Part 3 of my countdown to World Menopause Day on Sunday 18 October 2026. Part 1: why HRT is harder to keep track of · Part 2: aches, pains and this year's theme · the World Menopause Day guide.
Sooner or later, almost every woman on HRT asks the same question: is this actually working? Answering it takes more than a feeling, and not being able to answer it for myself is one of the reasons I built HRTMe.
Why it's so hard to tell
The first problem is time. HRT takes a while to settle. The NHS says some early side effects, such as breast tenderness, usually improve after a few weeks, and that when you start HRT "your GP should review your medicine after the first 3 months". That's months of before-and-after to hold in your head.
The second problem is memory. We remember the last few days vividly and the previous six weeks as a blur, and brain fog makes that worse. Everyone's memory works this way, which is why so many of us end up shrugging at appointments and guessing.
The third problem is everything else going on. A run of bad sleep or a stressful month gets mixed in with how you feel, and it's hard to separate that from what your HRT is doing.
What "working" actually means for you
Before you can tell whether something is working, it helps to be clear what you wanted it to do. For most of us that's the symptoms that sent us to the GP in the first place: hot flushes, night sweats, broken sleep, low mood, brain fog, aches. Write yours down. They're your yardstick, and they're probably different from your friend's.
Then there's how you feel overall, day to day. Mood and energy often shift before any one symptom clearly does, and they're easy to miss if you're only watching for the big ones.
If you're on HRT that causes bleeding, or you're getting bleeding you didn't expect, that belongs on the list too. The NHS says to talk to your GP "if you're taking HRT and still having irregular or heavier bleeding or spotting after 6 months."
And there's one thing most of us never think to check: whether the HRT is actually going in. If you've been missing doses, a bad fortnight might be about the gaps rather than the medicine. That's what part 1 of this countdown was about.
The dose-change version: two pumps or three?
If you're on oestrogen gel, you'll know this conversation. "Let's try three pumps instead of two and see how you get on." Off you go, and then what? Weeks pass. You feel maybe a bit better? Or is that the weather, or the one night you slept properly?
"See how you get on" is fine advice from your doctor, but it quietly puts all the measuring on you, with nothing to measure with. A dose change only tells you something if you can compare before and after, and by the time you're asked, the before is last month, fading by the day.
How to actually do it
- Log how you feel every day, before you change anything. Mood, energy, brain fog, whichever symptoms matter to you. A quick daily tap. This builds your "before."
- When you change your dose, update it in the app. Two pumps becomes three. You type your strength in your own words, so it records exactly what you're on, whichever brand you're using.
- Keep logging. Same quick daily tap.
- Look at the weeks before the change and the weeks after. HRTMe picks out the patterns in your own logs: your most-logged symptoms, whether you're logging more or fewer than before, the days in your cycle that tend to be your best and worst, the symptoms that keep landing together. So you can see whether your better days got more frequent, whether the brain fog lifted, whether the night sweats eased off.
The same steps work if you're just starting HRT. Your first few weeks of logging are your "before", and the NHS's three months is your "after".
The app shows you what's in your logs and leaves the conclusions to you and your doctor. It won't hand you a made-up score for your mood.
Why charts beat a notebook here
You could, in theory, keep all this in a notebook. The trouble is that a notebook hides patterns inside pages of scribble. You can't flick back through three months of notes and see a trend. When the same logs become a simple chart, the before-and-after jumps out.
You'll also spot things you weren't looking for, like your worst days clustering at one point in your cycle, or two symptoms that keep turning up together. That makes a change much easier to judge than a single "better or worse?" gut feeling.
What to take to your review
This is where it pays off. Instead of "I think three pumps is maybe better?", you walk in with your GP report: here's the date I changed, here's how I was before, here's how I've been since, here are the doses I missed and here's my bleeding. Your doctor can make a proper call with a proper record, and you're a partner in your own treatment instead of a guesser. The questions worth asking while you're there are in the World Menopause Day guide.
The NHS says "if you do not feel better after 3 months, speak to your doctor", and that they "may suggest changing your dose, or switching to a different type of HRT." The decision stays between you and your clinician. A record just means you arrive with evidence to look at together.
Needing a few goes to get it right is normal. As the NHS puts it, "there are different types of HRT, and it can take time to find the type and dose that works for you", and you'll usually "start on a low dose" that "may be increased later, depending on how well it works." You deserve to be able to see that process as it happens. That's the whole reason this part of the app exists.
On Sunday 18 October it's World Menopause Day. Everything for the day is in the World Menopause Day guide.
— Jane
HRTMe is a medication reminder and wellbeing tracking tool. It doesn't provide medical advice, diagnosis, or treatment. Please talk to your prescribing clinician before making any change to your dose. If you've missed a dose, here's what to do if you forget to take your HRT, and the HRTMe FAQ has more on how the app works.