The Independent Pharmacy

Starting HRT Treatment - A Complete Guide

Scott McDougall
Scott McDougall
MPharm GPhC 2079324
Director & Registered Manager

Starting hormone replacement therapy (HRT) helps manage menopause symptoms and improve well-being. Whether you’re considering HRT for relief from hot flushes, mood swings, or bone health support, understanding what to expect is essential.

This guide provides a complete overview of HRT, from how it works to potential benefits and risks. You’ll learn about the different types of treatment, what changes to expect, and how to manage side effects.

While HRT can be life-changing for many, it’s not a one-size-fits-all solution. Proper medical guidance is key to finding the right treatment plan. With the right support - including from healthcare professionals, our menopause guides, and lifestyle changes - you can feel confident about your decision.

Learn everything you need to know about starting HRT and making informed choices for your health.

Key Takeaway 1

Most people see improvement in symptoms within 3 months of starting HRT

Key Takeaway 2

Side effects are common at first but usually improve within weeks

Key Takeaway 3

Regular check-ups with your doctor help make sure your HRT is working well

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Before Starting Your HRT Journey

Before beginning HRT treatments it’s important to prepare to make sure you have a safe and effective experience. The first step is booking a consultation with a healthcare professional. During this appointment, they’ll discuss your symptoms, medical history, and treatment goals to decide if HRT is the right choice for you.

Several important health checks may be required before starting treatment. These can include blood tests to check hormone levels, cholesterol, and liver function, as well as blood pressure monitoring. If there is a history of conditions like blood clots, heart disease, or certain cancers, you may need extra checks.

Lifestyle adjustments, such as improving your diet, staying active, and reducing stress, can support your treatment. Knowing which ones you want to do, before you start treatment, can be helpful. Taking the time to understand HRT and its potential effects will help you feel more confident in your decision and set you up for a smoother journey.

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Different Types Of HRT Available

Hormone replacement therapy comes in several types. This lets you choose the option that best suits your lifestyle and health needs.

Tablets

You could choose tablets as a convenient form of HRT, which you would take daily. However, this option may slightly increase the risk of blood clots, especially if you have certain health conditions.

Patches

You apply HRT patches to the skin, allowing hormones to release gradually. Replacing them every few days makes patches a great choice for those who want to avoid taking tablets daily. Since the body absorbs hormones through the skin rather than the digestive system, patches carry a lower risk of blood clots.

Gels & Sprays

You apply gels and sprays directly to your skin, usually on your arms or thighs, for easy absorption. These options offer flexible dosing and provide a low-risk, non-invasive method. However, you must take care to prevent skin contact with other people before the gel or spray dries.

Each type of HRT has its advantages, and the best choice depends on your personal preferences, medical history, and lifestyle.

Your First Week On HRT

Starting hormone replacement therapy is an exciting but sometimes uncertain step. During your first week, you may not notice major changes right away, as hormones take time to build up in your system. However, you might experience early reactions such as mild headaches, nausea, or slight bloating as your body begins adjusting.

You may also experience mood changes. You could feel an initial boost in energy and well-being, or you may have slight mood swings as your hormone levels shift. If you’re using a patch, gel, or spray, it’s important to apply it correctly and at the same time each day to maintain consistent hormone levels.

This first week is basically all about adjustment - both physically and mentally.

Staying hydrated and following a healthy routine can help make the transition easier. You should keep track of any symptoms you get. If any side effects feel severe or concerning, check in with your doctor for support.

What To Expect In The First Month

During your first month on HRT, your body will gradually adjust to the new hormone levels. Changes may be subtle at first, but monitoring your symptoms can help you track progress and spot early signs that the HRT is working.

Weeks 1-2

You may notice small improvements in mood, sleep quality, and energy levels. However, mild side effects like headaches, nausea, or breast tenderness may happen as your body adapts.

Weeks 3-4

Menopause symptoms such as hot flushes and night sweats may start to reduce, although it can take longer for them to go away entirely. Your skin may begin to feel softer (oestrogen) or slightly oilier (testosterone).

Throughout the first month, it’s important to monitor your symptoms and keep track of any changes. If you get too many side effects, your healthcare team can adjust your dosage or recommend a different form of HRT.

Common Side Effects And How To Manage Them

When starting hormone replacement therapy, you may experience mild side effects as your body adjusts.

Common side effects include:

You may also notice that your weight goes up and down, or that your skin gets oilier or more sensitive.

Most side effects improve within a few weeks to a couple of months as your hormone levels stabilise. To manage these side effects, try staying hydrated, eating a balanced diet, and getting regular exercise. If you feel nauseous, it may help to take any tablets with food. To improve breast tenderness, you can try wearing loose, comfortable clothing, and gentle exercise might help reduce bloating.

