What are the side effects of HRT?

Most HRT side effects are mild and settle within a few months, things like breast tenderness, bloating, mild nausea, headaches or spotting as your body adjusts.

When you start HRT, temporary side effects are common as your system settles:

• Tender breasts, bloating or fluid retention
• Mild nausea, headaches or leg cramps
• Mood changes
• Irregular bleeding or spotting in the first few months

These usually ease, and adjusting the type, dose or delivery method, for example switching from tablets to a patch or gel, resolves most persistent ones. Separately, there are small risks to weigh, and the specifics depend on the type of HRT, your age and your health history, which is exactly why it is an individual decision rather than a blanket yes or no. It is worth knowing that body-identical, transdermal options such as patches and gels carry a more favourable profile than older oral types for some risks, which your doctor can factor in; whether bioidentical hormones are safe is a common and worthwhile question here.

Keeping side effects in proportion matters, because fear of them stops many women trying a treatment that could help. The common early niggles are adjustment effects that fade, not the serious risks that headlines tend to focus on, and weighing both sides honestly is the point of the benefits of HRT read alongside this. The two answers are meant to be read together.

One symptom deserves a clear rule rather than reassurance: bleeding. Some irregular spotting in the first months is expected, but new, heavy or persistent bleeding, especially after a settled spell or after menopause, should always be reported and checked, because it occasionally signals something that needs investigating rather than a simple HRT adjustment.

What to do: do not abandon HRT at the first niggle. Give it a few months and tell your GP about anything that does not settle, since the regimen can usually be tweaked. Report any heavy or unexpected bleeding, severe headaches or leg swelling promptly. The decision to start, continue or stop should always be made with your doctor, weighing benefits against your personal risks, and timing is part of that, as covered in when to start HRT.