When should you start HRT?

The best time to start HRT is usually when symptoms start affecting your life, not at a fixed age. Starting before 60, or within about ten years of your last period, gives you the most favourable balance of benefit to risk.

There is no magic birthday for HRT. UK guidance from NICE supports starting it for women with troublesome perimenopausal or menopausal symptoms, and you do not have to wait until your periods have stopped completely, which catches many women out. If hot flushes, broken sleep and mood changes are disrupting your perimenopause, that is already a valid reason to talk about it.

Timing matters because of what is often called the window of opportunity. Starting HRT under 60, or within roughly ten years of your final period, is when the benefits of symptom relief, bone protection and a more favourable effect on the heart and blood vessels most clearly outweigh the small risks. Start much later and that balance shifts, which is why later starts call for a more individual conversation.

Signs it is worth raising with your GP now rather than waiting:

• Hot flushes or night sweats that disrupt your sleep or your day
• Mood changes, anxiety or brain fog that feel out of character
• Periods becoming erratic alongside new physical symptoms
• Vaginal dryness or discomfort during sex, often helped by local oestrogen, which is separate from systemic HRT
• Early menopause under 45, or premature menopause under 40, where HRT is usually recommended at least until the average age of menopause to protect bone and heart

For some women the conversation is genuinely different. A history of certain breast cancers, or of blood clots, changes the calculation, and your doctor will weigh the route (patches and gels carry lower clot risk than tablets) and the dose accordingly. That is careful medicine, not a reason to assume HRT is not for you.

What to do: if symptoms are affecting your work, sleep, relationships or mood, that is your signal. Bring it to your GP rather than waiting for a number on the calendar, and walk in with a record of your symptoms. The daily tracker makes that easy and turns a vague "I don't feel right" into something your doctor can act on.