Medically reviewed by Catherine Hansen, MD, OBGYN & Menopause specialist

Let’s dive into a topic that resonates with many women in their journey towards understanding menopause treatment: “When is the best time to start menopausal hormone therapy (MHT) or hormone replacement therapy (HRT)?” This is not just a question about timing; it’s about quality of life, health, and well-being.

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Understanding Perimenopause: The Prelude to Menopause

Perimenopause is like the overture to the symphony of menopause. It’s the transitional phase leading up to menopause, marked by various signs indicating hormonal changes in your body. Typically, perimenopause starts in your 40s, but it can begin as early as your mid-30s. Key indicators include irregular periods, hot flashes, night sweats, mood swings, and sleep disturbances. If these sound familiar, you might be stepping into the world of perimenopause.

Menopause, it should be noted, is the moment that happens when you haven’t had a period for 12 consecutive months.

Perimenopause lasts on average 3-4 years, though for some women it can be up to 10! You might sail through it, or you might be bogged down by unpleasant symptoms. (Ever heard of a “tsunami period?” It’s not an experience anyone would choose.)

The Role of Menopausal Hormone Therapy

Menopausal hormone therapy, also known as hormone replacement therapy, is a treatment used to relieve symptoms of menopause. It involves the administration of estrogen or a combination of estrogen and progesterone to balance the declining natural hormones in your body. There are a variety of types of hormone replacement therapy, and if you are beginning HRT for menopause symptoms, you should discuss the options with your doctor.

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Timing is Everything: When to Start HRT

The question of when to start menopausal hormone therapy is crucial because timing can significantly impact its effectiveness and benefits. Generally, the best time to begin MHT is during the early stages of menopause, shortly after you’ve reached the official diagnosis (no menses for 1 full year). MHT is safest, most effective and provides the biggest “bang for your buck” if it is started in the first 10 years of menopause or before the age of 60. However, every woman’s journey is her own, and the decision should be made in consultation with a healthcare provider, considering personal health history and risk factors.

While each person’s experience is unique, if you’re having vasomotor symptoms (hot flashes, night sweats) or other concerns that are impacting your day-to-day, it might be time to take action to stop your suffering. Headaches, low libido, sleep disruptions, heavy periods or skipped periods, and mood swings can all be signs that perimenopause is in full swing and menopause is right around the corner.

Benefits of Timely Menopausal Hormone Therapy

  1. Relief from Vasomotor Symptoms: Hot flashes and night sweats, also called the vasomotor symptoms of menopause, are the hallmark symptoms of menopause. Starting MHT during the early stages of menopause can effectively reduce these discomforts, helping you maintain a better quality of life.
  2. Reduction in Certain Cancer Risks: Some studies have suggested that MHT reduces the risk of colon cancer. Other studies have revealed confusing results with breast cancer, indicating that certain hormone regimes, administered at certain times in a woman’s life (usually bioidentical hormones at younger menopausal years) can actually reduce breast cancer risk while other regimes (more synthetic hormones at older ages) are thought to increase breast cancer risk. The bottom line with cancer risk is that, if taken according to guidelines and as part of a healthy lifestyle that includes a healthy diet, regular exercise, adequate sleep and stress management, MHT can be trusted to be quite safe. As indicated, MHT should always be openly discussed with your healthcare provider.
  3. Alleviation of Vaginal Symptoms: Vaginal dryness, itching, and discomfort during sex are common during menopause. MHT can help in rejuvenating vaginal tissue, improving lubrication, and making sex more comfortable and enjoyable. Perhaps most importantly, MHT can help protect against tissue damage and aging because vaginal tissues are especially sensitive to loss of estrogen.
  4. Regulation of Periods: For women in perimenopause, MHT can help in regulating periods, providing predictability and relief from heavy, painful, or unpredictable menstrual cycles.
  5. Bone Protection: MHT is shown to reduce bone loss, also called osteopenia or osteoporosis, and to reduce fractures. As women age, fractures are a major health concern, so protecting your bones is essential.
  6. Relief From Other Common Symptoms: Sleep disruption, heavy periods, headaches, mood swings, itchy or dry skin, and weight changes are all common symptoms of low estrogen that can be addressed with MHT.
  7. Heart Health: While there is not yet a consensus, some studies show that taking estrogen or combination therapy (estrogen and progestin) can protect women’s cardiovascular health when hormone therapy is started as soon as menopause begins.

