What to expect from hormone replacement therapy for perimenopause

Perimenopause involves changing ovarian hormone levels, so periods may become irregular while symptoms fluctuate. HRT can replace some hormones and may help flushes, night sweats, sleep problems and vaginal discomfort. It is not a contraceptive, and pregnancy can still occur while periods continue.

The regimen may use oestrogen with progestogen when a womb is present. Breast tenderness, headaches, bloating and spotting can appear after starting or changing treatment, then may settle.

Tell the clinician about migraines, clots, liver disease, breast or womb conditions, medicines and pregnancy plans. Discuss a separate contraceptive method and whether it can be used alongside HRT. Record bleeding and symptoms so the dose and formulation can be reviewed rather than changed without advice.

Seek urgent help for sudden breathlessness, chest pain, coughing blood, one-sided leg swelling, or sudden neurological symptoms. Arrange prompt review for heavy or persistent bleeding, a new breast change, severe headache or yellowing of the skin.

Ask how HRT will affect bleeding, which contraception is compatible, when symptoms should be reviewed, and whether your migraine pattern changes the choice of treatment.