If HRT makes you feel worse in the days after you take the progesterone part — low, anxious, bloated, irritable or crampy — you're not imagining it. Some women are sensitive to the progestogen in hormone therapy. The good news is there are usually several ways to make HRT work for you.

What is progesterone intolerance?

If you have a uterus and take estrogen for menopause symptoms, you also need a progestogen to protect the lining of the womb. Some women tolerate this part poorly and get side effects from it — and some types are better tolerated than others. “Progesterone intolerance” is the term for these unwanted effects from the progestogen component of HRT.

Symptoms of progesterone intolerance

Symptoms often appear in the days you take the progestogen (especially on a cyclical regime) and can include:

• Low mood or feeling depressed
• Anxiety or irritability
• Bloating and fluid retention
• Breast tenderness
• Headaches
• Acne or greasy skin
• Cramping
• Disturbed sleep and fatigue

Why it happens

It comes down to individual sensitivity. Women with a history of PMS or PMDD can be more prone to it. The type of progestogen, the dose, the route (oral or vaginal) and whether it's taken cyclically or continuously all make a difference.

What can help

These are options a menopause doctor can consider with you — the right one depends on your history and how you're taking HRT now:

• Switching to micronised (body-identical) progesterone (Utrogestan), which many women tolerate better
• Using progesterone by the vaginal route
• Adjusting the dose or regimen — for example continuous rather than cyclical, or a longer cycle
• Using the Mirena IUS to deliver the progestogen with very low levels in the bloodstream
• Reviewing the estrogen dose and balance

This is individualised — what suits one woman won't suit another, which is exactly the kind of fine-tuning a menopause specialist does.

When to get specialist help

If HRT side effects are making you want to give up, it's worth seeing a menopause specialist before you do — a tolerable option can usually be found.

Frequently asked questions

Is progesterone intolerance common?
It's not rare — a proportion of women get side effects from the progestogen part of HRT, particularly those with a history of PMS or PMDD.

Does body-identical progesterone cause fewer side effects?
Many women tolerate micronised (body-identical) progesterone, such as Utrogestan, better than older synthetic progestogens, but responses vary.

Can I use the Mirena instead of taking progesterone?
Often yes. The Mirena releases progestogen locally to protect the womb lining with very low levels in the bloodstream, which some women find much more tolerable.

Will I have to stop HRT?
Usually not. Most women can keep the benefits of estrogen by changing the type, dose, route or delivery of the progestogen.

This information is general and not a substitute for personalised medical advice.

Struggling with HRT side effects?

Book a 45-minute consultation and we'll help you find an option that works. You can also read more about HRT basics and body-identical hormones.