What to Expect When Starting Hormone Replacement Therapy (Timeline & Monitoring)
If you live in Chicago and hot flashes, night sweats, poor sleep, and mood swings are taking over your days, you may be wondering if hormone replacement therapy (HRT) is your next step.
HRT gives your body back some of the estrogen it stopped making around menopause. For many women, that means fewer flashes, deeper sleep, and feeling more like yourself again.
Here, you will walk through what to expect in your first year on HRT: how quickly it may work, a realistic symptom timeline, and how your doctor will monitor you. HRT is usually safest when started near the time of menopause, often before age 60, and care at a practice like the Women’s Health Center of Chicago helps you build a plan that fits your body and your life.
What Hormone Replacement Therapy Is and If It Is Right for You
HRT is a treatment that replaces some of the hormones your ovaries used to make, mainly estrogen, and sometimes progesterone. When estrogen drops at menopause, your brain and body feel the change. Blood vessels, sleep centers, bones, and even your bladder all react.
Replacing a small, steady amount of hormone can smooth out those signals. Many women in Chicago use HRT to keep working, caring for family, and enjoying life without feeling hijacked by symptoms.
If you want a deeper dive into symptoms and options, you can review a comprehensive menopause symptom guide from the Women’s Health Center of Chicago.
How HRT Works to Ease Menopause Symptoms
Estrogen acts like a thermostat helper in your brain. When levels are higher and steady, hot flashes and night sweats usually calm down. You may notice:
- Fewer sudden heat waves and drenching sweats
- Less vaginal dryness and discomfort with sex
- More stable moods and fewer 3 a.m. wake-ups
There are two main hormone setups:
- Estrogen only for women who no longer have a uterus
- Estrogen with progesterone for women who still have a uterus, to protect the uterine lining
You can take hormones in different ways:
- Systemic HRT (pills, patches, gels) travels through your bloodstream and treats full-body symptoms
- Local HRT (vaginal creams, tablets, or rings) stays in the vagina area to help dryness and bladder symptoms with very little hormone reaching the rest of your body
Who Is a Good Candidate to Start HRT
You might consider HRT if you:
- Have hot flashes most days or wake up soaked at night
- Dread sex because of vaginal dryness or burning
- Went through menopause early because of surgery, chemotherapy, or other medical treatment
- Feel worn out, moody, and foggy from sleep loss tied to flashes
Most experts suggest starting systemic HRT within 10 years of your last period or before age 60. Recent 2025 FDA label updates support this timing and have removed older black box warnings for many menopausal women.
Your OB-GYN will ask about:
- Past blood clots, stroke, heart attack, or liver disease
- Personal or strong family history of breast or uterine cancer
- Blood pressure, weight, cholesterol, and smoking
Together, you decide if the benefits outweigh the risks for you. For many women near menopause, the balance is positive, especially when care is personalized, such as with BioTE hormone replacement therapy in Chicago.
Timeline: What to Expect in the First Days, Weeks, and Months on HRT
Everyone’s body responds at its own pace, but some patterns are common.
Week 1 to Week 4: Early Changes and Common Side Effects
In the first few days to weeks, you may notice:
- Slightly milder hot flashes
- A bit less night waking
- Feeling a touch calmer or more “even”
Some women feel better very quickly. Others need a few weeks for hormone levels to settle. Early side effects can include:
- Breast tenderness or fullness
- Mild nausea, bloating, or headaches
- Light spotting, especially if you still had irregular periods
These early effects usually fade after a few weeks. Call your doctor right away if you notice:
- Severe headache or vision changes
- Chest pain or trouble breathing
- Sudden leg pain or swelling
- Heavy bleeding, like a very strong period
Early follow-up, even by phone or telehealth, is a key part of using HRT safely.
Month 2 to Month 3: Symptom Relief Levels Out
By 2 to 3 months, many women notice a clear shift. Hot flashes and night sweats are often far less frequent or far milder. You may wake up only once at night instead of three or four times.
During this window, you may also feel:
- Less vaginal dryness or burning
- More stable mood and fewer sharp mood swings
- Better energy because sleep is deeper
This is a common time for your OB-GYN to review how things are going. If your flashes are still strong, or side effects bother you, the plan can be tweaked.
Your doctor might:
- Change the dose
- Switch from a pill to a patch or gel
- Adjust how often you take progesterone
Month 4 to Month 12: Long-Term Benefits and Ongoing Adjustments
After a few months, your body usually settles into a new normal. Symptoms that drove you to seek help in the first place often feel far more manageable. You may notice your:
- Workdays are less disrupted by sudden heat
- Relationships feel smoother because sleep and mood are better
- Confidence is higher, since you feel steady in your own skin
Long term, starting HRT around menopause can also support bone health and may help heart health for some women, especially when started before age 60 and used at the lowest effective dose.
Some women stay on HRT for several years. There is no strict stop date. Each year, you and your OB-GYN look at your age, health, and symptom load to decide whether to stay the course, lower the dose, or slowly taper off.
If you are curious about long-term forms like implants or pellets, the Women’s Health Center of Chicago also offers menopause management and HRT plans that include those options when appropriate.
How Your Doctor Monitors You While You Are on HRT
Good monitoring makes HRT feel less scary and more like a planned partnership. You are not left on your own once you pick up the first prescription.
Before You Start: Baseline Exams and Tests
At your first visit, your OB-GYN will:
- Talk through your symptoms, goals, and daily routine
- Ask about your period history, pregnancies, surgeries, and family history
- Check your blood pressure, weight, and sometimes waist size
- Do a breast and pelvic exam if you are due
You may be sent for:
- A mammogram, if you are due or overdue
- A Pap test, depending on your past results
- Blood tests for cholesterol, blood sugar, and sometimes thyroid or liver function
This information helps shape a plan that fits your body, not someone else’s.
First Follow-Up Visits: Fine-Tuning Your Dose
A follow-up visit is often scheduled about 3 months after you start HRT. Sometimes it happens earlier if you have strong side effects or worries.
At this visit, you and your doctor discuss:
- How often you still have hot flashes or night sweats
- Any bleeding or spotting patterns
- Breast tenderness, mood, and sleep
- How easy it is for you to remember your dose
Your doctor might adjust:
- The hormone dose
- The form (for example, pill to patch, or adding a vaginal cream)
- The timing, such as taking pills at night instead of morning
Yearly Checkups: Deciding Whether to Keep, Change, or Stop HRT
Once you are stable on HRT, you will usually have a full review once a year. At that visit, you can expect:
- A check-in on symptom control and quality of life
- A breast and pelvic exam
- Mammogram orders and, when needed, a bone density scan
- A new look at your heart and clot risk as you age
Each year, you and your doctor weigh benefits and risks again. Some women stay on the same dose, some lower it, and some start a slow taper. Staying in regular contact with your OB-GYN helps you use HRT as safely and effectively as possible.
Conclusion
Starting HRT is a big step, but it does not have to feel like a leap into the dark. Most women notice at least some relief within weeks, with bigger changes settling in over the first few months, while steady monitoring keeps treatment safe.
You can help your doctor by tracking your symptoms, sleep, mood, and any bleeding in a simple notebook or app, and bringing your questions to each visit.
If you live in Chicago, you do not have to manage menopause alone. Partnering with an experienced women’s health provider, such as the team at the Women’s Health Center of Chicago, can help you feel informed, supported, and more like yourself again.
