Once you’ve decided to try menopausal hormone therapy, you’ll probably experience jitters and excitement. At this stage it’s very normal to wonder what’s coming next and how quickly you might feel symptom relief.

In this article, we talk about how long it might take for hormone therapy to start working, how to know when you’re at the right dose, and what you’ll experience as you begin.

How long does it take for MHT to start working?

There’s no one answer to this question, but our own research has shown that by four weeks of MHT, women reported a 58% reduction in the severity of their symptoms. Symptoms can begin to improve almost immediately, with some people feeling relief within a few days and most noticing improvement around the two-week mark. If you start MHT and aren't feeling some relief within two to four weeks, your medical provider wants to know—it could mean you need a different dose or a bit more time. Often, treatment leads to progressively decreasing symptom severity over the first few months.

Usually, your provider will give your initial dose at least four weeks so see whether it’s powerful enough to help your symptoms. This is because you don’t want to overdo the dosing—your provider wants to put you on the lowest dose of hormone therapy that gets you effective symptom relief.

Women typically start feeling better anywhere between two to four weeks after starting MHT. However, if there’s no improvement in symptoms at all after four weeks, they’re likely not on the appropriate dose for them. – Dr. Leah Millheiser, Chief Medical Officer

What can I expect to happen after I start taking MHT?

Occasionally, women will experience side effects before their symptoms improve. Side effects are normal when starting hormone therapy. Not everyone will experience them, but for those who do, they’ll likely dissipate within a few weeks. Some typical side effects include:

• Breast tenderness
• Mood changes
• Headaches
• Spotting or bleeding

Hang in there! When treatment starts to work, the impact of MHT should be clear. Most women experience:

• Fewer hot flashes
• Less waking up during the night
• Better quality of sleep at night
• Improved mood
• Increased energy
• Feeling like yourself again

What’s the right dose for me?

Your medical provider will work with you to determine the right dosage of medication based on the severity of your symptoms and your health history. Doses usually start low and are increased over time based on whether symptoms are improving.

If you’re getting the symptomatic relief you’re looking for on your initial dose, it won’t be increased. If you’re getting some relief but feel more comfortable staying on a lower dose, we don’t need to adjust it. Your ideal dose is something that you and your medical provider decide. It’s subjective and depends on you, your medical history, and your goals.

It’s not an exact science but really depends more on each woman’s symptoms and how they respond to the [hormone] therapy. – Dr. Leah Millheiser

Will my dosage and treatment change over time?

‍

We may discover that your initial dose is either too strong, not strong enough, or just right for you. This is why we monitor you and your symptoms closely at first. 

After four weeks on your initial dose, we may make adjustments until you feel your symptoms are more manageable, or they’re more in balance with the quality of life you want.

As you progress through perimenopause and menopause, your symptoms may change or new symptoms may appear. If your treatment is no longer working as expected, you should reach out to your provider to talk about whether a change in dosage is needed.

When should I reach out to my medical provider after starting MHT?

Because not all women respond in the same way to hormone therapy, there is no standard rule. However, here’s a guideline:

• 2 weeks, if you notice zero improvement or change
• 4-6 weeks, if you’re improved but not where you’d like to be
• Any time, if you notice new spotting or bleeding
• Any time, if you're experiencing bothersome side effects