Is it common to have sore breasts on HRT?

A guide to temporary side effects you may experience after starting HRT, including breast pain

Hormone replacement therapy (HRT) is usually the first-line treatment for perimenopause and menopause symptoms [1].

If you’ve recently started HRT and want to know more about potential side effects – specifically sore breasts – this article sets out what you need to know.

Is it common to have side effects after starting HRT?

HRT is usually really well tolerated, and few people have side effects. The most common side effects that can occur in the first few weeks after starting HRT are sometimes known as the ‘four Bs’:

Breasts: your breasts may become tender, painful and more sensitive. This can be due to the oestradiol (the type of oestrogen used in natural, body identical HRT) or progesterone. This can last for several weeks but usually settles. Wearing a well-fitting, supportive bra can also help if you’re experiencing this symptom.

Bleeding: this may come and go or last for a few weeks. If you are perimenopausal when you start HRT, your bleeding pattern may alter initially and may take three to six months to settle into a regular pattern. If you are menopausal when you start HRT (are no longer having periods), bleeding may occur, but this usually settles within three to six months.

Bloating: if your HRT regimen includes progesterone or a synthetic progestogen, you may experience a bloating feeling, which usually improves.

Blues: You may find that your mood is affected, or you feel more emotional than usual. If these feelings persist then you may need to change your dose or type of HRT.

What should I do if I’m experiencing side effects?

Side effects usually settle over time. If side effects have not settled after three to four months, discuss them with you should discuss them with Newson Clinic at your follow up appointment. You may find that changing brands, the delivery method (such as changing from tablets to patches) or type of hormone might help improve side effects.

If you experience any side effects that are not mentioned here, are unexpected, persistent, or if you do not respond to treatment as anticipated, it is important to consult your Newson Clinic clinician promptly. Individual responses to treatment can vary, so always follow the advice of your clinician tailored to your specific health needs.

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References

1. National Institute for Health and Care Excellence (NICE) (2024) ‘Menopause: identification and management’