The Best Time to Start Hormone Therapy for Menopause May Be Earlier Than You Think

A new analysis highlights surprising health perks beyond symptom relief.

October 24, 2025

woman applying hormone replacement therapy patch to thigh

Controversy and confusion have shrouded hormone replacement therapy (HRT)—which involves using estrogen to help alleviate menopause symptoms—since a flawed 2002 study suggested it could up your risk for conditions like cancer and stroke. Though these results were refuted (among other issues, the study included mostly women several years postmenopause), they left a lingering mark in the form of a black box warning on HRT that many doctors are actively pushing to get removed. And new research being presented this week at the 2025 annual meeting of The Menopause Society further supports their case by clarifying a key point: The risks and benefits of HRT aren’t just driven by whether you take it but when.

The analysis of more than 120 million patient records found that women in perimenopause (a.k.a. the leadup to menopause) who had used HRT for at least 10 years before hitting menopause (which marks the one-year mark after your last period) had 60% lower odds of developing breast cancer, heart attack, and stroke compared to those who started HRT after menopause and those who never took hormones.

To be sure, this type of look-back review of health records can’t prove causation, Monica Christmas, MD, a board-certified ob-gyn at UChicago Medicine and associate medical director at The Menopause Society, tells SELF. So we don’t know that using HRT during perimenopause actively prevents those negative outcomes. But it is “promising” evidence that starting HRT at an earlier age is associated with “hopeful benefits,” she says.

There may be a key window of opportunity for beginning HRT.

The fact that the women in the study who started HRT several years prior to menopause had less risk of poor health outcomes is “very reassuring” because it adds to the evidence for “treating patients when they start getting symptoms [during perimenopause] and not waiting until later, when they can become much worse,” Sameena Rahman, MD, a Chicago-based board-certified gynecologist and menopause specialist, tells SELF. “More and more data is pointing to the fact that we should be having discussions about addressing menopausal changes with patients by their mid-30s,” she adds.

After all, symptoms like hot flashes, night sweats, and brain fog can strike well before your period starts to let up, and even when cycle changes do arrive, “they can initially be extremely subtle,” Stacey Silverman Fine, MD, a board-certified ob-gyn at virtual family planning platform Maven Clinic, tells SELF. Hence why so many women don’t realize their discomfort could be perimenopause unless a doctor proactively brings it up. Add to that the ways in which menopause symptoms have historically been brushed off and the fears around HRT, and it’s no wonder so many women have delayed or avoided treatment. What this research suggests is that getting on HRT earlier can help prevent that suffering and may even offer some long-term protection, Dr. Rahman says.

By contrast, waiting until later in life to start HRT could backfire. The above study also found that the women who began HRT after menopause had a nearly 5% higher likelihood of having a stroke than those who didn’t use HRT at all. This mirrors previous research showing that beginning HRT when you’re several years past menopause could raise your cardiovascular and dementia risk. Experts aren’t sure why the risk profile for starting HRT seems to flip on its head postmenopause, but research suggests it has to do with the baseline increase in health issues with age. Using estrogen might have a less positive effect in someone who, for instance, has already developed stiffness and plaque buildup in their arteries, or aging-related abnormalities in their brain, than in someone who hasn’t.

That doesn’t mean that “at age 60, or when someone is a certain number of years past menopause, we yank [HRT] out of their hands,” Dr. Christmas clarifies. It just means that at that point, your doctor may want to re-evaluate whether it’s still necessary to manage menopause symptoms and whether you’ve developed any cardiovascular risk factors or conditions that make using estrogen relatively more risky.

But ultimately, “we don’t have clear evidence to suggest that we really do need to stop HRT at a certain point,” Dr. Rahman notes, “particularly if someone is healthy and doing well on it.” What we’ve determined based on studies like the above is just that it’s less safe to start it postmenopause; continuing it into these years may not be an issue.

Determining whether and when to start HRT requires weighing the pros and cons for you.

Despite the link in the study between starting HRT in perimenopause and a lower risk of heart attack, stroke, and breast cancer, there isn’t enough data yet to suggest taking it just for the purpose of helping stave off these conditions; more studies are needed to fully determine the long-term effects of HRT, Dr. Fine notes. It’s still recommended primarily to alleviate the symptoms of menopause and, in some cases, for the prevention of osteoporosis, Dr. Rahman points out, given how estrogen supports bone health.

There are also potential downsides to consider, namely a slightly elevated risk of blood clots and breast cancer; and people with a history of breast or endometrial cancers, blood clots, heart attack, stroke, or liver disease are generally advised to avoid HRT. It’s also possible to have side effects from HRT, like breast soreness or tenderness, spotting or bleeding, bloating, and headaches, Dr. Rahman notes. (That said, these tend to be less intense than the side effects of birth control pills, which are also commonly recommended to manage perimenopause symptoms, but consist of synthetic hormones at a higher dose than the body-identical ones in HRT.)

So, deciding when and whether to get on HRT still comes down to a personal cost-benefit analysis. The above research just adds credence to the idea of not waiting until you’ve had your last period or put up with “enough” to intervene, Dr. Rahman says. Finding relief with HRT ahead of menopause might just be a boon for your health too.