When to Start HRT?

#HRT #BHRT #hormonereplacment #hormonetherapy #perimenopause #perimenopausesupport #whentostarthrt #womenshealth #hormonebalance #healthyaging

This is a question that seems to be popping up all the time…. When do you start HRT?

Unfortunately there is no straight answer to this and also the answer will be different for every woman. So I could not tell you to start progesterone at age X and then estradiol at age Y.

One thing that’s common for every woman though is that you would always start with supplementing progesterone. You may remember progesterone is your first hormone to decline and for some women that can start from age 35, for other women that may be much later. So when you would start, this really depends on the symptoms you are experiencing. 

Just as a reminder, the typical symptoms of low progesterone are:

• Increased anxiety

• Irritability

• Increased PMS

• Like of deep sleep

• Shorter cycles or spotting

I started progesterone when I was 42 and I could’ve probably started earlier than that. You may only start progesterone when you are 45. Or you may start when you are 38 - there’s no rule really. And the severity of the symptoms often also depend on the amount of stress we are experiencing. So sometimes when we are able to better manage our stress or reduce stress, we can actually start later with hormone therapy. When you are already taking HRT and experience an increased period of stress, you’ll likely have to increase your dose to still feel balanced.

Then estradiol is the second hormone to decline. This usually happens around the 45 years mark. And when our estrogen declines, our brain is definitely not happy about that because it has many estrogen receptors and it doesn’t like those fluctuations at all.

So here we would be starting to experience: 

• Memory issues

• Depression or low mood

• Fatigue

• Heavy bleeding

• Skipping cycles

• Tender and sore breasts

• Headaches

• Weight gain

• Increased cholesterol

• Hot flashes

Also good to know that you would only ever take estrogen in the form of cream, gel, mist or patches, but never orally as a pill. This is because when you’re taking estrogen as a pill, it has to be metabolized by your liver and that can increase or contribute to a risk of breast cancer. To lower or avoid that risk you will only take a topical estrogen (that you put on your skin). 

Some doctors like to prescribe DHEA, which is a precursor hormone that can be converted into estrogen or testosterone. I don’t like to work with this, because it’s a little bit of a hit or miss what your body will do with it; you won’t really know if it’ll be converted into estrogen or testosterone.

Of course, testosterone is another important hormone that we don’t talk so much about but that can be key to improving your well-being, especially in terms of self-confidence, energy, sex drive &  strength. It is mostly used as injection or topical cream.

Start Earlier for Better Protection

As a general rule of thumb, it’s recommended to start HRT earlier, rather than later. When you start early in perimenopause, it has more significant benefits for the blood vessels, brain, and bones than if it is started later after hormones have been rock bottom for a while. 

It used to be said that starting HRT after age 60 is not recommended anymore. Also, a lot of women are told that they will have to come off their HRT at a certain point.

Overall, the research is clear that HRT is safe for most women who start it within about 10 years of their last menstrual period. For those women, there are actually more benefits than risks, especially in the first 5 years of treatment. Source 

There is no data that supports stopping HRT is beneficial. You should decide with your practitioner if benefits outweigh the risks in your specific case. 

If a woman stops HRT, she can experience a rebound of acute symptoms, and she will lose the protection of her body systems and tissues that hormones provide. 

Just consider how important estrogen is for protecting your brain from dementia or Alzheimer’s, protecting your heart from heart disease, Protecting your bones from osteoporosis, protecting your tissues from drying out and degrading (joint pain, frequent urinary tract infections, frequent yeast infections, painful intercourse).

I hope this helps you see a little bit clearer. I also recommend that you work with a practitioner or Doctor who is specialized in Hormone therapy and women’s health. They'll be able to accompany you in this and help you make the right choices for you. And also support you in finding the right dosage that feels good for you.

If you have any further questions, please don’t hesitate to reach out to me or leave a comment here I’d be happy to assist.