By your late forties most women are on something — thyroid replacement, an antidepressant, a statin, a migraine preventive, a supplement or three. Hormone therapy gets added to that list by someone who can see only part of it, and nobody sits down and looks at the whole thing. This is how to make that review happen.

Where we stand: Menova is an independent publication. We sell no medication and no supplements, we are not your doctor or pharmacist, and this is general education, not medical advice. Do not start, stop or change any medication based on this page.

Why this falls through the gap

Not negligence — structure. Your hormone therapy may come from a menopause service or a telehealth provider. Your thyroid medication comes from somewhere else. Your migraine preventive came from a neurologist three years ago. The supplements came from a shop.

Each prescriber sees their own part. Nobody holds the whole list, and the person best placed to check it is the one nobody asks.

Ask a pharmacist — the most underused free service you have

Pharmacists are trained specifically in interactions, they can see your dispensing record, and in many health systems a medication review is free and does not need a referral. You can usually just ask.

Bring everything: prescriptions, anything bought over the counter, supplements, herbal products, and anything prescribed by a service your regular clinician does not know about. Say what you take, not what you were prescribed — these differ more often than anyone admits.

What is worth flagging

This is not a list of things that are unsafe together. It is a list of combinations worth someone looking at.

Thyroid replacement. Oral estrogen can change how much of your thyroid hormone is available, and the dose sometimes needs reviewing. Transdermal routes behave differently. If you take both, ask when your levels will be rechecked after any change — see HRT and thyroid medication.

Enzyme-inducing medicines. Some anticonvulsants, some tuberculosis treatments and a few others speed up how the liver clears hormones, which can make a standard dose less effective. If you take one and hormone therapy is not working, this is a specific thing to raise rather than a mystery — see epilepsy and menopause and what to change when HRT isn't working.

St John's wort. The same problem, bought without a prescription. It also interacts with antidepressants and several other drugs. Worth naming because people do not think of it as a medicine — see how to tell whether a supplement is worth buying.

Anticoagulants and antiplatelets. Relevant both to hormone therapy and to how heavy bleeding is managed — see anticoagulants and heavy bleeding.

Antidepressants. Some interact with tamoxifen, which matters after breast cancer, and some are themselves used for hot flashes — so the same drug can appear on your list for two reasons. See antidepressants and menopause and menopause after breast cancer.

ADHD medication. Response is reported to shift across the cycle and through the transition — see ADHD medication in menopause.

Migraine preventives, particularly if you have migraine with aura, which changes which hormone routes are discussed — see migraine with aura and HRT.

Iron and thyroid replacement, and iron and calcium, which compete for absorption and simply need separating in time — see how to actually take iron.

Anything affecting the liver or gallbladder, which can influence route choice — see gallbladder, liver and HRT.

The supplements problem

Undisclosed supplements cause real interactions, and they are the part people leave off the list because they do not feel like medication.

Two things worth knowing: "natural" does not mean inert — St John's wort is the clearest example — and supplement labels are not verified before sale in most markets, so what is in the bottle may not match what is on it. See what the supplement research says.

Say what you actually take. Nobody is going to tell you off, and the alternative is a clinician reasoning from an incomplete list.

Route matters more than people expect

Oral and transdermal hormone therapy behave differently, and that difference is exactly what makes some combinations easier to manage. Route is a legitimate thing to ask about when you are on several medications — see HRT types and forms.

When to raise it

  • Before starting hormone therapy, not after
  • When anything else changes — a new prescription from any prescriber
  • If hormone therapy is not working at a reasonable dose, before assuming it is the wrong treatment
  • Annually, as part of a review — see building a relationship with a clinician
  • If you use telehealth, every time, because that service cannot see your other prescriptions unless you tell it — see how to judge a telehealth service

Keep the list yourself

Nobody else will. One page: drug, dose, what it is for, who prescribed it, when it started. Add supplements at the bottom. Update it when anything changes and photograph it, so it is on your phone when you need it.

That page is also what makes an emergency admission safer, and it is the thing most people do not have — see keeping your own health record and menopause in hospital.

The sentence to use

To a pharmacist:

"I've just been prescribed hormone therapy and I take four other things plus some supplements. Could you check the whole list for interactions?"

To a prescriber:

"Before we start — here's everything I take, including what I buy myself. Is there anything on here that changes what you'd choose, or the route?"

Both take thirty seconds and are the reason a lot of problems never happen.

Our free printable visit prep sheet has space for the full list, and the free blood test sheet covers what should be checked alongside. The free 2-minute Menova self-check organizes your symptom picture — no account, not a diagnosis, and your answers never leave your device.

This article is general education, not medical advice. It is not a complete list of interactions and is not a substitute for a review by a pharmacist or prescriber who can see your full record. Do not start, stop or change any medication, supplement or dose based on this page.

Sources: NICE NG23 — Menopause, The Menopause Society, NCCIH — St. John's Wort, and NHS — Hormone Replacement Therapy.