HRT for perimenopause: what to ask your doctor and what to bring
Hormone therapy (HRT, also called MHT) is the most effective treatment for hot flushes and night sweats, and current guidelines consider it appropriate for many women in perimenopause. For healthy women under 60 or within 10 years of menopause, The Menopause Society says the benefits generally outweigh the risks for bothersome symptoms. The best appointment is a short one with good data: your symptoms scored over a few weeks, your cycle dates, what you've tried, and a few specific questions.
What to bring
- Symptom scores over 2–8 weeks, not a memory. The Menopause Rating Scale (0–4 for 11 symptoms) is a recognised format.
- Period dates for the last 6–12 months, including skipped months.
- Your top three symptoms and how they affect sleep, work and relationships.
- What you've tried — lifestyle changes, supplements, medicines — and the effect.
- Your history: migraines with aura, blood clots, breast cancer in you or close relatives, liver disease, high blood pressure.
MenoShift builds this as a one-page PDF: stage, Menopause Rating Scale by month, cycle dates and gaps, treatments and their effect, and five questions for the visit.
Questions worth asking
- Given my stage and symptoms, which treatment options apply to me — hormonal and non-hormonal?
- Would you recommend estrogen through the skin (patch, gel, spray) or tablets, and why?
- Which progestogen would protect my womb lining, and should it be cyclical or continuous while I still have periods?
- What should I expect in the first three months, and when do we review?
- Should we check anything else — thyroid, iron, blood pressure, bone health?
- What would make us change or stop the treatment?
Types of hormone therapy, in brief
| Component | Forms | Notes |
|---|---|---|
| Estrogen | Patch, gel, spray, tablet | Through-the-skin forms do not raise clot risk the way tablets can |
| Progestogen | Micronised progesterone, hormonal IUD, tablets | Needed if you have a womb, to protect the lining |
| Vaginal estrogen | Cream, pessary, ring | Low-dose, local; for dryness and bladder symptoms; can be used long-term |
| Testosterone | Gel or cream (off-label in many countries) | Considered for low libido when HRT alone hasn't helped |
What guidelines say about risks
- Breast cancer: combined HRT is associated with a small increased risk that grows with duration; estrogen-only HRT has little or no increase. Your clinician can put numbers on this for your situation.
- Blood clots and stroke: higher with tablet estrogen; transdermal estrogen at standard doses does not appear to increase clot risk.
- Benefits beyond symptoms: HRT prevents bone loss and reduces fracture risk.
- Timing matters: starting before 60 or within 10 years of menopause gives the most favourable balance.
If HRT isn't for you
Non-hormonal options include fezolinetant (for hot flushes, where approved), certain antidepressants, gabapentin, CBT for menopausal symptoms, and vaginal moisturisers and lubricants. NICE also highlights CBT for low mood and anxiety in the transition.
MenoShift turns a 20-second daily check-in, your cycle and your Apple Watch nights into a plain explanation of the day — with the source. No account; nothing leaves your phone.
Download MenoShift on the App StoreFAQ
Can I take HRT while I still have periods?
Yes. In perimenopause HRT is often given as a cyclical regimen, with a monthly bleed. Your doctor will choose the regimen.
Do I need blood tests before HRT?
Usually not if you are over 45 with typical symptoms; diagnosis is based on symptoms and cycles. Tests may be used under 45 or in special situations.
How quickly does HRT work?
Many women notice hot flushes easing within a few weeks; full effect can take up to three months. A review is usually planned around three months.
Is it safe to take HRT long term?
There is no fixed time limit in current guidelines; the decision is reviewed with your clinician based on your symptoms, benefits and personal risks.
Sources: The Menopause Society, 2022 hormone therapy position statement; NICE guideline NG23 (2024 update); British Menopause Society tools for clinicians; Menopause Rating Scale (Heinemann et al., 2004).
Related
This guide is general information, not medical advice. If symptoms worry you — especially bleeding after 12 months without a period, very heavy bleeding, or chest pain — see a clinician.