HRT symptoms returning after a year on meds: can they wear off? Been denied a review.

[RumPidgeon]

Not sure where I stand with this so came to seek advice:

menopausal, on HRT (1mg Elleste tablets), been on them for a year. For the last 4 weeks I have been experiencing the very same problems that got me to take the medication in the first place: hot flushes, poor sleep quality and very little sleep, then permanently fatigued all day. I feel sad, not depressed, just meh.

I contacted the GP to ask for a review and the nurse said I couldn’t get a change of HRT meds and has prescribed some sleeping tablets (but only 7 “because they’re highly addictive” 😳

What can I do in this situation other than going private?
I’m convinced the effectiveness of HRT meds is wearing off but the nurse said this cannot happen. I have no idea so please share your views with me. Thank you!

God this gives me the rage. So you can’t get a review, like, ever? That’s nuts.

I’m on the gel and progesterone tablets. I started off a few years ago with one pump. I’m now on about 3. I used to take the 100mg progesterone tabs, now I’m on double.

I”m sorry I don’t have more advice apart from trying again with your GP or going private.

You do need regular reviews with HRT. They only prescribe up to six months at a time usually and need to monitor your blood pressure as well. Insist on it

You need regular reviews and your HRT needs tweaking until you find a combination and level that suits you.

Of course you can get a change of meds or dose of it's not working. That's ridiculous. Ask again for a review with an actual GP, and if they won't give one complain to the practice manager.

You need a proper review and if your GP won’t agree to this you need to make a formal complaint to the practice manager.

It's just pathetic, isn't it? Having to beg and plead for the most basic care 😡 it's absolutely standard and normal to need your HRT dose increased after a period of time. You don't need sleeping tablets, you need more oestrogen. Agree with others - insist on a GP appointment and complain to the practice manager if you get any pushback. On the other hand, if private is an option for you, Newson Health are excellent and you can book an online appointment within a few days

I'm also wondering why you're on tablets rather than gel, patch or spray. Oestrogen is much safer when taken transdermally rather than orally

Yes I am wondering this too re the tablets. Guidelines state that everyone should be started on gel or patches now because they don’t carry any of the risks that the oestrogen tablets do.

I had to have a review after a year and I remember he was surprised I was still on the initial dose of one pump of gel as he said most people have had to increase it to 2 pumps in the first year. So yes, I think your body does get used to it a bit maybe? I would insist on seeing a doctor and swerving the nurse.

It's not so much that HRT wears off as that your own background hormone levels continue dropping and it's not unusual that this means you need more of a top up. Is there a reason you're on oral estrogen?Transdermal (patch etc) is normally the first option as it has lower risk of blood clots. I would definitely go back and ask for a review; check the NICE guidelines as this should be done as standard.

Demand a review, state Nice guidelines and go to Practice manager if that fails
JFC its like the 1950s, prescribing sleeping tablets

Thank you for all the replies - I am most grateful. I thought I was going mad. This nurse kept insisting that I should try antidepressants or sleeping tablets and maybe things will sort themselves out.

I tried the gel first but I often teach in water and the gel and patches were deemed incompatible so I took the pill.

I wake up with a racing heart, I barely sleep and feel exhausted all day. The sadness and feeling of emptiness has come back, I feel close to tears most days, can’t find any joy, I am dead from the neck down. I just don’t feel like myself.

She kept insisting that none of these issues could be resolved by looking at my HRT. 😢

Why is this still so hard on 2026?? What do I say on AskMyGP?

Thank you! Only just catching up as I’ve been working.
Very 1950s indeed. She wasn’t rude - just kept cutting me off and saying that once I catch up on sleep the world will look different again.

'Thank you for all the replies - I am most grateful. I thought I was going mad. This nurse kept insisting that I should try antidepressants or sleeping tablets and maybe things will sort themselves out.'

Appalling. That nurse is giving massively out of date advice and needs to read the NICE guidelines, which are not difficult to find or understand!

Re spending time in water, you could apply the oestrogen gel at night?

I’ve had this too where the HRT which worked beautifully once didn’t seem as effective. For me it results in cystic acne so I can’t even ‘carry on’. If you have the gel for estrogen you could experiment with dosage. I tried 1/2 pump more until I felt it was effective again. Then I simply asked my GP to adjust the prescription to reflect the higher dose. Plus see if I need more progesterone. I think this is the biggest benefit of the gel.

you say you work in water - could you do the gel just before bed? That’s what I do. Also helps a bit with the sleep.

but I also have magnesium tablets and magnesium cream on my feet which keep me knocked out. I hate the 3am racing heart wake ups and night flushes.

Do try the gel, it might make all the difference.

Of course you can have a review - I've had one in person after 6 months and an online one after a year, which asked me if I wanted to change anything, whether I was happy with the meds, did I want to discuss further etc, did I have any change in symptoms. I didn't get to it right away because I couldn't find the BP monitor at home and I was badgered to complete it.

Firstly just adding my outrage! I've been on hrt about 18 months and in that time had 1 in person and 3 telephone appointments - both dose reviews and trouble shooting / discussing options.

Second have you tried the patches in water? The only time I've had issues with patches coming off has been the periods of extreme heatwaves where it was well over 30 degrees inside and outside. But I have worn them in the sea and swimming pools all summer no problem. I clean the skin first with alcohol and warm the patch between my hands first then it seems to stick well.

Good luck!!

That nurse needs a good talking to!

I remember the GPs palming me off on the nurses sometimes, and a nurse who insisted vaginal oestrogen wouldn't help my bladder. Oh and a GP insisting on blood test for hormones. Etc etc. You just have to be firm and consistent in your attempts.

Just book a GP appt

Of course you can - I've changed mine/increased dose three times since I started - over the phone! No issues whatsoever.

Sleeping tablets by the way is normal - because they really are addictive and should only be a short term solution.

FYI for info- I use Evorel patches and swim and shower everyday - i have never had a patch fall off - i have to prise them off!

No @Lottapianos I was told to put it on in the morning. I have no idea why I am on what I am on tbh.

Same. Sometimes they are a right bugger to remove!

Just to follow up I find my patches fall off in hot tubs/water parks but not "just" swimming. You do have to have them under your swimsuit though, so I don't have them on my thigh, but on my bum.

I’ve also read somewhere that HRT meds can lower testosterone and I can’t help wondering if that’s also what happened to me.

I requested a GP appointment and was detailed in my request but got a nurse calling me back. I’ll probably have to go in and speak to a receptionist (they’re usually fine face to face) and plead my case.

Will ask about Evorel. Thank you for all the good tips and replies. Very helpful.

It really doesn't matter what time of day, as long as it's consistent.