If your HRT isn't working as well as it used to, it may not be the dose that's an issue. It could be that you need these simple application hacks from menopause doctor Shahzadi Harper

Sometimes clients come to the clinic of Dr Shahzadi Harper, GP  aka Instagram's The Perimenopause Doctor, complaining that they’re feeling rubbish, despite being on HRT gel or patches.

When a blood test then shows a mysteriously low level of oestrogen or progesterone, the natural assumption might be that the dose isn't strong enough.  But hang fire, says Dr Harper; there may be a simpler solution. "Before we [increase the does], we go back to basics. I ask them to show me how and where they’re applying it.” 

Often, she says, it’s a case of incorrect application, where the topical HRT may simply not have the chance to absorb properly. For example you might get dressed before your oestrogen gel is dry and it comes off on your clothes.  Or if a patch is applied to skin that is oily, it may slide off.

“You want to ensure you’re getting the right dose, so you’re not wasting the prescription you’ve paid for, and also to maximise the gel or patch’s efficiency. In this way,  you are less likely to think your HRT isn’t working for you and increase or ask for a bigger dose unnecessarily,” says Dr Harper.

They are easy mistakes to make, says Dr Harper, so to help better educate women on how to apply HRT, she made a video for Get The Gloss, below, addressing the problem.

How to apply HRT correctly 

  1.  Ensure the skin is well-exfoliated and free from oil
    Dr Harper recommends using a body scrub to get rid of dry skin on your arms, bum or hips. But, she warns, “don’t put HRT on straight after using an oily exfoliator or a moisturiser in the morning, wait until the end of the day.” 
  2. Keep it away from keratosis pilaris or bumpy skin
    If you have those annoying bumps on the back of your upper arms – keratosis pilaris – apply your HRT elsewhere. Not only will the gel find it harder to soak in here but, Dr Harper points out, “those bumps are blocked sebaceous glands, so if you add a layer of gel, you could be making things worse.” Regular exfoliation should help clear them up.
  3. Poor circulation? Apply straight after the shower
    In cold weather, our circulation can suffer, points out Dr Harper. “I suggest tapping your arms, legs or bum repeatedly just before you apply the gel as this will help improve circulation and so help absorption. Or apply it just after a shower, when your body is warm.”
  4.  Let it dry properly – don't get dressed for at least 3 minutes
    HRT gels need three to five minutes to dry, but make that an hour if you’re going to pull on Lycra leggings or tight jeans on top, says Dr Harper. Otherwise, most of the good stuff will end up soaking into the fabric.
    Hang on, who has a free hour to twiddle their thumbs in the morning? “If you are somebody who is in a rush first thing, doing school runs and getting to work, don’t put your HRT on then. Do it in the evenings. Find the time of day that best suits you and stick to it.”
  5. Split dose your gel
    If you’re using more than two pumps of gel, split them up, says Dr Harper.  For a four-pump regime, for example, "apply two on your arms and two on your legs. Don’t apply all four in the same place, as you’ll be there forever. You might get impatient and end up putting on your clothes too quickly.”
  6. Take oral progesterone an hour before dinner if possible
    Keeping to a routine also applies to oral progesterone, which should be taken either an hour before you eat or a couple of hours afterwards. Dr Harper recommends you take it before dinner if you eat late, in case you fall asleep before you have chance to take your meds.
  7.  Be militant about your patch’s lifespan
    “They must be re-applied every three and a half days, not every three and then every four days,” says Dr Harper. “Because by the time you get to the end of the fourth day, it’ll be falling off and there won’t be much left to absorb. Put an alarm on your phone to remind you.”

What if you feel your HRT still isn’t working properly?

If you’ve ticked all the boxes above, then it’s time to see your doctor for a review. “You may need a blood test, you may need to change the preparation of the HRT, as not all suit everyone,” says Dr Harper.


MORE GLOSS: Do you need a menopause test?