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What to Expect When Starting Hormone Therapy for the First Time

What to Expect When Starting Hormone Therapy for the First Time

Perimenopause / Menopause Treatments
Hormone Therapy

By Elizabeth Kicko, MS-RN, CNM, PHN, WHNP-BC, MSCP, Medically reviewed by Barbra Hanna, DO, FACOG, MSCP, 10/24/2023

Congratulations! If you’re reading this, you are probably starting or considering starting hormone therapy for the first time and you are in for a treat!  Prepare for a serious reduction in hot flashes, better sleep, more focus, and more control over your life again. That being said, getting to glory does require a few weeks of patience as your body adjusts to your hormone dosing. Here is a short guide of what to expect over the first few weeks and months as you get started.

Week 1

You’ve received your prescription by now, and if you have chosen to use a patch, you have selected a place on your body where you will wear your it.   For most women, this is somewhere near the bikini line, but it is safe to apply to your lower back or belly. It is best to avoid areas where you sweat the most, areas where your clothing might create rubbing friction when you pull them on and off, and areas of excessive sun exposure. The manufacturer says the face and breasts are a bad idea, too. Your patch will sit snugly on your skin until you remove it and replace it with the next patch.

Try picking a set schedule so it is easy to remember which days you should change the patch, for example: Mondays and Thursdays, or Tuesdays and Fridays if you are using the twice-weekly version. If you forget to change your patch, you do not need to panic.  We do recommend you replace your patch as soon as you remember. Consistency is key to hormone bliss. Until then, your medication will wear off and you will probably experience a resurgence of symptoms. You may also experience spotting if you have a uterus. It’s best to try to be good at remembering to swap them out to avoid any unwanted side effects. Similarly, be sure to remove the old patch before you place the new one so as to not accidentally double your dosage. Switch the location of your patch, left to right/ side to side, with each placement to avoid skin irritation.

Your patch has a pretty good adhesive, so you shouldn’t struggle with patches falling off by mistake, but it does happen from time to time.. If you find that your patch has fallen off, you can pop it back on with a waterproof bandaid over it, or go ahead and toss it and put a new one on - just be sure to reset your placement schedule to match it.

For those of you who chose to use a gel dosed in individual packets, we recommend you apply it to your thigh, alternating thighs each day. It may be a bit sticky going on but once it dries, it provides hormone bliss! For gel users in the pump version, you are applying one pump of the gel to your arm each day.  Either way, you apply the gel, make sure you wash your hands immediately after applying it to avoid sharing your hormone therapy with a pet, loved one, or coworker.

Pro Tip:
If you find yourself having trouble with your patch not sticking, try applying it the opposite time of the day you bathe - For example, if you shower in the morning, change your patch in the evening. You can also try holding the patch in place and counting to 5 to ensure the adhesive sticks.

If you have also been prescribed progesterone/progestin, we recommend taking your progesterone before bed - progesterone can make you sleepy. Consistency of use is key to preventing unwanted uterine/vaginal bleeding or spotting in those who have a uterus.  If you forget to take your progesterone/progestin, we recommend you take it as soon as you remember. Some women experience spotting with missing even just one day.

During week one of using hormone therapy,  some lucky women enjoy improvement in their hot flashes and night sweats in as soon as 3-7 days.  However, you shouldn’t expect to see too many changes in your symptoms. Either way, sit tight, the magic is in the works!

Pro Tip:
If you are still menstruating naturally, you can avoid some unnecessary side effects from starting your medication by timing the first patch with the onset of your next menses. This is not required, but it can help your body adjust to the change in your estrogen and progesterone levels more seamlessly.

Week 2

Many women start to feel relief as early as week two, however, most women experience a temporary increase in hot flashes, skin changes (like acne or dryness), breast soreness, changes to their sleeping patterns, and night sweats. While the dosing of hormone therapy is much, much lower than starting a new birth control pill or early pregnancy, the process is similar. Your body just needs a moment to adjust to the subtle increase in estrogen and then things will calm down.

Estrogen slowly enhances blood flow back to places where it has been receding from the process of menopause. This means you might experience some hair loss as damaged hair follicles shed and are replaced by healthier ones. Your skin may start producing more oil again (ultimately a good thing!), so you may need to change up your skincare routine as you welcome back more supple skin. Vaginal tissue will start to also receive better blood flow, meaning more lubrication and discharge. You should begin to notice better sleep by the end of week two.

Pro Tip:
If you have a uterus, you should be taking progesterone/progestin in tandem with your estrogen, unless you have an active progestin IUD like Mirena or Liletta.   Women without a uterus may skip this part of the treatment, however, natural progesterone can help with sleep. If your sleep is not improved using estrogen alone, you can consider also taking progesterone.

Weeks 3-6

By now, bothersome side effects from starting your treatment will start to normalize, and you should start really enjoying the benefits of your hormone therapy. This is the window where it becomes clear if your dosing needs an adjustment. Most women find that their starting dose is pretty perfect, however, menopause is dynamic. Estrogen and progesterone will naturally fluctuate up and down as you approach and pass through menopause, and we expect to need to adjust your dosing up and down to match those changes. Part of your care with us will include checking in to make sure you are well covered. We are here to help make adjustments and suggestions any time you need them. Many women ask us if they should get blood work done to test their hormone levels as things change, but the research shows that using a symptom-based approach to determine your dose is the most effective way to manage symptoms.

Weeks 6-12

Here you are, practically forgetting what it was like to wake up drenched in sweat. You’re getting better sleep, your skin and hair feel healthier, and you might even see that doing a regular workout routine is kicking back the benefits more readily than before. You’re looking and feeling good, sister! Around week 8-10, you’ll get a notification to schedule an appointment with one of the specialists from MyMenopauseRx (since your brain fog is lifting- you are so much more on it!) so that we can get your next refill in place before you open up that last box of patches or gel.  At this time, we will reassess your symptoms using the Menopause Rating Scale and work together to decide if we need to adjust your dose, add any useful supplements, or check any blood work. From here on out, we will continue to be available to you for questions and adjustments, and we will request a check-in at 6-month intervals to reassess your progress, get the scoop on any changes to your medical and mental health, and help remind you about other healthcare screenings you may benefit from. Generally speaking, you should get bloodwork done every 1-2 years (more often if you have heart disease, diabetes, or other health issues like thyroid problems), cancer screenings like breast, cervical, and colon at regular intervals, and vital signs, like your blood pressure and weight should be regularly monitored. We are here for you and excited to partner with you in your wellness journey.

Pro Tip:
Mail-order pharmacies and some retail pharmacies can take a bit to get your hormone prescriptions filled and ready for you to pick up. So you don’t run out of patches, gel, or capsules/tablets, we recommend booking your follow-up appointment at MyMenopauseRx at least 2 weeks in advance of your running out of your medication(s).

What If I Don’t Feel Like All My Symptoms Are Under Control?

Many women are in love with their treatments, but find that not every symptom is being perfectly ironed out. Talk to us and we can strategize what lifestyle modifications, treatment adjustments, supplements, or combination therapies might make a difference. Sleep, sex, weight, and mental health are big ones that often need a little more TLC. If you aren’t feeling just right- talk to us. We are here to help

The content is meant for educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Please seek the advice of your physician with any questions you may have regarding a medical condition.