What to expect when starting HRT

You are exploring hormone replacement therapy as a treatment method for your menopausal symptoms and are eager for more information. Or maybe your doctor has recommended it? Either way, it is important that you have accurate science backed information, so that you can make a well informed decision and are well prepared for treatment. We are very happy that you are taking the initiative to read more and in this article we will explain everything you need to know about hormone replacement therapy. Including what the different types of treatment are, what side effects to expect, how long it takes to see results—and everything in between. 

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What is HRT

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Let’s start with a quick refresher on what Hormone replacement therapy (HRT) actually is and how it helps reduce menopausal symptoms. As you approach menopause and your egg count is nearly exhausted, you ovaries will start to produces less of the hormones estrogen and progesterone until both are around 1% of the original levels. The unpleasant menopausal symptoms are largely caused by low levels of hormones, and/or the fluctuation of hormone levels, and the resulting (temporary) imbalances in hormone levels.  

"HRT is the most effective treatment for key menopausal symptoms"

HRT is a treatment that does exactly as the name suggests: it replaces (replenishes) one or both of these hormones your body is producing less of and keeps it at steady levels.  HRT is the most effective treatment for key menopausal symptoms such as vasomotor symptoms (hot flashes and night sweats), vaginal dryness, mood related symptoms, low libido and prevention of osteoporosis (weakening of bones). It may also have an indirectly positive effect on a range of other symptoms such as sleep issues, but clinical research is still ongoing to prove this.

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HRT can be prescribed as a systemic treatment that impacts (and benefits) symptoms in your whole body, or as a localized treatment targeting one specific symptom such as a cream for vaginal dryness. There is a range of different preparations to consider (tablets, patches, gel, implantation, spray etc) based on personal preference and type of symptoms that are being treated. Lastly, your physician will either prescribe estrogen-only HRT or a combination therapy that includes progesterone and estrogen - depending on whether or not you’ve had a hysterectomy.  

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How is the right dose and type of HRT determined?

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HRT treatment is personalized to your needs and the right dose and type of HRT will depend on your own goals, medical history, period pattern (or lack thereof), preference, and the severity and type of symptoms you are experiencing. Having said that, your doctor will start you on the lowest available dose for your symptom(s), to minimize the chance of side effects occurring. If your symptoms are

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You may be wondering why dosage and type isn’t standardized? When it comes to Menopause the medical community has learnt a LOT in the past few decades but there are still (many) aspacts that are not understood well. One of these areas is why the depletion of hormones impacts different women in different ways. For example, for one woman a 10% reduction in Estrogen may cause debilitating symptoms that significantly impact her life (and happiness!) while for another woman a reduction of 95% doesn’t cause any discomfort whatsoever. So when it comes to treating menopausal symptoms a doctor will focus on the impact a symptom has on the quality of your life, and is not focused on bringing your estrogen levels to a standard pre-determined level.  

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Needless to say, the communication between your doctor and you is key to getting the dosage right. Let your doctor in at every step of your journey. Let them know how you feel or if you notice an improvement or not.

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Will my dosage and treatment type change?

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As you progress through your menopause journey your physician will closely monitor the ongoing effectiveness and suitability of your hormonal treatment. As your natural hormone levels continue to fluctuate and decrease you may discover that the initial dose and/or treatment type needs to be adjusted. This is not the case for everyone, but if you feel your symptoms returning or start experiencing new symptoms you should reach out to your physician to discuss your options.  

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How quickly can I expect HRT to start working?

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There is no one one size fits all answer here, but generally speaking a woman should start feeling a gradual decline in the severity of her symptoms within two - four weeks of using HRT.  Symptoms like hot flashes and night sweats tend to respond quicker, and will disappear within two weeks or even sooner of starting HRT. Other symptoms will continue to disappear over time, usually within the first couple of months. Often, treatment leads to progressively decreasing symptom severity over the first few months.

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‍What kind of side effects can I expect?

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Side effects are normal when starting with any type of hormone therapy (including birth control), and occasionally, women will experience side effects before their symptoms improve. Although there is no definitive data what percentage of women experiences side effects and for how long, the most frequently side effects include:

• Breast tenderness
• Mood changes
• Headaches
• Spotting or bleeding
• Acne
• Bloating

Not everyone will experience side effects, but for those who do, they’ll likely subside or dissipate within the first three months of starting treatment. Let your doctor know if any of these side effects persist or are too bothersome. 

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Long-term risk. Clinical studies have indicated that using HRT increases your risk of developing breast cancer, heart disease, and stroke. However, these risks are small, and the benefits of using HRT outweighs the risk. Talk to your doctor about these risks to be sure taking HRT is safe for you.

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How long should I take HRT for?

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Based on several research carried out, there is no limit to how long you should use HRT as long as you are using the lowest effective dose. Some women use HRT for 2-5 years when their symptoms are the most severe, while other women may stay on it for a decade or longer.   

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When should I reach out to my doctor after starting HRT?

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In general, following up with your doctor once every year is recommended to reassess your dosage and the need to continue to use hormone therapy. 

You should reach out to your doctor immediately if you notice any of the following:‍

• No improvements or changes after 4 weeks of using HRT
• Your symptoms get worse, and/or new symptoms appear
• Abnormal vaginal bleeding or irregular spotting
• You are not satisfied with the effect of your treatment after 4-6 weeks.

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