Is It Ever Too Late to Start Using Menopausal Hormone Therapy?

While there’s no hard rule about when to start MHT, guidelines say it’s best started—and most effective—within 10 years of menopause or before the age of 60.

The exception to this is vaginal estrogen (cream, tablet or ring inserted vaginally), which can be applied locally to treat genitourinary symptoms including dryness, itchiness, and discomfort or pain during sex. Vaginal estrogen can be used at any age, and is sometimes even used in addition to systemic estrogen of other forms (pills or patches). Whenever you begin hormone therapy, you must always do it under the care of a doctor.

Surgical Menopause

If you begin menopause early because your ovaries have been removed, estrogen replacement may be recommended in order to protect your bones, lessening the long-term risk of osteoporosis and fractures. In cases of surgical menopause, when menopause happens suddenly and immediately, resulting from the removal of ovaries, hormone replacement is often prescribed for it’s many protective benefits (possibly including cardiovascular, bone and brain protection) and to maintain sexual health.

If you’ve had a hysterectomy in addition to oophorectomy (removal of ovaries), you do not need progesterone (progestin) replacement, because progesterone is prescribed to protect the uterus. No uterus, no progesterone.

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Personalizing Your Menopause Treatment

Menopausal hormone therapy isn’t a one-size-fits-all solution. It’s essential to have an individualized approach that considers factors such as age, health history, the severity of symptoms, and your personal preferences. It’s also important to regularly review and assess the therapy with your doctor to ensure it continues to meet your needs and maintain your health.

One of the challenges many women experience during perimenopause is that symptoms can change over time, so treatment may need to change over time as well. This is why it’s essential to have open communication with a doctor you trust—one who understands the trajectory of menopause and how to approach it at each stage.

Get Expert Guidance

When our doctors at Pandia Health prescribe hormone therapy, they are using the detailed health information you provide to create a treatment plan that’s specific to your body and needs. Our doctors are certified by the Menopause Society (formerly NAMS/the North American Menopause Society) and can help you understand why and how hormone replacement therapy can help you.

Starting Hormone Therapy

It may take a few weeks to months to feel the full impact of your hormone replacement therapy but some people notice a positive effect in a few days. Common side effects include breast tenderness, spotting, headaches, and nausea. None of these should be extreme, and they should dissipate as your body adjusts. If the medication is making you feel awful or causing major discomfort, talk to your doctor about adjusting your dose.

If you notice a reduction in symptoms within a week or two, that’s great! If you’re not feeling improvements after about 2-3 months, you should check in with your doctor about whether you might need a different dose or a new regime.


Embracing menopause as a natural phase of life doesn’t mean you have to suffer through its symptoms. In fact, treating menopausal symptoms can be beneficial to your health. According to the Menopause Society, hormone replacement therapy is safe and effective when prescribed properly, and for most women the benefits outweigh the risks.

Understanding when to start menopausal hormone therapy can play a pivotal role in managing this transition smoothly. Remember, the journey through perimenopause to menopause is as unique as you are. Whether it’s deciding on the timing of hormone replacement therapy, choosing the right type of hormone therapy, or finding alternative menopause treatments, it’s all about what works best for you.

Are you ready to explore this step? At Pandia Health, our doctors are experts in menopause. They partner with you to find the best menopause treatment for your symptoms, with a goal to make you feel better as fast as possible. Our service is all online, so it’s convenient and discreet. We even FREE ship your medication to your door! Begin your consultation today!

Disclaimer: This article is for general informational purposes and is NOT a substitute for professional medical advice. Always seek the advice of your healthcare provider before starting or changing birth control.