Hormone therapy
How long does HRT take to work?
Many menopause symptoms start to ease within a few days or weeks. Side effects are often mild, and the first dose review is when full benefit is usually judged.
How long before hormone replacement therapy starts to work
Many menopause symptoms should start to improve within a few days or weeks of taking HRT (NHS: benefits and risks of HRT). It can take up to three months for HRT to work fully (NHS: common questions about oestrogen).
On oestrogen tablets, patches, gel and spray, it may take a few weeks before you notice symptoms improving. It is best to keep taking the oestrogen for at least that long, if you can, to see whether it helps (NHS: how and when to take oestrogen). A hot flush can ease while sleep or mood has hardly changed. The NHS gives one timing for symptoms as a group, so I would track them until the review and look at them together.
Hot flushes, sleep, mood and vaginal dryness all sit in that symptom group. NICE calls HRT the most effective treatment for hot flushes and night sweats (NICE: menopause guideline). For those two symptoms, that is what the guideline means by a treatment that works.
I would write down which symptoms improved first and which side effects are still a problem, and bring that to the review. Print the menopause symptom checklist for your GP and take it to that appointment. If the review is about flushes, print a week from the hot flush diary and take it in. The length of menopause is a separate question, answered in how long menopause lasts.
The three-month review and what happens next
A GP will usually book a review about three months after you start HRT, or if you change the type, to see how well it is working (NHS: about HRT). NICE says to review treatments for menopause symptoms at this first appointment, to see how well they work and how well you tolerate them. After that, the review is once a year, unless treatment is not helping or side effects mean you need to be seen sooner (NICE menopause recommendations).
The NICE clinical knowledge summary uses the same timing after HRT is started or changed, and an earlier review when treatment is ineffective or causes adverse effects (NICE CKS: managing menopause). If you do not feel better by that appointment, speak to your doctor about changing the dose or the type.
For patches, gel, spray, tablets and local vaginal oestrogen, read what HRT is and the forms it comes in. Bring the checklist if you have been marking how often each problem happens.
HRT side effects: what to expect in the first weeks
HRT side effects are common. The NHS describes them as usually mild, and says they often pass within three months of starting treatment (NHS: about HRT).
Oestrogen is linked with headaches, breast pain, bleeding, nausea, mood changes, leg cramps, rashes, diarrhoea and hair loss. Progestogen is linked with period changes, breast tenderness, tiredness, dizziness and acne, and it shares headaches, nausea, mood changes and rashes with oestrogen (NHS: HRT side effects).
A new headache or low mood can feel like menopause symptoms returning. Mood changes, including ones that start after treatment, are covered in HRT, anxiety and low mood. Hair loss listed with oestrogen is covered in HRT and hair thinning. Many of these side effects fade after the first few weeks.
How long HRT side effects last
Headaches linked to oestrogen usually last only a few days after you start, while your body gets used to the medicine (NHS: oestrogen side effects). Breast pain or tenderness usually improves after a few weeks.
Irregular vaginal bleeding or spotting is common for the first three to six months after starting HRT, and it usually settles within six months.
It is a good idea to carry on at least until the review, if you can, because these effects often improve over time (NHS: HRT side effects). Women writing about their own first months on HRT describe very different timing. Some notice a change sooner than the NHS window, and others describe another long wait after a dose increase.
Hormone replacement therapy dose
If someone chooses HRT, NICE says to use the lowest effective dosage (NICE CKS: HRT prescribing). At the review, NICE's summary on managing menopause says to check for bothersome effects, such as breast tenderness, mood swings, fluid retention or irregular bleeding, and for symptoms that have not eased. A change of dose or preparation is offered when one of those is a problem.
Fluid retention is one reason people ask about weight. The trials are covered in whether HRT causes weight gain.
A different preparation can be another progestogen, or another way of taking the oestrogen, such as moving between tablets and a patch, gel or spray. How the way you take oestrogen relates to clot risk is explained in HRT risks in plain numbers.
Readers who write about a dose change often describe waiting eight to twelve weeks before they ask again. That wait is what readers report, not an NHS rule. I would contact a GP sooner if a side effect is severe.
When to call your GP sooner
Speak to a GP if side effects are severe, or if they are still there after the review (NHS: HRT side effects). Mention irregular bleeding at that appointment. If spotting has not settled within six months, contact your GP.
If nothing has improved by the review, ask about a change of dose or type. Changing the prescription, or stopping it, is a decision for your GP or a menopause clinic. More hormone therapy guides are on the hormone therapy topic hub.
My take
I would note the review date on the day the prescription starts. I would judge the result by the symptoms that took you to the GP, and by any side effect that still wakes you at night or makes a working day hard.
If hot flushes have eased and mood has not, I would ask at the review whether the dose should change. Read HRT, anxiety and low mood before the appointment, so you have the mood facts ready.
Sources
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