The commonest side-effects are:
• feelings of nausea
• breast tenderness
• feeling bloated before a period
• slight weight-gain
• leg cramps
• feelings of pre-menstrual tension and other complaints caused by taking progestogen.
Weight gain. This is usually short-lived. A small minority gain five pounds or more, but even those who put on weight at the start of HRT usually end up only about one pound heavier than when they started. Allow yourself two or three months for your body to adjust before worrying about any extra weight – you’ll probably lose it anyway, although the progestogen stage of the cycle may cause a weight gain of two or three pounds, like it did before the menopause, and this is lost again when the course of progestogen finishes. As we get older, we all start to burn calories more slowly than we did in our youth, so if you are eating the same amount of food as you did several years ago you will end up putting on weight unless you can take more exercise to burn it up. A thickening of the waist is not quite the same as weight gain, and is due to getting older, not to HRT. Before the menopause, a woman produces mainly female hormones, but also a small amount of male hormones too; the oestrogen causes the typical female shape of large breasts and hips and a small waist. But when oestrogen falls, the male hormones start to predominate, so the older woman tends to have a thicker waist, smaller breasts and a deeper voice.
Many of those who gain more weight are smokers who have been advised to give up smoking while they are on HRT – so they eat instead! Others lose weight on HRT. These are often women who were distressed and unhappy because of menopausal symptoms and who used to eat to ‘comfort’ themselves. Once on HRT they feel happier in themselves, so don’t feel the need to eat so much.