How do I know if I need HRT?

Unsure about hormone replacement therapy? Discover what suits you.

Having doubts about starting hormone replacement therapy during (peri)menopause is completely normal.

When can hormone replacement therapy (HRT) help?

Vasomotor symptoms: hot flashes, night sweats
Sleep problems
Vaginal dryness / pain during sex
Bone loss (osteoporosis prevention)

When should you be extra careful?

Points of attention:

Previous breast cancer. Tailored advice from a specialist remains essential.
Thrombosis or increased risk of blood clots: Systemic (working on your entire body) hormone replacement therapy, especially oral forms, can slightly increase the risk of venous thromboembolism and stroke; transdermal forms (through the skin: spray, gel, patch) generally have a lower risk.
Untreated high blood pressure
Heart attack, stroke
Severe liver problems
Unexplained vaginal bleeding
Certain types of brain tumors

This doesn't automatically mean "no HRT", but it does mean a doctor needs to think carefully with you.

Timing hypothesis

The well-known "timing hypothesis" — that starting within ±10 years of menopause carries fewer risks and possibly more benefits — is increasingly recognized in modern analyses:

Various meta-analyses and reviews show that early initiation (<10 years after menopause) is associated with a lower risk of overall mortality and cardiovascular events than starting later.
HRT works most favorably when you start around the period when your body loses estrogen. When you start much later, the blood vessels have already been affected, making the risk/benefit balance less favorable.

Common doubts

"Are hormones safe?"

For most healthy women under 60 years old, or within 10 years of their last period, HRT is safe and effective, especially in low doses and through the skin (patch/gel).

"Are my symptoms severe enough?"

Your symptoms don't need to be "severe enough" according to others. You decide whether they affect your quality of life.

"What if I want to stop later?"

You can always stop or taper off HRT. It's not a lifelong commitment unless you want it to be.

"Is there a difference between pills, patches, and gel?"

Patches/gel: lower risk of thrombosis → often the first choice
Pills: slightly higher risk of clot formation
IUD with progesterone (e.g., Mirena): for endometrial protection

"What if I'm still menstruating?"

During perimenopause, hormones are still erratic; many women receive cyclical HRT or only progesterone support. You don't have to be fully in menopause to use HRT.

This information is intended solely for educational and informational purposes. It does not replace medical advice, diagnosis, or treatment by a doctor or other qualified healthcare provider. Always consult your (family) doctor if you have questions or concerns about your health or treatment.