# How to start HRT: what to ask your GP · Unpaused > Source: https://unpaused.cc/articles/how-to-start-hormone-replacement-therapy Hormone therapy ## How to start HRT Book an appointment with your GP when menopause symptoms bother you. You share your history, decide together, and choose an HRT type based on your periods. By Ines Kovac. Published 20 October 2026\. 7 minute read. ### How to start HRT in practice A GP should explain the benefits and risks of HRT and help you decide whether it is suitable ([NHS: when to take HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/when-to-take-hormone-replacement-therapy-hrt/)). Fill in the [menopause symptom checklist to print for your GP](/articles/menopause-symptom-checklist-to-print-and-take-to-your-gp) and take the sheet with you. It records how often each symptom happens, how much it bothers you from 1 to 10, and the effect on sleep, work and mood. When flushes or night sweats are the reason for the visit, the [hot flush and night sweat diary](/articles/hot-flush-and-night-sweat-diary-log-episodes-and-triggers-for-your-gp) prints the episodes and the triggers you suspect. ### How to get hormone replacement therapy The NHS advises you to see a GP if you are over 45, have menopause symptoms, and are considering HRT. The advice is the same if you are under 45 and have these symptoms, because that can be early or premature menopause ([NHS: about HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/about-hormone-replacement-therapy-hrt/)). The [early menopause](/articles/early-menopause) guide explains how that diagnosis is made under 45. You do not need to wait until your symptoms are severe, or until your periods stop completely. If you are unsure of the stage, the [perimenopause or menopause stage checker](/articles/perimenopause-or-menopause-a-stage-checker-from-your-age-and-your-last-period) applies the calendar rules for age and the last period. Tell the GP if you use hormonal contraception. The HRT you are offered depends on two things: whether you still have periods, and whether you have had a hysterectomy ([NHS: menopause treatment](https://www.nhs.uk/conditions/menopause-and-perimenopause/treatment/)). Patches, gels, sprays, tablets and progestogen schedules are set out in the [HRT forms guide](/articles/hormone-replacement-therapy-for-menopause). ### Before the appointment: what to bring The checklist already asks about your periods. Alongside it, write down every prescribed medicine, anything you buy over the counter, and herbal supplements. Readers who describe getting ready for this visit talk about a short list of what bothers them most, and how it hits sleep, work or mood. That is what readers report. Bleeding and other symptoms the NHS says to raise sooner are on the checklist page, with the NHS wording for when to get in touch. ### What happens at the GP appointment If you are 45 or older and your symptoms are typical, NICE says the diagnosis rests on those symptoms, with no confirmatory lab test ([NICE quality standard 143](https://www.nice.org.uk/guidance/QS143/chapter/Quality-statement-1-Diagnosing-perimenopause-and-menopause)). Follicle-stimulating hormone (FSH) does not help at that age, because levels fluctuate in perimenopause and the result would not change management. CKS says not to use FSH routinely in otherwise healthy people aged 45 or over with typical symptoms ([NICE CKS: diagnosing menopause](https://cks.nice.org.uk/topics/menopause/diagnosis/diagnosis-of-menopause-perimenopause/)). Blood tests such as FSH are not required for that diagnosis in this age group ([NICE CKS: menopause assessment](https://cks.nice.org.uk/topics/menopause/diagnosis/assessment/)). If you were told to wait for a blood test first, those are the rules for this age and this symptom pattern. NICE expects the clinician to discuss each option with you: the HRT type, the route, the dose, and how long you might take it ([NICE NG23 recommendations](https://www.nice.org.uk/guidance/NG23/chapter/Recommendations)). NICE also says that, overall, combined HRT or oestrogen-only HRT is unlikely to affect life expectancy. Your own history still changes the balance. The extra cases per 1,000 women are in [HRT risks in plain numbers](/articles/hrt-risks-in-plain-numbers-breast-cancer-clots-and-stroke-per-1-000-women), and the [HRT risk picker](/articles/hrt-risk-picker-extra-cases-per-1-000-women-by-hrt-type-age-and-years-of-use) sorts those counts by type, age and years of use. If you still have a womb, oestrogen is paired with a progestogen. Sequential and continuous products are explained in the forms guide linked above. A GP will usually recommend a review at three months, or after a change of type, then yearly if all is well. CKS says to bring that review forward if treatment is not helping or side effects appear ([NICE CKS: managing menopause](https://cks.nice.org.uk/topics/menopause/management/management-of-menopause-perimenopause-or-premature-ovarian-insufficiency/)). ### Questions to ask your GP Take this list into the appointment. * Which type should I take while I am still having periods, and do I need a progestogen because I still have a womb? * If tablets worry me, which route should we talk about? * What should I watch for before the review? * When is that review? * What if the symptoms have not improved by then? * What are the other options if HRT is not suitable for me? If low mood is the main reason for the visit, read [HRT, anxiety and low mood](/articles/depression-and-hormone-replacement-therapy) before you go. That guide covers mood symptoms, and it explains when an antidepressant is part of the