What if hormone replacement therapy does not relieve hot flushes?

Hot flushes may continue if treatment has not reached its full effect, the dose or delivery method needs adjusting, doses are being missed, or another medicine is interfering. Symptoms can also be related to thyroid problems, infection, anxiety, alcohol or other triggers rather than menopause alone.

Your clinician may ask about the start date, adherence, bleeding, sleep, medicines and the pattern of each episode. Do not increase or stop hormones without advice, because the safest plan depends on your health history and the type of HRT you use.

Write down when flushes occur, what you were doing, room temperature, food or drink triggers, sleep disruption and any palpitations or sweating. Dress in removable layers, keep the bedroom cool and use a fan or cool drink if these measures help.

At review, ask whether the treatment schedule or form should change and whether a non-hormonal option could be suitable. Mention migraines, clotting history, unexplained bleeding, breast symptoms and every prescription, supplement or herbal product you take.

Arrange prompt medical advice for new unexplained vaginal bleeding, chest pain, breathlessness, one-sided leg swelling, severe headache, weakness, confusion or fainting. Seek urgent help for sudden severe symptoms. A flush with fever or feeling acutely unwell may need assessment for another cause.

Ask when improvement should be expected, whether your dose or delivery method is suitable, which triggers matter, and how to monitor bleeding or other side effects while the plan is reviewed.