There is such a wide range of dosages available that your doctor should be able to adjust your prescribed dose to your symptoms. If your symptoms are mild, you will start on a low dose; if they are severe you will start on a higher dose. (The further you are from the menopause, the more likely you are to get side-effects in the early days of taking oestrogen, so a low dose would probably be prescribed for you initially.) If the low dose is not getting rid of the symptoms, ask your doctor if he can give you a higher dose; if the higher dose is producing unpleasant side-effects, ask for a lower dose. Women who have had a hysterectomy or oophorectomy will usually be started on a higher dose, as their symptoms will probably be more severe than women passing through a natural menopause.
If you have severe symptoms of breast tenderness, nipple sensitivity, leg cramps, continuing weight gain and feelings of nausea, you might feel better on a lower dose of oestrogen. If you develop acne, bloatedness, disturbances of your digestive system, a drop in libido, breast discomfort, and feelings of pre-menstrual irritability, then you might feel better on a lower dose of progestogen. However, before you rush off to the doctor, be prepared to stick with your initial treatment for two or three months, unless the HRT is giving you really awful side-effects; in most cases they diminish considerably, and often go completely after a few months.
Women who start HRT before their periods stop completely may find it takes longer to get the dosage exactly right This is because if you are still having natural periods, then you are still producing some oestrogen, even though its falling levels may be causing hot flushes, night sweats and all the rest If you take extra oestrogen in the form of HRT, don’t be surprised if you suffer some of the effects of this extra dose. Also, as your own level of oestrogen falls steadily, your HRT dose may need gradually to be increased in order to compensate.
The other group of women who may initially suffer side-effects from higher doses of oestrogen (tender breasts, for example) are those who are many years past the menopause and haven’t produced much oestrogen of their own for a very long time. If this happens to you, your doctor may suggest that you start on a lower dose, and then progress to a higher dose when your body has adjusted to the oestrogen. Alternatively, it may help if you take the HRT on alternate days to start with. You may also find that evening primrose capsules bring relief for breast tenderness.
As well as adjusting the dosage to menopausal symptoms, your doctor will want to consider whether you are at risk of osteoporosis or arterial disease. If you are, he will probably suggest starring at a medium or high dose, as the low dose may not give enough protection for some women.