How do you know when you need to start HRT?

[vetprob]

Just that really. I had bloods done a couple of years ago to test my hormones and they predicted my menopause will come at age 52 (in about 5 years time). Obviously peri is probably in full swing - or is it? I'm assuming here.

I'm pretty tired these days, can't seem to stay up very late. And brain fog is definitely a thing (but it has been since DS arrived 13 years ago tbf 😄).

Other than that no real symptoms as such.

Any advice?

It’s nothing hormonal related ( I have a friend that works in a blood lab and she said they’re basically ruling out that it could be anything else ) renal, liver function, thyroid , prolactin, reading from the list . These are all standard apparently .
My hormone levels aren’t being measured or tested , but this is because I’m over 45 , according to the nurse I spoke to on the phone it’s standard to be offered HRT for my symptoms as they’re all screaming menopause

Everyone's different. It you are feeling OK, then you might never need HRT or be happy to manage your symptoms in other ways. Whether you are 42, 52 or 62. On the other hand, if you are suffering from symptoms caused by menopause, then you should consider HRT, whether you are 42 or 52. I would not put any faith in a one off blood test which predicted a definite point for the menopause.

Vaginal atrophy, or genito-urinary syndrome of menopause, causes you to feel dry and itchy, increase likelihood of UTIs, makes sex painful, lower abdo pain, urinary incontinence.... And it's all resolved with twice weekly cream for most women.

Honestly, @vetprob forget the "52" prediction which is just nonsense. If you feel you would benefit from systemic HRT with patches or gel, or from topical vaginal estrogen - SEE YOUR GP.

I’m 54 and am lucky to have no symptoms at all. I asked my doctor if I should take HRT and they said no. However I don’t want to be in a situation in 20 years time where my health will have been impacted by not taking it. I saw a specialist privately who gave me some common sense advice. To take the HRT and if I felt worse, to stop, but if I felt the same or better, to carry on. I’m about 8 months in. On just 1 pump of oestrogen and I take progesterone at night. I don’t feel any better but certainly don’t feel worse so I’m happy to carry on.

Periods went haywire (every 10 days, nothing for 3 months, flooding etc). I felt…just flat all the time, zero joy about anything ever. Or I was utterly raging or crying at toilet roll ads 🤦‍♀️
Brain fog, joint pain, dried up lady bits, weight gain, wanting to murder my DH for existing.
After several….skirmishes with the GP, I saw a private specialist and got HRT. Game changer. All symptoms resolved, I am myself again.

Nailed it, with possible addition of not caring about anything much at all and half considering that death might be a blessed release

@rainydaysawaynailed it.

@rainydaysaway yes! Oh my days - and I did not want to take my dog either! How mean of me

When I experienced absolute rage for the first time ever in my life. I had never felt so out of control of my emotions. Luckily it was just in front of Dh, I then promptly burst into tears. As we have been together 30 years he knew that this was peri.

Add into it, brain fog, can't find words, memory issues, I now add things into a list in my phone otherwise I would forget things. Joint pain, adrenaline floods for no reason followed by the crash as my body resets. I started to get anxious about driving even locally even though I would describe myself as a confident driver. Then dry hot flushing which means no sweating but just hot then fine then hot, repeat.

Throughout all of this which has gone on for 4 years my periods are still regular and I am just turned 52. My lovely older sister advised me to go when the symptoms got too much but before I committed homicide. Even though I have listed everything above it was small stuff but the hot flushing was bad.

I had a blood test last week just to check my thyroid level and have just started HRT. I am hoping it gives me back my confidence and drive, I just feel a bit flat.

My symptoms really aren't that bad compared to what I read here - just some night sweats, poor sleep & noticing cycle length changing. But I decided to try it as I'm higher risk for alzheimers and the current research suggest it can lower risk (https://www.nature.com/articles/s41582-025-01149-9). Plus - I don't want to get crazy mood swings and brain fog so thick I can't see through, not if I can help it.

Although if @rainydaysaway is right I should have been on it since I was about 14! 😄

This was me. Exactly. Even the age. I’m a marathoner who’d never experienced plantar fasciitis until menopause! Started HRT. Pain gone. Joints fine. Sleeping. Moods ok. It’s like some wonder drug.

I’m here to push vaginal Oestrogen even if you don’t need or want more general hrt. It’s low dose as topical and therefore very safe.
I left it too late and the vaginal / vulval discomfort was driving me so mad it took me quite a while to work out what was irrelevant, what was making it better, what was making it worse. Wish I’d been tipped off to deal with it sooner.

what I eventually learned:

The pessaries can feel irritating if you’re already irritated. Can be worth persevering.

the cream comes with one applicator that is very hard to wash as the cream is greasy and it gave me thrush.

the vulva can be very dry and cracked and if, like me, youre generally prone to dry skin just treat it with whatever cheap unperfumed thick moisturizer you already slather on other dry body parts. Dont be shy.

dont be scared of a little hydrocortisone to calm it all down on the vulva.

wash with aqueous cream. No soap.

careful with your washing powder. As little perfume as you can find.

love your fanjo. Dont ignore it if it’s even a teeny bit grumpy. Moisturize it, air it, check if you have thrush or dry skin or what and do something as fast as you can.

