Hormone Replacement Therapy

When Should You Begin HRT?

Once a woman decides to begin hormone replacement therapy, her next big decision is when to begin. Your doctor can help you decide what is best for you. The decision will depend in large part on the reasons why you are taking HRT.

For Controlling Menopause Symptoms

Menopause symptoms such as hot flashes and vaginal dryness can continue on and off for several years, but eventually they will end. Some women decide to take HRT to control these symptoms, and then discontinue HRT when they no longer need it for symptom control. Most experts agree that taking HRT for five years or less poses little or no danger.

To control menopause symptoms, HRT should start when the symptoms begin.

Need To Know:

If your symptoms are mild to moderate and they are not interfering with your daily activities, you may choose not to take HRT. If your symptoms are severe enough to interfere with your activities, you may want to take HRT immediately.

For Its Protective Benefits

If you decide to take HRT for protection against osteoporosis:

  • The greatest protection against osteoporosis is obtained when HRT is started soon after menopause.
  • HRT should be started within five years of menopause in order to have any significant effect on bone density.

Is It Ever Too Late To Start?

Opinions differ among experts on whether it is ever too late to start HRT. Most agree that in order to have a significant effect in preventing osteoporosis, it should be started within five years of menopause.

What Should You Expect When Beginning HRT?

Hormone replacement therapy can cause some side effects, most of which are temporary. Some forms of combination therapy, in which women take both estrogen and progesterone, can cause monthly bleeding similar to a period.

Nice To Know:

Every woman’s experience with HRT is different.

Minor Side Effects

Some women who begin hormone replacement therapy experience side effects. Most of the side effects are temporary and will go away within several months. They include:

  • Bloating and fluid retention
  • Nausea
  • Breast tenderness (can be relieved with over-the-counter pain relievers)
  • Vaginal bleeding (may require ultrasound studies and biopsies of the tissue in the uterus)

Monthly Bleeding

When hormone replacement therapy first started, women were given estrogen alone. This was later shown to increase their risk of certain types of cancer. In response, combination therapy was introduced, with women taking both estrogen and progesterone.

Earlier combination therapy caused women to bleed lightly once a month, in a fashion similar to menstrual periods, although the flow generally is lighter. Today, a new form of HRT is available that combines estrogen and progestin. It eliminates monthly bleeding in the vast majority of women.

Nice To Know:

A study published in the February 2000 issue of the American Journal of Obstetrics and Gynecology shows that women are much more likely to stay with hormone replacement therapy if it does not cause monthly bleeding.

The Importance Of Regular Checkups

If you are taking HRT, you should have regular medical checkups. The American College of Obstetricians and Gynecologists recommends that all women taking HRT get a medical checkup every year. The exam should include:

  • A check of your blood pressure
  • A pelvic exam
  • A clinical breast exam
  • A mammogram

How Long Should HRT Continue?

Because of possible increased risks for breast cancer with long-time use, some doctors suggest stopping HRT after about 10 years.

The problem with this approach is that the protective benefits from HRT can decline and eventually disappear. For women who take HRT because they are at higher risk for osteoporosis, this may not be the best option.

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