Starting hormone therapy for perimenopause or menopause: the first visits, labs and months

What the process looks like, in brief

Starting hormone therapy for perimenopause or menopause usually happens in stages: a consultation about your symptoms, history and risks; lab work; a review of the results and a decision about whether therapy fits you and in what form; and then scheduled follow-up visits and labs so the dose can be adjusted. The decision belongs to you and a licensed provider together, because hormone therapy has real benefits for some women and real risks for others.

I am Jennifer Simon, BSN, RN, RFNP, Chief Operating Officer of ReGen & Aesthetics Concierge of Texas in Dallas, where our nurse practitioners run a women's bioidentical hormone therapy program. This guide walks through what starting looks like, in our practice and in general. It is educational information, not medical advice. Talk to your own provider about whether hormone therapy is right for you.

The symptoms that usually bring women in

MedlinePlus, the National Library of Medicine's consumer site, describes hot flashes and sweats as usually at their worst for the first one to two years after the last period, and lists vaginal dryness, sleep problems, anxiety, and moodiness or irritability among the symptoms hormone therapy is used for. In our consultations, women also often describe changes that are harder to name.

Many of these symptoms can have other causes, including thyroid problems, iron deficiency, depression, sleep disorders and medication side effects. That is one reason a careful evaluation includes labs and a full history, rather than a prescription based on a checklist.

• Hot flashes and night sweats
• Poor sleep or waking at night
• Brain fog, forgetfulness or low motivation
• Mood swings, anxiety or irritability
• Vaginal dryness or lower libido
• Weight gain that does not respond the way it used to
• Irregular periods, dry skin or thinning hair

Perimenopause or menopause: why the stage changes the conversation

Perimenopause is the transition before periods stop, and it can last for years. Menopause is generally defined as twelve months in a row without a period. The distinction matters because symptoms, cycles and hormone levels behave differently in each stage. During perimenopause, levels can swing from week to week, so a single lab result is a snapshot rather than the whole story, and irregular bleeding needs its own evaluation.

Tell your provider where you think you are: whether you still have periods, how regular they are, when the last one was, and whether you have had a hysterectomy or ovaries removed. Those answers shape which hormones are discussed, whether progesterone is needed, and how your follow-up is planned. If you are not sure which stage you are in, that is fine. Working it out is part of the first visit.

Stage one: the consultation

The first visit is mostly listening. Your provider asks about your symptoms and when they began, your menstrual history, your personal and family medical history, your medications and supplements, and what you most want to change. This is also where the safety screening happens, and it matters.

MedlinePlus states that women should not take hormone therapy if they have had a stroke or heart attack, have a history of blood clots in the veins or lungs, have had breast or endometrial cancer, or have liver disease. If any of those apply to you, say so at the start, and expect your provider to involve your other doctors. Bring a list of your medications, your last mammogram date and any recent lab results, so nothing is missed.

If you have a primary care provider or gynecologist, let them know you are considering hormone therapy, so your care stays coordinated.

Stage two: the labs

In our program, initial consultation and lab work are required for every patient before any therapy begins. The panel is chosen for your situation and typically looks at estradiol, estriol, progesterone, free and total testosterone, DHEA, pregnenolone, thyroid markers including T3, T4 and TSH, and vitamin D. The goal is not to chase a perfect number. It is to understand your starting point, rule out other explanations for your symptoms, and have a baseline to compare against later.

When the results come back, your provider should sit down with you and explain them in plain language, including when something is normal and the answer to your symptoms probably lies somewhere else. If a clinic offers hormones without drawing blood or reviewing your history, I would keep looking.

Ask for copies of your results so you can follow the trend over time.

Stage three: choosing a form and a starting dose

MedlinePlus notes that hormone therapy comes in the form of a pill, patch, injection, vaginal cream, tablet or ring. The form matters, because it affects how the hormones are absorbed, how often you take them and what your follow-up looks like. In our practice, the options include weekly injections given in the office, or at-home prescriptions such as a daily topical cream, sublinguals, capsules or troches. Oral progesterone is prescribed when indicated or preferred.

Our program describes its hormones as bioidentical, meaning molecularly identical to the hormones the body makes. Some of what we prescribe, such as our daily topical cream, is prepared by a compounding pharmacy. Compounded preparations are not FDA-approved products, and you should feel free to ask any provider which parts of your plan are compounded, which are FDA-approved, and why one is recommended over the other for you. That is a normal question, and a good provider will answer it directly.

• Which form do you recommend for me, and why?
• Is this product compounded or FDA-approved?
• Do I need progesterone, and why?
• What starting dose are we using, and how will we adjust it?

Stage four: the first months and the follow-up rhythm

Starting hormone therapy is rarely a single dose that is right forever. Most plans involve adjustments in the first months as your provider compares how you feel with your follow-up results. In our women's membership, that rhythm includes ongoing monitoring, follow-up lab work and quarterly provider consultations, with follow-up labs, medication and consults included in the membership.

Keep notes between visits on sleep, hot flashes, mood, energy and any side effects. Your notes, combined with your labs, are what make each adjustment precise rather than a guess.

Expect the early visits to be the busiest. That is when your provider learns how your body responds to the form and dose you started with, and when small changes make the biggest difference. Once things are stable, visits settle into the regular rhythm, but you should never wait for a scheduled appointment to report bleeding, a new symptom or a side effect that worries you.

Side effects and risks to keep on your radar

Side effects our program lists include breast tenderness, spotting or cycle changes, mood changes if the dose is too high, and acne or hair changes with testosterone. Most are reasons to call your provider and adjust, not reasons to panic. MedlinePlus advises contacting your provider if you have vaginal bleeding or other unusual symptoms during hormone therapy, and continuing regular checkups.

The longer-term risks deserve a direct conversation with your provider. MedlinePlus lists an increased risk of blood clots, an increased risk of stroke, and gallstones, and notes that taking estrogen and progestin together for longer than three to five years may increase breast cancer risk, while taking estrogen alone increases the risk of endometrial cancer. It also notes that hormone therapy can make a mammogram image look cloudy, so keep up with your breast screening and tell the imaging center you are on hormones. How these risks apply to you depends on your age, history and the type of therapy, which is exactly why the decision is individual.

Mistakes I see women make at the start

The first is waiting too long to ask because a previous provider dismissed the symptoms as just part of getting older. Symptoms that affect your sleep, work and relationships are worth a real conversation. The second is the opposite: starting a product from a friend, a website or a supplement aisle without labs, screening or follow-up. Hormones are powerful, and whatever form they come in, they deserve monitoring.

The third is expecting hormones to fix everything at once. If weight is one of your concerns, hormone therapy may be part of the picture but rarely all of it; my guide on what medical weight loss with semaglutide or tirzepatide costs in Dallas explains another option some women discuss. The fourth is skipping follow-up visits once symptoms improve. That is exactly when monitoring keeps a good result safe.

What starting with us looks like

You can book online or by phone and be seen at our office next to Hilton Park Cities, or start with a virtual consultation available across Texas. Your nurse practitioner takes a full history, orders your labs, reviews the results with you, and talks through whether hormone therapy fits, which form makes sense and what the risks are for you specifically. If it does not fit, you will hear that too.

If you go ahead, our Women's Wellness and BHRT membership is listed on our website at $199 a month, with the initial consultation and labs billed separately, and we offer financing through CareCredit. If you are noticing broader changes in energy, weight and mood, my guide on what a medical consult looks at when you feel unlike yourself explains our whole-picture approach, and if your partner is noticing changes of his own, my guide on the signs of low testosterone and when men should get tested covers the men's side.

Questions people ask me