The commonest side-effects are:

• feelings of nausea

• breast tenderness

• feeling bloated before a period

• slight weight-gain

• disturbances of the digestive system

• leg cramps

• headaches

• feelings of pre-menstrual tension and other complaints caused by taking progestogen

Although this may seem a daunting list, most of these problems are quite short-lived for the majority of women on HRT.

Feelings of nausea. These usually wear off quite quickly, and are much less of a problem with the patch and implant than with tablets.

Breast tenderness. This, too, usually wears off after the first week or two. If it is troublesome, it may be relieved by starring with a low dose of oestrogen and building up once your body has become used to having the hormone again.

Feeling bloated. This is caused by fluid retention, and may include swollen ankles. Talk to your doctor about it; he may prescribe ‘water tablets’, or the symptoms may subside by themselves.

Disturbances of the digestive system (known as gastrointestinal disturbances). These are more common with oral HRT than with other types. If you take the oral form, these symptoms are often relieved by taking the tablet with food, or at bedtime; if this doesn’t help, a non-oral route like the patch or implant may solve the problem.

Leg cramps. Cramp, especially in the calves, sometimes occurs in the first few months of taking HRT. It may be worse at night, and usually disappears before long. If you regularly get cramp in one leg only, mention it to your GP, who will want to check that you are not at risk of developing a thrombosis.

Headaches. These are usually short-lived, too. If you developed migraine at the time of the menopause, HRT may relieve it; if the HRT causes headaches, they should pass, but if they don’t your doctor may suggest changing the dosage or type.

PMT and other symptoms of progestogen These have been covered in Chapter 3. Again, the patch form of progestogen may see the end of many of these troublesome complaints, so should the newer progestogens when they become available.

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If you are considering any sort of investigation or treatment, Australia’s National Health and Medical Research Council recommends that you ask your practitioner the following sorts of questions:

• What is the possible or likely nature of my illness or disease?

• What is your proposed approach to investigation, diagnosis and treatment?

— what does this approach entail?

— what are its expected benefits?

— what are the common side-effects and risks of the intervention proposed?

— is the intervention a standard procedure or is it experimental?

— who will carry out the intervention? How much of that particular procedure has that person performed? And with what results, including rates of complications in her/his series of patients. (If he/she doesn’t know, this may indicate a reluctance to self-monitor and may be a bad sign.)

• What are the other options for investigation, diagnosis and treatment?

• How certain is the diagnosis?

• How certain is the treatment outcome?

• What is likely to happen if the proposed investigation or treatment does not occur, or if no procedure or treatment is undertaken?

• What significant long-term effects may be associated with particular investigations or treatments?

• How much time is involved in conducting particular investigations or treatments, and in recovering from them?

• What costs are involved, including costs payable after receiving Medicare and health-insurance rebates?

If you find it difficult to ask these sorts of questions, take someone along with you who can.

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A clock is bad for someone who is conscious of the number of hours they feel is necessary to sleep each night. A common experience for most people who wake up in the middle of the night is to look at the clock by their beds. Some will exclaim, ‘My goodness, it is now one in the morning. This is it, I will be unable to sleep again and will stay awake for the rest of the night’. The worry of what time it is in the middle of the night can give rise to tension and anxiety. Of course, this tension and anxiety will prevent the person from falling asleep again. Then when they look at the clock again after a while, they will panic and say to themselves, ‘It is now two, and there is only a few hours before morning’.

Marking the hours of the night. There is a self-fulfilling prophecy for some people. They believe that, once they wake up in the middle of the night, they will not sleep again. Their tension increases as they mark the hours through the night. This tension is in fact reducing their chances of sleep. So, as the night approaches, they already predict that they are going to wake up in the middle of the night and will not be able to fall asleep again. The night comes and they wake up in the middle of the night and immediately look at the clock to find out what time it is. Each time they look at the clock, they generate more anxiety within, which prevents them from sleeping. Each time they fail to sleep, they are convinced once more of their own prediction.

Anxiety is cumulative and their confidence to sleep is reduced with succeeding nights that they fail to sleep. Looking at the clock and marking the hours of the night is to be avoided completely, as this generates tension and reduces the confidence to sleep.

No clocks. A normal sleep pattern always consists of a few awakenings at night. The older we are, the more frequent we wake up in the night. However, it is common that we do not always remember these awakenings, and we fall back into sleep. Next time when you wake up in the middle of the night, tell yourself it is perfectly normal and healthy to do so. Do not bother to find out what time it is or try to work out how much time you have slept or how long it will be before daybreak. It is very tempting to look at the clock, but once you get used to putting the clock away you will surely sleep much better. Just lie back, do nothing, practice self-relaxation, and you will fall back into sleep.

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