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  • Writer's pictureClaire White, APRN-CNP

What to Expect When You Start Bioidentical Hormone Replacement Therapy

Updated: Dec 22, 2023

What to Expect When You Start Hormone Replacement Therapy

You've completed your first appointment with me and now you are about to start treatment. Starting hormone replacement therapy (HRT) can provide welcome relief for unpleasant menopause symptoms. But there may be lingering questions after leaving your first appointment.

The goal of this post is to give you realistic information on what to expect, both benefits and side effects, while you pursue HRT.

We’ll cover:

  • How hormone therapy works

  • Expected timeline for symptom relief

  • Possible short-term side effects

  • Long-term health benefits

  • Risks to be aware of

  • Tips to get the most out of treatment

Let’s get started!

How Hormone Replacement Therapy Works

Zen, medication, harmony. Beautiful lotus flower and stack of stones on water surface, hormone replacement therapy copy

HRT involves taking small doses of hormones like estrogen, progesterone, testosterone, DHEA, and others to restore normal levels. This relieves symptoms that occur from the declines during menopause.

The most common delivery methods are:

  • Estrogen and progesterone pills

  • Skin patches

  • Vaginal rings

  • Gels or creams

  • Pellets placed under the skin

Bioidentical hormones have the same chemical structure as your body’s hormones. They are engineered to be identical matches and bind optimally to hormone receptors.

The right combination and dosing will balance your hormones for optimal functioning. Let’s see what you can expect in the first weeks and months after starting HRT.

What to Expect in the First Months

Most women notice some effects within 1-2 weeks after beginning hormone therapy. But the full benefits build gradually over 3-6 months as levels regulate.

Here's a look at the timeline you can expect:

1-2 Weeks

  • Increased energy

  • Improved mood and sleep

  • Some relief from hot flashes/night sweats

1 Month

  • More stable moods

  • Fewer sleep disruptions

  • Less vaginal dryness during sex

  • Some hot flashes subsided

2-3 Months

  • Significant reduction in hot flashes

  • Less stiffness and joint pain

  • Increased muscle tone

  • Improved skin texture and moisture

  • Thicker, shinier hair

  • Better sleep quality

3-6 Months

  • Resolution of sleep problems

  • Balanced mood - less irritability

  • Clearer thinking and focus

  • Reversal of weight gain

  • Restored libido and sexual satisfaction

  • An overall sense of wellbeing

While benefits accumulate over months, most women report feeling dramatically better within 6-8 weeks.

What About Side Effects?

Some women experience temporary side effects when first starting HRT while the body adjusts:

  • Breast tenderness or swelling

  • Headaches

  • Nausea

  • Bloating

  • Redness/irritation at patch application sites

These symptoms usually resolve within 2-3 months. But let me know if they persist.

There is also a small risk of blood clots in the first year for some women taking oral estrogen. So be aware of any leg pain, redness, or swelling and report it promptly.

Otherwise, most women adjust without problems and enjoy the many benefits that make them feel like themselves again.


Long-term Effects: Weighing Benefits

Research shows hormone therapy has significant benefits when taken for up to 5-7 years:


  • Alleviates menopause symptoms

  • Reduces bone loss and risk of osteoporosis

  • Lowers LDL cholesterol

  • Protects metabolic health - improves insulin sensitivity

  • Reduces risk factors for heart disease

  • Preserves cognitive function and lowers dementia risk

  • Protects collagen and skin health

  • Maintains fitness, muscle strength, and endurance

Tips to Get the Most Out of HRT

Here are some suggestions to follow that will help you get optimal results:

  • Take hormones regularly - Try to stick to consistent times and never skip more than 1-2 days.

  • Don’t stop abruptly - Taper down dosage over several weeks when ending therapy to prevent symptoms from rebounding.

  • Use the lowest effective dose - I will adjust to meet your needs while minimizing risks.

  • Get follow-up blood tests: Monitoring your levels helps determine ideal dosing. So, please don't miss our appointments.

  • Report any side effects - Promptly notify me about any unusual symptoms.

  • Implement a healthy lifestyle - Nutritious eating, regular exercise, stress management, and good sleep hygiene will all enhance results.

  • Get your screenings - Have regular mammograms, lipid profiles, bone density tests, pelvic exams, etc. to monitor your health on HRT.

  • Consider adding testosterone: Testosterone therapy provides additional benefits for some women. We can discuss testosterone if I haven't already done so.

Take the Next Step for Your Improvement

Understanding what to expect will help you get started on the path to feeling your best again. Now that you have realistic information about hormone therapy, you can start your journey and have peace of mind about what’s ahead.

I hope this post helped you learn what to expect when starting hormone replacement therapy during symptoms of menopause. Don't hesitate to reach out with any other questions! I'm here to help support your hormone health and vitality.

This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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