Side-effects of HRT
It should be explained that weight gain is very common around the time of the menopause and HRT does not cause any weight gain beyond mild fluid retention. Other adverse effects can be described as those related to the specific hormone. 
Oestrogen:
- Headaches
- Nausea
- Leg cramps
- Fluid retention
- Bloating
- Breast tenderness enlargement and tenderness
- Dyspepsia
- Angioedema
These may resolve within 3 months so if tolerable, women should be encouraged to persist. Other options to help the symptoms include reducing the dose of oestrogen, changing the type of oestrogen and changing the route of administration.
Progestogen:
- Headache or migraines
- Breast tenderness
- Fluid retention
- Lower abdominal and back pain
- Acne
- Mood swings and depression
These may resolve within 3 months so if tolerable, women should been encouraged to persist. Other options to try and alleviate the effects include reducing the dose of progestogen or changing the regimen allowing a reduced frequency of dosing, changing the progestogen or the route. If appropriate, changing to a continuous combined therapy can be beneficial
Unscheduled vaginal bleeding deserves a separate mention and is common within the first 3 months of HRT use. Monthly cyclical regimens normally give predictable bleeding patterns. Unexplained bleeding should be investigated, confirming cervical smear history, speculum examination, transvaginal ultrasound and gynaecology referral. Changing the progestogen and altering the dose can help. Using the levonorgestrel-releasing intrauterine system (IUS) can help idiopathic menorrhagia