Hormone Therapy Side Effects & When to Seek Help
What to expect when starting or adjusting menopausal hormone therapy (MHT)
What Is Normal When Starting MHT?
When you begin menopausal hormone therapy (MHT), your body needs time to adjust to changing hormone levels. Most side effects are mild and temporary — they typically improve or resolve within the first few weeks to months as hormone levels stabilise.
Below are the most commonly reported side effects and what to expect.
Common Side Effects (Usually Temporary)
Headaches
Can occur when starting MHT as oestrogen levels stabilise. Usually settles within 2–4 weeks. Report headaches that are severe or sudden to your doctor.
Breast tenderness
Common when starting oestrogen therapy. Usually resolves within 1–3 months. A well-fitted bra can help with comfort. Report any new lump or change in breast shape.
Bloating
Can occur in the first few weeks of treatment as hormone levels adjust. Usually improves over time.
Mood changes
Some women notice mood fluctuations when starting or adjusting MHT. This usually settles. Report persistent low mood or anxiety to your doctor.
Fatigue
Can occur in early weeks of treatment. Usually improves as hormone levels stabilise.
Spotting or light bleeding
Expected if you are on cyclical Prometrium (withdrawal bleed). Some irregular spotting is common in the first few months of continuous therapy. Always report unexpected or heavy bleeding.
Skin reactions
Mild redness or irritation at the patch or gel application site. Rotate sites each day or with each patch change to reduce this.
Water retention
Some women notice mild fluid retention or a feeling of puffiness in the first few weeks. This generally settles with time.
💡 Give it time
Most side effects from MHT improve significantly within 4–12 weeks. Do not stop your medication without discussing it with your doctor first — adjusting the dose or formulation may resolve the issue.
Symptoms to Discuss With Your Doctor (Non-Urgent)
The following symptoms are not emergencies but should be discussed with your prescribing doctor within a few days:
Headaches that are frequent or worsening
Breast tenderness that is severe or not improving after 2–3 months
Persistent mood changes, low mood, or anxiety
Irregular bleeding that continues beyond the first 3–6 months of continuous therapy
Skin reactions that are spreading, painful, or not settling with site rotation
Any side effect that is significantly affecting your daily life
Seek Medical Review Within 24–48 Hours
These symptoms are not typically emergencies but should be reviewed promptly:
Unexpected vaginal bleeding after 12 or more months without a period (postmenopausal bleeding)
New lump in the breast, change in breast shape, skin dimpling, or nipple discharge
Significant mood change that is distressing and sudden
Emergency Red-Flag Symptoms
The following symptoms require immediate emergency care. Call 000 or go to your nearest Emergency Department:
🚨 Call 000 or go to Emergency for
- Chest pain or shortness of breath — may indicate a clot in the lungs (pulmonary embolism) or a cardiovascular event. Seek emergency care immediately.
- Calf pain, swelling, or redness in one leg — may indicate a deep vein thrombosis (DVT). Do not wait — seek emergency assessment.
- Sudden severe headache — described as the worst headache of your life, or unlike any headache before. Especially if associated with visual disturbance, neck stiffness, or vomiting.
- Sudden changes in vision — blurring, loss of vision in one eye, double vision, or visual disturbances.
- Sudden weakness, numbness, or speech difficulty — possible stroke. Act FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 000.
📞 In an emergency
Emergency:Call 000
After-hours health advice:1800 022 222 — healthdirect Australia (24/7 nurse-on-call helpline)
For non-urgent questions about your treatment, contact your prescribing doctor's clinic during business hours.
Visual Quick Reference
Common side effects and urgent symptoms — see panel 9 of the Arami Hormone Therapy Guide
Concerned about a side effect?
Book a review appointment to discuss any concerns about your hormone therapy.
Medical Disclaimer
This list is not exhaustive. Always read the Consumer Medicines Information (CMI) leaflet supplied with your medication for the full list of possible side effects. If you are ever unsure whether a symptom requires urgent attention, seek medical advice. It is always better to be checked.