If you have made the decision to start taking HRT, you may have more questions about this. For example, how will you feel and what should you look out for?
This guide explains what you can expect and answers some commonly asked questions.
When should I start taking my HRT?
Estrogen
If you are still having periods, it is useful (though not essential) to start taking the estrogen part of your HRT within the first 5 days of starting your period.
If you don’t or rarely bleed, you can start it at any time.
Progesterone
If you have been prescribed progesterone in a cyclical pattern (usually 2 weeks on, 2 weeks off), it is important to start your progesterone on day 15 of your cycle and take it for 14 days before stopping for 2 weeks (during which time you may have another period).
If your periods are irregular and unpredictable and you have no idea when day 15 is (don’t worry this is very common!), you can start it at any time when you are not bleeding and your doctor can advise how best to time the 2 weekly on-off pattern when taking the progesterone.
If you do not have periods anymore and you’re going to be taking progesterone continuously, you can start your estrogen and progesterone immediately or at any time to suit you.
How soon will I feel better?
This is a question nearly everyone has when starting HRT.
Some women notice a difference within a few days, but for the majority it is a slow and steady improvement over weeks and months. You may notice physical symptoms get better first, for example, if you’re on the correct dose of estrogen for you, hot flushes and night sweats are often much better after 4-6 weeks.
However psychological symptoms, such as low mood or anxiety, can take a few more months to improve.
It is important to take the HRT medication as explained for at least 3-6 months before deciding whether it is benefitting you or not.
If you have questions about how to apply your HRT, there is more information in the resource Understanding the different types of HRT.
Will there be any side effects?
You may experience some of the following in the first few weeks after starting estrogen and progesterone treatments:
- breast tenderness
- vaginal bleeding or spotting
- abdominal bloating
If you’re taking progesterone, you may also notice a dip or change in your mood initially.
If you notice certain side effects only during the two weeks you are taking the progesterone, mention this to your menopause doctor at your 3 month review appointment.
These side effects are common and are not usually cause for clinical concern as it is just a sign that your body is adjusting to the hormones and they usually only last for a few weeks.
If any vaginal bleeding is heavy, persistent or prolonged, it contains clots, or you are bleeding after sex, contact your GP to discuss this further.
Less commonly, some women experience headaches, nausea or leg cramps as a side effect of HRT, if these symptoms persist, discuss it with your doctor.
Patches: If using patches, sticky marks from the glue can be removed with baby oil and a cotton pad or dry flannel. If your skin becomes red from the patch, stick the next patch to a different area of skin. If skin irritation persists, mention this to your menopause doctor as there are often other brands to try that may not cause the same reaction.
If any side effects from your HRT have not settled down by your 3 month follow up appointment, you can discuss these further with your menopause doctor as there are often other doses, types or routes of administration that can be tried.
For most women, any side effects from HRT will resolve after 3-6 months.
Changing your HRT dose
It is common for your menopause doctor to increase the dose of estrogen after a few months to optimise symptom relief.
If your dose is increased, you may notice some side effects reappear, such as breast tenderness or bleeding but again, these should resolve after a few more weeks or months.
If you are taking estrogen in gel or spray form, you may have been given a range of possible doses, for example 2-3 pumps of gel. If you have been using the lower number of pumps (or sprays) and symptoms are still troubling you, you can increase to the higher number within the given range at any time.
Ongoing or return of symptoms
Some symptoms may not improve on the initial HRT regime provided for you. Or you may see good improvement of symptoms initially and then feel as if some symptoms creep back in over time. This can be common and does not mean that HRT is not working for you. It often means your dose may need increasing slightly or you are not absorbing the medication as well as you were. It may also mean that you might benefit from testosterone replacement alongside estrogen (and progesterone).
Whatever the reason for ongoing or returning symptoms, there are usually other options to try, so if you are not satisfied with your level of symptom relief, discuss this at your follow up appointment.
Establishing an HRT routine
If you’re using estrogen gel or spray, it’s useful to make this part of your daily routine. Apply the gel or spray at the same time every day, for example after a shower before you get dressed in the morning, or when you’re going to bed at night.
Avoid applying moisturiser or sun cream to the area within one hour of applying your gel or spray.
Don’t worry if you apply your gel or spray an hour or two later e.g. at the weekend, it isn’t usually an issue. The important factor is taking the amount prescribed for you on a consistent basis.
If you are splitting your dose of gel or spray into a morning and evening application, 12 hours is an approximate guide of time between a split dose, but this is not essential. Don’t worry if you forget and it’s not exactly 12 hours in between; a few hours either side of this doesn’t cause a problem.
If you are taking micronised progesterone, it’s advisable to take it on an empty stomach before bed as it can act as a mild sedative.
Inserts in HRT packaging
The information contained in the box of most HRT medications is often inaccurate and is based on outdated research. Don’t let the leaflet cause you unnecessary worry.
For up to date and evidence-based information about side effects and possible risks, read our range of HRT resources:
Understanding the Different Types
Last updated: June 2026
