Starting HRT: When to Start and What to Expect

Hormone replacement therapy (HRT) can ease common menopause symptoms such as hot flashes, sleep disruption, mood changes, and vaginal dryness. If you’re wondering when it makes sense to begin, what the first months feel like, and how to talk with a clinician, this guide from EaseMD walks you through the essentials in plain language.

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What is hormone replacement therapy (HRT)?

HRT supplements hormones that naturally decline with age—primarily estrogen and, in some cases, progesterone and/or testosterone. The goal is symptom relief and improved quality of life while using the lowest effective dose. Common formats include pills, patches, gels, sprays, vaginal inserts, and compounded creams.

Symptoms HRT may help

• Vasomotor symptoms (hot flashes, night sweats)
• Sleep disturbance and brain fog
• Mood changes and irritability
• Vaginal dryness, discomfort with intimacy, recurrent UTIs
• Joint aches and overall energy changes

When should I consider starting HRT?

Many begin during the menopause transition (perimenopause) or within the first 10 years after their final period, when symptoms are most disruptive. If hot flashes affect your day, sleep is suffering, or vaginal symptoms impact intimacy or urinary health, it’s worth a conversation with an EaseMD clinician. Personal and family history shape timing and formulation.

Green-light clues

• Frequent hot flashes/night sweats that impact daily function
• Insomnia or persistent fatigue tied to menopausal changes
• Vaginal dryness or pain not improved with moisturizers alone
• No history of estrogen-sensitive cancers or recent blood clots
• Blood pressure and cardiovascular risk reasonably controlled

What to expect in the first weeks and months

Symptom relief can start within 1–3 weeks for hot flashes and sleep and may continue to improve over 2–3 months as your dose is fine-tuned. Vaginal symptoms often respond quickly with local (vaginal) estrogen. Your clinician will check in, assess side effects, and adjust the plan.

Possible side effects (usually temporary)

• Breast tenderness or mild bloating
• Spotting (especially if cycles are irregular)
• Headache or mood changes while dose is being optimized

Tell your clinician about any unexpected or severe symptoms. Using the lowest effective dose and choosing the right route (for example, transdermal estrogen for some cardiovascular risk profiles) helps balance benefits and risks.

Who may not be a candidate?

People with a history of estrogen-sensitive breast cancer, active liver disease, unexplained vaginal bleeding, or a recent blood clot should discuss alternatives. Your EaseMD clinician will review your history to determine the safest path.

Partner with your clinician

HRT is personalized. Share your top goals (sleep, hot flashes, comfort with intimacy), your medical history, and any supplements or prescriptions you take. Consistent follow-ups help dial in the dose and route that fit your life.

This article is for general information only and isn’t a substitute for professional medical advice. Always talk with a qualified clinician about your personal health.