When is hormone replacement therapy recommended for perimenopause?

Perimenopause is the transition before menstrual periods stop. Hormone levels can change unevenly, so symptoms may appear while periods are still happening. Hormone replacement therapy replaces oestrogen, with a progestogen added when needed to protect the womb lining. It can be given as tablets, patches, gels, sprays, or local vaginal treatment, depending on the symptom and medical history.

A clinician considers symptom pattern, menstrual status, migraine history, blood pressure, clotting or liver problems, and personal or family history of hormone-sensitive cancers. Treatment is individualised; it is not automatically suitable for every person with perimenopause.

Keep a brief record of bleeding, sleep disruption, hot flushes, mood changes, and vaginal or urinary symptoms. Arrange a consultation if these problems interfere with work, relationships, exercise, or rest. Bring a list of medicines and describe any previous reaction to hormones.

Ask which formulation fits your symptoms and whether contraception is still needed, because hormone replacement therapy does not reliably prevent pregnancy during perimenopause. Review the plan after starting treatment so dose, route, and symptom response can be reassessed.

Seek prompt medical assessment for very heavy bleeding, bleeding after sex, bleeding between periods, or a new persistent change in your bleeding pattern. Urgent help is needed for chest pain, sudden breathlessness, one-sided leg swelling, sudden weakness, or a severe allergic reaction after treatment.

Unexpected bleeding after starting hormone replacement therapy should be reported, particularly when it continues or returns after an initial adjustment period. A clinician may need to examine the cervix, review the womb lining, or change the treatment.

Ask: Which symptom is treatment intended to improve? Do I need oestrogen with a progestogen? Which route is safest with my health history? How will bleeding be monitored? What non-hormonal options could I try?