plan. ### Hormone replacement therapy near me On the NHS, care near you starts at the GP practice where you are registered. The hormone replacement therapy provider to ask for, if you are referred, is a healthcare professional with expertise in menopause. An endocrinologist for hormone replacement therapy is a common search. For a routine start, NICE recommends referral to a clinician with expertise in menopause. People with early menopause or premature ovarian insufficiency are sometimes referred to another specialist. The early menopause guide explains that work-up. In the United States, The Menopause Society publishes a Find a Practitioner directory ([The Menopause Society: find a practitioner](https://portal.menopause.org/NAMS/Directory/Menopause-Practitioner.aspx)). It gives contact details for members and for Menopause Society Certified Practitioners (MSCPs) who asked to be listed. The Society says this is not a complete list, and that it does not endorse or recommend the people on it. If a clinic is offering compounded hormones, read [bioidentical and compounded hormones](/articles/bioidentical-hormone-replacement-therapy) before that appointment. ### If HRT does not help or is refused If the treatment has not improved your symptoms, or side effects are still there, NICE says the GP should refer you to a menopause specialist. Consider that referral when HRT is contraindicated, or when there is uncertainty about the most suitable option. CKS says a specialist referral should be offered if symptoms are ongoing despite treatment ([NICE CKS: menopause](https://cks.nice.org.uk/topics/menopause/)). You can ask the same practice for another appointment, including with a different clinician. Some people writing about a first NHS visit describe being offered an antidepressant before HRT was discussed. The mood guide above explains what the guideline says about that choice. Starting, changing or stopping a prescription is a decision for your GP or a clinician with menopause expertise. ### What happens after you start Once you have started HRT, the next planned check is the follow-up you agreed at the first visit. The guide on [how long HRT takes to work](/articles/how-long-does-it-take-hormone-replacement-therapy-to-work) explains how symptoms tend to change in those months, and which effects often ease. The guide on [NHS and US HRT costs](/articles/does-insurance-cover-hormone-replacement-therapy) covers prescription charges in England and US insurance. If the sheet is still blank, fill it in and take the printout to the appointment. The [hormone therapy topic hub](/topics/hrt) collects the other guides. ### My take I would start with an appointment at the GP practice you are registered with, and I would take the filled-in checklist. I would judge that visit by two things: a date for the review, and a named next step if this type has not helped by then. ### Sources * [NHS: when to take HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/when-to-take-hormone-replacement-therapy-hrt/) * [NHS: about HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/about-hormone-replacement-therapy-hrt/) * [NHS: menopause treatment](https://www.nhs.uk/conditions/menopause-and-perimenopause/treatment/) * [NICE quality standard 143](https://www.nice.org.uk/guidance/QS143/chapter/Quality-statement-1-Diagnosing-perimenopause-and-menopause) * [NICE CKS: diagnosing menopause](https://cks.nice.org.uk/topics/menopause/diagnosis/diagnosis-of-menopause-perimenopause/) * [NICE CKS: menopause assessment](https://cks.nice.org.uk/topics/menopause/diagnosis/assessment/) * [NICE NG23 recommendations](https://www.nice.org.uk/guidance/NG23/chapter/Recommendations) * [NICE CKS: managing menopause](https://cks.nice.org.uk/topics/menopause/management/management-of-menopause-perimenopause-or-premature-ovarian-insufficiency/) * [NICE CKS: menopause](https://cks.nice.org.uk/topics/menopause/) * [The Menopause Society: find a practitioner](https://portal.menopause.org/NAMS/Directory/Menopause-Practitioner.aspx) Written by Ines Kovac Menopause guides: symptoms, HRT, sleep and everyday changes Ines Kovac writes the practical guides on Unpaused: perimenopause, symptoms, hormone therapy, sleep, hot flushes and weight. She builds each piece from NHS and NICE pages, The Menopause Society's position statements and the studies behind them, and links every claim a reader might want to check. She says plainly what the evidence supports and where it runs out, and she never tells a reader to start or stop a medicine. Corrections are added to the page that had the error. [ikovac@unpaused.cc](mailto:ikovac@unpaused.cc) Last checked 2026-10-20 --- Plain, practical menopause advice Plain, practical guides to perimenopause and menopause: symptoms, hormone therapy, sleep, hot flashes, weight and food, each checked against health services and medical societies. [desk@unpaused.cc](mailto:desk@unpaused.cc) ### Topics * [Perimenopause](/topics/perimenopause) * [Symptoms](/topics/symptoms) * [Hormone therapy (HRT)](/topics/hrt) * [Hot flashes](/topics/hot-flashes) * [Sleep](/topics/sleep) * [Weight and diet](/topics/weight-and-diet) * [All guides](/articles) ### About us * [About](/about) * [Authors](/authors) * [Editorial policy](/editorial-policy) * [How we make money](/how-we-make-money) ### Legal * [Terms](/terms) * [Privacy](/privacy) * [Contact](/contact) Unpaused © 2026 Unpaused. General health information, written from sources we link. It does not replace advice from your own doctor, nurse or pharmacist. [How we make money](/how-we-make-money) [Editorial policy](/editorial-policy) [Who writes here](/authors)