Unwanted symptoms can occur with oestrogen and also progestogens if combined regimens are required.

When reproductive hormone levels are changing, women report alterations of feelings that they may find difficult to describe. This may happen in pregnancy, after childbirth and when taking hormones (pill or HRT). Many women feel healthier and happier when pregnant but there is a wide variation. Similarly most women feel better on HRT but others may have a negative reaction.

Oestrogens: In one study, sixty-one women received either conjugated e quine oestrogens (Premarin) or a placebo (a look-a-like preparation but without the active drug) for six months. The treatment was then reversed for a further six months. The women were not told whether they were taking oestrogen or placebo first (a placebo-controlled study (placebo & controlled trials). Thirteen (21%) reported leg cramps with oestrogens and three (5%) had leg cramps with placebo. Eight (13%) had mastalgia (breast tenderness) with oestrogen but six (10%) had this symptom with the placebo. A few had eye irritation, fluid retention, nausea, vaginal discharge or limb pains. The authors concluded that the incidence of side effects was low and they did not cause any major difficulties for the patients. The leg cramps were difficult to explain but they were not associated with thrombosis (Q4.22).

Progestogens: There is little data about the incidence of progestogen induced side effects. They may be dose related and differ according to the progestogen used. Symptoms attributable to progestogens are similar to those seen in premenstrual syndrome (Premenstrual Syndrome - PMS). They may be physical including acne, greasy skin and rashes or psychological with depressed mood, anxiety, aggression and panic attacks. These side effects can be minimised or abolished for the majority by ensuring that the smallest safe dose is prescribed. If progestogens are taken for only seven days each month the chance of endometrial hyperplasia (thickening) (HRT and progestogen) is only 4%. A change of progestogen (or perhaps progesterone gel Crinone) may be appropriate.




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