When to Start HRT - What You Need to Know - Stella
4 mins

When to start HRT

byDr. Lucy Wilkinson

There is no single best time to start HRT. Any decision should take into account your own personal situation, medical history and menopause symptoms. But there are a few things that you need to bear in mind when making the call, as Stella’s clinical advisor Dr Lucy Wilkinson explains. Read on to find out more about the best time to start HRT.

Knowing when to start HRT can be really tricky and everyone approaches this choice in their own way. Some people might prefer to try lifestyle changes or non-hormonal treatments first. Others can be keen to get started as soon as their menopause symptoms become troublesome.

When should you start HRT?

Before considering HRT, it’s important to check that the symptoms bothering you really are due to menopause. Hot flushes, sleepless nights and mood swings are all typical of menopause, but can also be caused by other conditions which need a very different sort of treatment. Because of this, your doctor might want to do a few further tests before recommending HRT.

Your doctor will also need to feel confident that HRT is a safe option for you. They will take a full history and review your notes to ensure that you don’t have any conditions which could make HRT potentially more risky for you, including medical problems like a history of breast cancer or risk factors for other diseases.

When you and your doctor have agreed that HRT is safe and appropriate, it’s time to make the decision!

No one can tell you if and when you should start HRT – this is a decision you need to make for yourself. You will likely want to take into account a number of factors including:

  • How bad your symptoms are and how they are affecting your life. If you’re unsure or find it hard to keep track, try keeping a log. 
  • Any big life events coming up, like weddings or holidays. When adjusting to HRT, there are potential side effects (such as irregular bleeding) which might mean you prefer to wait until you have a clearer calendar! 
  • Your own personal feelings about HRT. If you’re feeling conflicted, it’s reasonable to wait a few months before making a decision.

The exception to this is if you have premature ovarian insufficiency. In this case, doctors will usually advise that you need to be on HRT as soon as you are diagnosed. This is to protect yourself from osteoporosis and cardiovascular disease. You should continue your treatment at least until the average age of menopause (51 years old in the UK).

Learn more about early and premature menopause.

What does the evidence say?

Evidence suggests that it’s better to start HRT within ten years of menopause and before the age of 60. This has been shown to maximize the benefits of HRT, including a reduction in your risk of coronary heart disease and lower risk of death from cardiovascular causes.

Research also shows that you are at no increased risk of cardiovascular disease or death from cardiovascular issues if you start HRT ten years after menopause.

Starting HRT at 60 and beyond is less common. This is because your baseline risk of a number of conditions (like breast cancer and serious blood clots) increases with age. The added risks of HRT can be too much, and your doctor may well advise against it. This should be taken on a case-by-case basis, though, with careful consideration of the risk-benefit ratio.

One exception to this is vaginal HRT. As this is a very low-risk option and targets symptoms which can be lifelong, vaginal HRT is commonly started in those over 60. This is a great option if you’re suffering from any symptoms of genitourinary syndrome of menopause (GSM), including vaginal tightness, dryness, pain, painful sex, recurrent urine infections and needing to pee more frequently.

Learn more about the risks and benefits of HRT. Find out more about menopause on our blog or in our symptoms library.