Hormone Replacement Therapy in Menopause: When to Start?

Menopause marks the end of the female reproductive cycle and brings a series of hormonal changes that directly impact the body and quality of life. Among the therapeutic options to face this moment, Hormone Replacement Therapy (HRT) stands out as one of the most effective.

But after all, what is the ideal time to start HRT?

In this article, we will explain when hormone replacement may be indicated, which signs deserve attention, and why medical follow-up is essential.

What is menopause?

Menopause is officially diagnosed after 12 consecutive months without menstruation. It occurs, on average, around age 50, but symptoms can begin much earlier, in the so-called perimenopause, a transition phase that can last years.

During this period, it is common for a significant drop in estrogen and progesterone levels to occur, triggering symptoms such as:

• Hot flashes
• Night sweats
• Insomnia
• Irritability and anxiety
• Decreased libido
• Vaginal dryness
• Joint pain
• Weight gain

When to consider hormone replacement therapy?

HRT can be considered as early as the beginning of perimenopause, especially if symptoms are intense and affecting quality of life.

Main indications for starting HRT:

1. Moderate to intense climacteric symptoms
2. Early menopause (before age 40)
3. Increased risk of osteoporosis
4. Vaginal dryness and sexual dysfunction
5. Persistent mood and sleep changes

Is there an "ideal window" to start?

Yes. Studies indicate that the best results and lowest risks of HRT occur when treatment is started within the first 10 years after menopause or before age 60. This period is known as the "window of opportunity," because:

• Improves symptoms more effectively
• Reduces cardiovascular risk (when well indicated)
• Brings more safety in prolonged therapy use

When is HRT not indicated?

Hormone replacement therapy is not recommended in cases such as:

• History of hormone-dependent breast cancer
• Severe liver diseases
• Previous thromboembolic events
• Vaginal bleeding of unknown cause

Therefore, individualized evaluation with a professional is essential before starting any treatment.

Conclusion

HRT can be a powerful ally in caring for women's health during menopause, relieving symptoms and promoting well-being.

But the decision about when to start should be made based on medical evaluation, clinical history, and hormonal tests.

If you are entering menopause or facing symptoms that affect your daily life, seek a trusted doctor to understand if HRT is indicated for you.

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