When it comes to HRT, there’s still so much confusion. For years, the old advice was to “wait until your periods stop” before starting treatment. But for many of us, the hardest symptoms come before menopause — during perimenopause. So why wait?

This is the first of a two-part series:

• Part 1 looks at why it makes sense to start HRT during perimenopause.
• Part 2 digs into one of the most confusing aspects: bleeding on HRT — what’s normal, what isn’t, and why progesterone matters.

Because the truth is simple: women need clear, practical information to make decisions, not vague warnings or half-explanations.

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Part 1: Starting HRT in Perimenopause — Why Waiting Makes No Sense

For years, the advice was clear: wait until your periods stopped before starting HRT. But when you stop and think about it, that never really made sense. Many of the most disruptive symptoms — night sweats, brain fog, mood swings, anxiety, joint pain, heavy bleeding — happen during perimenopause as well as continuing into menopause. So why wait?

Thankfully, medical thinking has shifted. In the UK, Europe, and Asia, many well-informed doctors are now comfortable prescribing HRT to women who are still having periods. In the US, the approach can look different. It’s often more common for women to be offered the pill if they’re still bleeding regularly. Some doctors will describe the pill as “a form of HRT.” And while it’s true that the pill can help manage excessive bleeding, like so much in menopause care, it’s complicated.

And here’s the truth: HRT in perimenopause can work brilliantly to ease symptoms and improve quality of life. It can also help protect long-term health. The reluctance in the past was partly down to fears of fluctuating hormones — would estrogen levels rise too high, or progesterone not be enough? But waiting until a woman has gone 12 months without a period — the so-called magic line of “menopause” — makes it simpler for doctors, not necessarily better for women.

Menopause isn’t a finish line. Once you’re in it, you’re in it for the rest of your life. Which makes the idea of “waiting until it’s official” before prescribing treatment even more absurd.

👉 Bottom line: Don’t wait until your periods stop. If you’re struggling with symptoms, HRT can be started safely in perimenopause.

🔗 Continue reading: Part 2 — Bleeding on HRT: What Women Need to Know

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Resources & Further Reading

📄 Websites & Guidelines

• NICE Guidelines: Menopause Diagnosis and Management
• The Menopause Society (formerly NAMS) — clinical guidance and patient resources
• British Menopause Society — professional and patient information on HRT use

🎧 Podcasts & Multimedia

• Dr Louise Newson Podcast — evidence-based conversations on HRT and perimenopause
• Health by Heather Hirsch — practical insights on perimenopause and treatment

📝 Related Blog Posts

• [Does Breast Density Really Matter?]
• [Vaginal Estrogen: The Simple Fix We’re Not Talking About]

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