If side effects are particularly bad, your healthcare team may change your dose or switch to a different form of HRT entirely. Having regular check-ups makes sure that your treatment remains safe and effective, and changes can be made based on your needs.

Getting HRT Through The NHS

Accessing HRT through the NHS usually starts with a GP appointment. Your doctor will discuss your symptoms, medical history, and suitability for HRT. In some cases, you may need additional tests before you can start treatment. This is to make sure HRT is right for you.

Once prescribed, you can collect HRT from a pharmacy, usually on a repeat prescription. As of April 2023, the NHS HRT Prescription Prepayment Certificate (PPC) allows you to pay a one-off annual fee to cover the cost of most HRT prescriptions, making it a more affordable option for many. Without the PPC, you pay the standard NHS prescription charge per item.

You may choose to go private for HRT, either due to long waiting times or to have more options, from a wider range of treatments. Private consultations and prescriptions can be more expensive, but you might be able to get more personalised options.

Finding The Right HRT For You

Hormone replacement therapy isn’t one-size-fits-all - finding the right treatment depends on your symptoms, medical history, and lifestyle. You may respond best to one form, such as patches, or you may need to try others like tablets, gels, or sprays before finding the best HRT treatment option for you. The right dosage and type of HRT also depends on factors like your age, hormone levels, and any existing health conditions.

It’s common to need adjustments in the first few months. If you keep getting side effects for a long time, or don’t notice improvements, your doctor may tweak your dose or suggest switching to a different form. This process ensures you receive the best balance of symptom relief and minimal side effects.

Working with your healthcare provider is essential for getting the most out of HRT. Regular check-ups allow you to discuss progress, raise concerns, and explore alternative options if needed.

Monitoring Your Progress

Keeping track of your symptoms is key to understanding how well HRT is working for you. Since changes can be gradual, tracking symptoms over time helps you notice improvements and identify any side effects.

Consider keeping a symptom diary or using a health app to record daily changes in mood, energy levels, sleep quality, and menopause symptoms like hot flushes or joint pain. Note any side effects, such as headaches or bloating, and how they affect your daily life.

Look for patterns, such as reduced night sweats or improved sleep, which indicate progress. If symptoms persist or new concerns arise, schedule a check-up to discuss possible changes to your treatment. Sharing these notes with your healthcare team can help make sure your treatment remains effective and best suited to your needs.

When To Review Your Treatment

After starting HRT, your first follow-up appointment will usually take place after around three months. During this check-up, your doctor will look at how well the treatment is working and discuss any side effects.

Things that can let you know the treatment is working include improvements in menopause symptoms, any ongoing discomfort, and potential side effects you may be experiencing. Your doctor may also check your blood pressure and have a chat with you regarding any concerns about long-term health risks. They can also discuss the best supplements for menopause for you.

If your current HRT isn’t working as well as you’d like, or is causing unwanted effects, your doctor may adjust your dose or switch you to a different form, such as patches instead of tablets.

After this initial three month review, annual check-ups help monitor your progress and keep track of your treatment. If symptoms change, you can request a review sooner.

Support Resources And Additional Help

Starting HRT can feel overwhelming, but plenty of support resources are available to help. Support groups, both online and in-person, offer a space to share experiences, ask questions, and connect with others on a similar journey.

For reliable information, look at sources like the NHS website, Women’s Health Concern, and the British Menopause Society. These provide up-to-date guidance on HRT and menopause management.

If you need further support, professional guidance from GPs, menopause specialists, or private clinics can help tailor your treatment. Speaking to a healthcare professional ensures you receive safe, evidence-based advice throughout your HRT journey.

Always Remember...

It is essential that you speak to a licensed medical professional before starting any HRT medication. They can provide personalised, expert guidance, assess potential risks and ensure that your chosen treatment is safe and suitable for your health needs.

Ready To Take The Next Step?

Starting hormone replacement therapy is a big step towards managing menopause symptoms, but finding the right treatment takes time. With proper medical guidance, regular check-ups, and a little patience, you can adjust to the changes and see real benefits. Tracking your progress and staying informed will help you make the best decisions for your health.

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Scott McDougall

Authored by

Scott McDougall
Scott McDougall
MPharm
2079324
Director & Registered Manager

Scott is one of the two founders of The Independent Pharmacy. He is a registered pharmacist and the registered manager of our service with the CQC.

Daniel Hurley

Reviewed by

Daniel Hurley
Daniel Hurley
MPharm IP
2078790
Pharmacist Independent Prescriber

Dan is an experienced pharmacist having spent time working in both primary and secondary care. He currently supports our clinical team by providing robust clinical governance review of our internal processes and information.

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