin.”

3. Headaches 

Headaches can sometimes occur in HRT patients, but should only be mild, Dr. Goldman says. 

Potential treatments: If needed, tylenol or ibuprofen can be safely used for headaches, offers Dr. Goldman. 

Dr. Anton recommends feverfew, ginger and peppermint essential oils. Place a few drops on your temples, forehead and back of neck, he says. Peppermint oil in particular acts as a natural pain reliever and can reduce inflammation in the tissues surrounding the brain that may lead to tension headaches.

4. Nausea 

Nausea is also a possibility, but should be mild if it does happen and go away on its own within a short period, says Dr. Goldman. 

Potential treatments: Eating or drinking ginger can help ease nausea. Ginger has proven effective in easing nausea with little to no side effects as long as it is ingested in reasonable amounts. You can try consuming it as ginger tea, ginger ale, chewing ginger candy, taking ginger capsules, supplements and even consuming ginger in raw form.

Keep reading for more on managing menopause symptoms:

How to Get Better Sleep During Menopause

Tired of Menopause Hair Loss? MDs’ 4 Home Remedies to Spark New Growth

The Secret Weapon for Menopause? Your Gut Health Might Surprise You — And Help You Feel Your Best

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.