There is no single best time to start HT. Any decision should take into account your personal situation, medical history, and menopause symptoms. But there are a few things that you need to bear in mind when making the call. Read on to find out more about the best time to start HT.
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When should you start HT?
Knowing when to start HT can be really tricky and everyone approaches this choice in their own way. Some people might prefer to try lifestyle changes or non-hormonal treatments first. Others can be keen to get started as soon as their menopause symptoms become troublesome.
Your healthcare provider will also need to feel confident that HT is a safe option for you. They will take a full history and review your medical record to ensure that you don’t have any conditions that could make HT potentially more risky for you, including a history of breast cancer, blood clots, or heart disease.
No matter what your medical history is, the decision to start HT is always a matter of weighing the risks and benefits. No one else can decide if and when you should start HT – this is a decision you need to make for yourself. You will likely want to take into account a number of factors including:
Before considering HT, it’s important to check that the symptoms bothering you really are due to menopause. Hot flashes, sleepless nights, and mood swings are all typical of menopause, but can also be caused by other conditions that need a very different sort of treatment. Because of this, your healthcare provider might want to do a few further tests before recommending HT.
- How bad your symptoms are and how they are affecting your life. If you’re unsure or find it hard to keep track, try keeping a log
- Any big life events coming up, like weddings or holidays. When adjusting to HT, there are potential side effects, such as irregular bleeding, which might mean you prefer to wait until you have a clearer calendar
- Your personal feelings about HT. It’s reasonable to wait a few months before making a decision if you’re feeling conflicted
Learn more about the benefits and risks of HT.
What does the evidence say about when to start HT?
Anyone who is having bothersome menopause symptoms should consider starting HT. It is common to have menopause symptoms before your periods have stopped – at this stage you are in perimenopause. Many people start HT during perimenopause. This may be as early as 40 years old.
Read more about the stages of menopause if you are unsure if you are in perimenopause.
That said, evidence suggests that it is better to start HT within 10 years of menopause and before the age of 60. This has been shown to maximize the benefits of HT, including a reduction in your risk of coronary heart disease and lower risk of death from cardiovascular causes.
However, even if you start HT 10 years after menopause, but before age 60, research shows that you are not at increased risk of cardiovascular disease or death from cardiovascular issues.
Starting HT at 60 or older is less common. This is because your risk of a number of conditions like breast cancer and serious blood clots increases with age. The added risks of HT may be more significant, and your healthcare provider may advise against starting HT.
One exception to these age considerations is vaginal HT. This is a very low-risk option and targets symptoms that can be lifelong, such as vaginal tightness, dryness, pain, painful sex, recurrent urine infections, and needing to pee more frequently. This group of symptoms is known as genitourinary syndrome of menopause (GSM).
It is very common to start vaginal HT to treat GSM after the age of 60 and it is safe to continue as long as it is helpful.
Learn more about the benefits and risks of HT.
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