A Comprehensive Guide to Starting Hormone Therapy for Menopause: What to Expect

A Comprehensive Guide to Starting Hormone Therapy for Menopause: What to Expect


Are you experiencing the challenging symptoms associated with menopause -  hot flashes, mood swings, and/or disrupted sleep? If so, hormone therapy may be a viable option for you. In this blog post, we will explore what to expect when starting hormone therapy (HT) for menopause, including the benefits, common symptoms during the initial phase, their duration, and what steps to take if they persist. We will draw information from trusted sources such as the American College of Obstetrics and Gynecology (ACOG) and the Menopause Society (formally NAMS).

A few reminders:

  1. If you are started on HT and they say, see you next year – find a new provider. Preferably a NAMS certified menopause practitioner.
  2. If your HT isn’t working for you, it is 1 of 3 things: dose, route or formulation.

Benefits of Hormone Therapy

Hormone therapy, also known as menopausal hormone therapy (MHT), is a treatment that involves supplementing the body with hormones (estrogen, progesterone, and/or testosterone) that it no longer produces in sufficient quantities during menopause. While the decision to undergo hormone therapy should be made in consultation with a healthcare provider, it is important to recognize the potential benefits it offers:

  • Alleviation of hot flashes and night sweats: HT has been shown to significantly reduce the frequency and severity of hot flashes and night sweats, providing relief from these disruptive symptoms.
  • Improvement in sleep quality: By addressing night sweats and reducing sleep disturbances, HT can help improve sleep quality, leading to better overall rest and well-being.
  • Relief from vaginal dryness and discomfort: Hormone therapy can alleviate vaginal dryness, itching, and discomfort, improving sexual function, intimacy, and overall quality of life.
  • Preservation of bone health: Estrogen helps maintain bone density, and HT can help prevent bone loss, reducing the risk of osteoporosis and fractures.
  • Potential reduction in the risk of colorectal cancer: Studies have suggested a possible protective effect of estrogen therapy against colorectal cancer, highlighting another potential benefit of HT.
  • Improvement in mood and emotional well-being: Hormone therapy may help stabilize mood, reduce irritability, and alleviate symptoms of depression and anxiety commonly associated with menopause.
  • Maintenance of cognitive function: Estrogen plays a crucial role in cognitive function, and some studies suggest that HT may help preserve memory and cognitive abilities in women during and after menopause.
  • Improvement in skin elasticity and appearance: Estrogen contributes to skin health and elasticity. Hormone therapy can help improve skin moisture, reduce wrinkles, and enhance the overall appearance of the skin.

Symptoms When Starting Hormone Therapy

When initiating hormone therapy, it is important to be aware of potential symptoms that may arise during the adjustment phase. The good news is, they are most often temporary.

These symptoms can include:

  1. Temporary breast tenderness: Some women may experience breast tenderness or swelling initially, which usually resolves within a few weeks.
  2. Spotting or irregular bleeding: It is not uncommon to experience irregular bleeding or spotting during the first few months of hormone therapy. This is generally temporary and tends to resolve on its own within 6 months.
  3. Nausea: While uncommon, some women may experience mild nausea or stomach upset when starting hormone therapy. If persistent or severe, it is important to consult your healthcare provider.
  4. Headaches/Migraines: If you have a history of migraines or menstrual headaches, HT may worsen symptoms in the beginning and generally disappear within a few weeks.
  5. Bloating (fluid retention): Starting any new HT may have you feeling a little bloated as your body adjusts in the first few weeks.

Duration of Symptoms

It's essential to understand that the symptoms experienced when starting hormone therapy are typically temporary and should go away within a few weeks or months as your body adjusts to the treatment. However, every individual is unique, and the duration can vary. If the symptoms persist beyond a few months or worsen over time, it is important to seek medical advice.

What to Do If Symptoms Persist

If symptoms do not resolve or become increasingly bothersome, it is crucial to consult with your healthcare provider. They can reassess your hormone therapy regimen and make necessary adjustments. In some cases, alternative treatment options or different hormone combinations may be recommended to address your specific needs.

When Hormone Therapy Is Contraindicated

While hormone therapy is a safe and effective treatment for many, there are certain situations where it may not be recommended. It is important to discuss your medical history and any existing conditions with your healthcare provider to ensure hormone therapy is appropriate for you. Some of the contraindications are yellow lights (proceed with caution) and others are red lights (no go). For instance, if you had a blood clot after a motor vehicle accident or a major surgery, you are likely still a candidate for HT.

Contraindications for hormone therapy may include:

  • History of estrogen-sensitive cancers: Women with a history of estrogen-sensitive cancers, such as breast or endometrial cancer, may be advised against hormone therapy due to concerns about potentially stimulating the growth of these cancers.
  • History of blood clots or stroke: Individuals with a history of blood clots in the legs or lungs or a history of stroke are generally not recommended to undergo hormone therapy, as estrogen can increase the risk of blood clot formation.
  • Uncontrolled high blood pressure: Women with uncontrolled high blood pressure may be advised against hormone therapy, as estrogen can further elevate blood pressure levels.
  • Liver disease: Severe liver disease or impaired liver function can affect how the body processes hormones, making hormone therapy potentially unsafe for individuals with these conditions.
  • Known or suspected pregnancy: Hormone therapy is not appropriate for women who are pregnant or suspect they may be pregnant, as it can have adverse effects on fetal development.


Starting hormone therapy for menopause can provide relief from bothersome symptoms and improve your overall quality of life. Understanding what to expect, including the potential symptoms during the initial phase and their duration, is essential for managing your treatment effectively. Remember, hormone therapy should always be discussed with a healthcare provider who can provide personalized guidance based on your medical history and individual needs. Don't hesitate to seek help if symptoms persist or worsen, as alternative options may be available to ensure your well-being during this transitional phase of life.