When should you start HRT? It's a good question, and one I see being influenced by the onslaught of media around menopause and hormonal replacement therapy in places like the UK.
This media attention is of course a huge positive in so many ways, but also leaves some women with serious HRT 'FOMO' (fear of missing out). Instead of starting from the lens of their own health and symptoms, their thinking goes along the lines of, "If everyone else is taking it, then shouldn't I start?"
Or hormonal replacement therapy is seen as some magic bullet to avoid menopause entirely. I am increasingly seeing young women who have only started to have the vaguest of (possible) perimenopause symptoms panicking and wanting HRT, for example. Without even investigating whether their symptoms are from another cause.
When is the best time to start taking HRT?
My answer when someone asks me about taking HRT is, "When your symptoms make daily life difficult or when your own detailed research and health investigations have you sure it's for you".
It depends on your health profile, your symptoms, and what you want from your menopausal (and perimenopausal) years. And what you yourself are comfortable with. It's your body, after all.
There is an exception to my offering of this advice, ladies! And that is if you are nearing age 60 or are almost ten years out from starting menopause. I will explain why then my advice would be different below.
But aren't you pro taking hormone replacement therapy?
This response of mine surprises some people. "Wait, aren't you the cheerleader for HRT?" Well, sure. For those who need it and want to be on medication. But women's bodies and experience of menopause seriously vary. I myself was dealing with perimenopause symptoms by 39. Meanwhile, I meet women who are 55, still get regular periods, and don't really have many symptoms yet.
Is HRT good for your health?
Yes. And for me this is yet another great reason to take it. But not all women want to be on medication. They are simply not comfortable with the thought. So even this reason is not right for everyone. Benefits of being on HRT can include:
less of a chance of developing diabetes
lowered risk of fractures particularly of the hip and spine
better blood lipid levels (which means lowered risk of heart attacks and strokes)
possible extension of your life span (as shown in this meta analysis).
But again, each woman has a unique health profile. Someone might genetically have a low risk for all of these things, and experience little to no menopause symptoms.
Of course there is the joy of genitourinary symptoms to consider. Dryness, itchiness, pain with sex, increased need to urinate. But the truth is that while HRT does help with all this, it doesn't eradicate it. And there are hormonal medications you end up needing whether or not you are on a HRT regime.
Don't I have to be fully menopausal to get HRT in France?
No. You just need to know how to work the system here. As it is true that both the old guidelines put out by the Health Authority (HAS) and the newer guidelines put out by the Collège National des Gynécologues et Obstétriciens (CNOGF) both suggest hormone replacement therapy only be offered when a woman has not had her periods for a year. And it's also true many gynaecologists who flout this advice only prescribe progesterone if you are perimenopausal, and not a full HRT regime.
But if you know how to describe your symptoms, then it's possible to get a full regime in France even when in perimenopause. I had four different gynaecologists offer it to me when I was still peri, all explained in my book.
The time window for starting HRT
So why would my advice around taking HRT be different for someone about to be sixty, or about to reach ten years since their last menstrual cycle?
If this is the case, I would more strongly suggest considering taking HRT if there are any symptoms at all you don't like, or you have any desire to do so. Simply as your window of opportunity for getting HRT prescribed, and for benefitting safely from it, is closing.
In France, guidelines around prescribing HRT recommend only prescribing to women aged 60 or under, or within ten years of being fully menopausal (no periods).
This reflects general guidelines in other countries. The reason being that the risks that HRT will increase your chance of things like a stroke increase slightly if HRT is started after 60, and even more so if HRT is started after 70. Of course our risk for such things increases with age regardless if we take HRT or not. And you might stumble across a practitioner who throws caution to the wind and prescribes to you anyway. But in general it's safer to start within ten years of your periods ending.
Hormone therapy: Is it Right for You?
It's up to you. My best advice is do your research! We are lucky that now there is heaps of information out there, and a growing body of clinical research. Make an informed decision.
The one thing I would say, though, is that you can start HRT, and if after giving it a good three months to settle you don't like it, you can go off it. But you can't get back the years of suffering and feeling like hell.
In my case I was given a HRT prescription four years before I dared to go on it, and I do sorely regret I didn't start when they first suggested it. As those were years I was barely functional, and that had a severe impact on my relationships, lifestyle, mental health, and even finances. The joys of hindsight...
Andrea-Marie is the owner of this site and the author of HRT in France, the definitive guide to getting a gold-standard hormonal replacement regime here.