So I had no periods for years due to mirena but these were symptoms

Early symptoms - niggling joint issues eg carpal tunnel in wrist, plantar facitiis. I didnt connect thrn
to menopause.

Next lot of symptoms - headaches and total lack
of libido.

Next lot - hot flushes and night sweats.

I felt like I was broken. And needed to quit my job as I just couldn't string a sentence together or form a sensible thought in my head.

For those of you on HRT, particularly the oestrogen gel, does it mess with your weight?

I was pre diabetic and have managed to shift three stone but need to lose the same again. It’s slow going at 50, but weight loss injections aren’t for me. I’m loathe to touch HRT if it will put the weight back on - it’s been a slog to get here!

My periods are regular and back to normal.
I started sleeping through the night again - and if I get woken for some reason I can get straight back to sleep. I used to wake at 2-3am and was awake till the morning. I had no idea my insomnia was linked to hormones!
The sweating stopped - I’m a bit odd because mine was during the day, my back would get damp with even a short walk!
I feel like a different person in terms of mood, I get stressed less easily and the anger I felt for the couple of years before I started HRT disappeared!
My itchy skin stopped. It had been driving me crazy!

I've only lost weight since I've been on HRT. For me, the help it gave me with sleep, tackling aching joints & general improved energy made it easier to exercise & manage my diet

Yes, unfortunately the one downside for me was that I put a lot of weight on after starting HRT, with no change in diet/ exercise (I exercise a lot). I found it absolutely impossible to lose even eating very low calorie until I went on WLI.

It varies from person to person though, so you might be one of the lucky ones.

For those of you on HRT, particularly the oestrogen gel, does it mess with your weight?

No.

Been on it for over 15 years and same weight as before (not overweight.)
I do have to be very careful with what I eat and am low-carb most days.

the cream comes with one applicator that is very hard to wash as the cream is greasy and it gave me thrush.

@Newstartplease24 This came up before by another poster and the point was made (by another poster) that you only need wash the outer tube carefully as the inner plunger doesn't touch your skin (or only the very end of it.) If you separate the two parts of the applicator it's really easy to wash it under the tap.

Aah thank you @purplescissors @JinglingSpringbells @Theeyeballsinthesky

WLI are definitely out for me unfortunately. I lost my weight on keto and am now attempting low carb. May revert to keto again but I’d rather not as it’s a PITA.

I’m 50 and honestly, I’m not sure what symptoms are due to the menopause and what are due to other issues. I’m AuDHD and care for multiple people so I’m also burnt out.

Lifelong anxiety (probably secondary to AuDHD) but it’s definitely peaking randomly some days. Lots of joint pain - I tore my rotator cuff recently from doing almost nothing. I get very hot at times but not sweaty. Itchy skin. Low on patience - I’ve really struggled recently (DM with dementia and cerebral palsy who lives in the annexe and two DC with high needs SEN who are with me 24/7).

Im not sure if HRT would help or if it’s just me and my life that’s the problem. I had the cream prescribed for me six months ago and I look at it every day wondering if I should start it 😂🫣

@vetprob

To answer your question re HRT - it is symptoms based. Women tend to get symptoms in peri and it affects everybody in a different way, and we all decide how much of whatever symptoms combination is too much.
For me - it was extreme tiredness, early waking (despite tiredness), and waking up hot. In general - i felt off and did not like it.
Was still having periods, so it was all peri-.

As to the test you took - don’t put too much weight on the result. Those tests measure ovarian reserve at the moment of testing. They are most precise for predicting impending menopause, or early menopause - if a younger woman has low reserves.
Whet they could tell you then - that you were not having it in the next 1-2years. Beyond that - the margin of error on those tests is 4-12 years. So they are pretty imprecise.

As to ‘what hormones to use when it happens’ - no test tells you that. OR, rather - it’a simpler and more complicated at the same time. Simpler - because the hormones are the known bit - you’ll need oestrogen and progesterone. (Unless you have hysterectomy). Some add testosterone, but not immediately. But them are the hormones for all.

Dosage is a different story. And no test can predict years before menopause which dose you’ll need. It’s symptoms based and your condition at the time - based.

Hope that helps. Doesnt sound like you need HRT yet, and maybe you’ll be the lucky one and have no symptoms.

You don't, because not everyone "needs" to take it, and lots of us are very happy to never take it.
If and when you reach a point where any symptoms become unmanageable, then you see a doctor and take it from there.
But if you are fortunate and your symptoms are mild, or non-existent, then that day will never come, and you will never need to consult any medical professional about menopause.
So keep your fingers crossed, and you might be lucky!

Surely you don’t need to take it until you have symptom that require it? I wouldn’t waste my time thinking about it unless it happens.

I was on the depo provera for 10 years, with no periods. Stopped taking it over 2 years ago aged 49. Didn't have any bleeding for 8 mths. Then my periods came back. Mixture of heavy, long, then light and short, then spotting. And in the last year I've had roughly 6 days of spotting over 2 mths.

This ‘nurse’ ripped you off. Is this in the Uk? Tests over 45 are irrelevant and HRT should be based on symptoms. Hormone test fluctuate too much for anyone in the world to predict an age.