Select relevant parameters below for evidence-based, person-centred HRT advice

Follow Up

After three months, symptoms are usually either fully or partially resolved. In some circumstances, there is no symptom improvement.

Symptoms fully resolved
Continue with current HRT regime. Review annually.

Symptoms partially resolved
Continue with current HRT plan. It is recommended to review your HRT plan annually. Possible problems that women on HRT have reported in terms of taking their medications:

  • Patches peeling off: Remember to apply the patch to clean, dry, nonhair bearing skin below the waist; the lower abdomen, thigh or buttock are suitable. If problems persist, it might be helpful to change to a different patch, size of patch, or change to gel or spray. Use of tape over a patch is not advised.

  • Allergic/irritant reaction to patch. This is usually caused by the adhesive. Consider trying a different brand of patch or change to gel or spray.

  • Gel taking too long to absorb. Advise that gel should be applied to clean dry skin as a thin layer to a large area involving the upper outer arm and shoulder or the mid-inner thigh. Allow to dry for 5 minutes before dressing. If problems persist, consider changing to a spray or patch.

  • Spray too difficult to use. Consider a change to a patch or gel.

If there is no issue in terms of the use of the medications, it might help to increase the oestrogen dose and review in clinic again in 3 months.

Doses of HRT should be balanced with any unwanted symptoms and increased until vasomotor symptoms, for example hot flushes, are absent (not reduced).

No symptom improvement

  • Exclude problems with patches/gel/spray as above.

  • Check estradiol levels to ensure adequate transdermal absorption (blood taken just prior to application of gel or Day 4 of a patch). Estradiol >250pmol/L reflects transdermal absorption. Dosage should be adjusted upwards to achieve symptom control.

  • Consider continued use of HRT for its other health benefits (bone and CVS health).

  • Consider alternative diagnosis for symptoms.

Treat as per Premature Ovarian Insufficiency (POI) Guideline.
Consider referral if appropriate.


Consider blood tests to exclude other causes

  • FSH levels two occasions >4 weeks apart (> 25 IU/l on two occasions).
    Normal levels do not exclude POI and should not delay treatment.

  • FBC, TFT, coeliac screen, B12, folate, ferritin, HbA1c. Consider 21OHAb (adrenocorticol antibodies)

  • Estradiol levels

  • Total testosterone and SHBG to calculate FAI

  • Prolactin

Most of the available clinical evidence for HRT comes from studies of women starting HRT around the age of natural menopause, but women who undergo early menopause or who have been diagnosed with premature ovarian insufficiency benefit greatly from HRT as well.

Do not commence hormonal treatment and consider referral to specialist services.

More information

Information is sourced from NICE, RCOG, MHRA, and other published literature. No warrant is given that the module is free of errors, complete or up-to-date, and no information herein should be considered a substitution for medical expertise, experience and judgement. For feedback, please use the link above.