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Dealing with side effects


  • There is no evidence that HRT causes weight gain
  • Side effects can be categorised into Estrogenic and Progestogenic
Estrogenic side effects
  • Breast tenderness/enlargement: Reduce dose of estrogen or change route. OTC Purchase: Evening Primrose oil, starflower oil.
  • Bloating Nausea: Take with food or change route
  • Headache: Change route
  • Leg cramps: Change route
Progestogenic side effects
  • There are 2 groups of progestogens: testosterone derived and progesterone derived
  • Women who have troublesome side effects from a progesterone in the testosterone group may find these side effects improve if they try a progesterone from the progesterone group and vice versa
  • Testosterone derived: Norethisterone, Norgestrel, Levonorgestrel
  • Progesterone derived: Medroxyprogesterone, Dydrogesterone, Drospirenone
  • Known side effects are PMS type symptoms, Breast tenderness, Lower abdominal pain, Backache, Depressed mood, Acne/greasy skin & Headaches
  • Give progesterone by LNG-IUS (Mirena coil) to avoid side effects
  • If postmenopausal, change to continuous combined HRT or tibolone as this avoids symptoms of progestogen fluctuation


drospirenone norethisterone levonorgestrel Norgestrel Medroxyprogesterone Dydrogesterone

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