HRT should be reviewed 3 months after starting or a change, then yearly, sooner if symptoms, side effects, or risks shift.
What An HRT Review Involves
Hormone therapy eases menopause symptoms, but the right plan needs upkeep. A review is a short, structured check with your clinician. You assess symptom relief, any bleeding, side effects, and day-to-day use. Your dose, route, and progestogen protection are checked if you still have a uterus. Blood pressure and weight are recorded. Screening dates are confirmed. The goal is steady relief at the lowest dose that works.
Set clear aims at the start: which symptoms you want to calm, how fast, and any limits you have around pills, patches, or gels. Keep a symptom diary for the first few weeks. Bring it to the review so tweaks are guided by real days, not guesswork.
Standard HRT Review Schedule At A Glance
| Stage | Typical Timing | What Gets Checked |
|---|---|---|
| First follow-up | ~3 months after starting or a change | Symptom relief, side effects, bleeding pattern, dose/route fit |
| Ongoing care | Every 12 months once stable | Benefits vs risks, blood pressure, weight, screening status, regimen |
| Unplanned review | Any time new issues arise | Red flags, drug interactions, life events, need for tests or referral |
How Often Should HRT Be Reviewed: Timelines And Triggers
Most people do best with a first check around three months. That window lets symptoms settle and early side effects fade. Many tweaks happen here: dose changes, a switch from oral to transdermal, or a fresh plan for progestogen if bleeding is erratic. After that, book a yearly appointment as your base rhythm.
Don’t wait for the calendar if something shifts. Seek a sooner slot if you get heavy or unexpected bleeding, chest pain, breathlessness, leg swelling, new migraine with aura, patchy vision, new breast changes, or rising blood pressure. Also bring the review forward for surgery, long-haul travel with immobility, a clot in the past, new smoking, new liver disease, or if you start medicines that raise clot or stroke risk.
Why Three Months, Then Yearly?
The first few weeks are when most dose questions show up. Many side effects calm by three to six months. A three-month visit keeps you close to help while changes are fresh. After that, a yearly rhythm balances safety with convenience. Annual visits allow a full review of risks, benefits, and screening, yet leave room to call earlier when life changes.
What Clinicians Usually Check During A Review
Symptoms and quality of sleep. Are flushes, sweats, aches, mood swings, or sleep problems under control? Note what still bothers you and when it peaks.
Bleeding pattern. On a cyclical plan, a predictable bleed is expected. On a continuous plan, any bleed after the first months deserves a closer look.
Side effects and adherence. Sticky patches, skin rash, sore breasts, bloating, headaches, nausea, low libido, or brain fog may call for a switch in route or dose.
Blood pressure and weight. Record both. Transdermal routes suit many with raised blood pressure or clot risk.
Progestogen protection. If you have a uterus, you need steady progestogen with systemic oestrogen. That may be a capsule, a combined product, or a Mirena device in date.
Screening and bone health. Check dates for breast screening and cervical screening as per age rules. Ask about falls, fractures, and family history. Weight-bearing exercise, calcium from food, and vitamin D in low-sun seasons help bones.
Route and dose choices. Gels and patches give flexible dosing and avoid first-pass liver effects. Tablets may suit when a simple routine helps adherence. The “right” plan is the plan you can stick with and that clears symptoms with the fewest downsides.
What To Expect In The First Three Months
Weeks one to four are about getting into a routine and learning the product. Patches may need a test run on hip, buttock, or lower abdomen to find a spot that stays put. Gels dry quicker on clean skin and need a few minutes before dressing. Tablets work best at the same time each day. Missed doses happen; write them down so you and your clinician can tell dose issues from simple slips.
By weeks four to eight, sleep and flushes often improve. Some people notice breast tenderness or queasiness that fades with time or a dose tweak. If you still have a uterus and the bleed feels off-pattern on a sequential plan, note the dates. Bring those dates to the three-month visit. Real numbers beat fuzzy recall.
When To Book An Earlier Review
Some changes can’t wait for the annual date. Book soon if you notice any of the following:
- Bleeding that’s heavy, prolonged, or happens after months on a no-bleed regimen.
- New chest pain, shortness of breath, a painful swollen calf, or sudden severe headache.
- New migraine with aura, new focal weakness, or brief loss of vision.
- Blood pressure that’s repeatedly high at home or in a pharmacy check.
- New breast lump or nipple change.
- Planned surgery with bed rest, a long flight, or a period in a cast or boot.
- Starting meds that alter clot risk or oestrogen levels (ask your prescriber).
Life Events That Change Review Frequency
Life rarely stands still. A new diagnosis, a pregnancy scare in perimenopause, new migraine aura, a clot, or a big weight change can tilt the balance and bring the next check forward. A family history update can do the same. If you stop smoking, move to a patch from a pill, or have a Mirena placed, a short follow-up helps you lock in the new plan.
Many stay stable for years on the same dose. Even then, a yearly visit still matters. It keeps screening on track and gives space to ask about sex pain, bladder symptoms, or mood shifts that creep in slowly. It also keeps your script lawful and your supply steady.
What You Can Track Between Reviews
A short log beats vague memory. Track flushes, night sweats, joint pain, mood, sleep, and bleeding days on a simple grid. Note missed doses, patch lift-off, or gel timing. Record blood pressure at home if you have a cuff. Add any new meds, supplements, or long trips.
Bring the log to each visit. It speeds good choices on dose and route. It also shows patterns, like headaches linked with the luteal phase on a cyclical plan, or tender breasts when the gel dose crept up.
Do You Need Routine Blood Tests?
In menopause care, dose changes are usually guided by symptoms and side effects, not hormone blood levels. Some checks are still useful at times: thyroid tests when fatigue is out of scale, iron stores with heavy bleeds, or a lipid panel when risk rises with age or family history. Your clinician will tailor this to you.
Special Cases: Early Menopause And POI
When periods stop before 45, or before 40 in POI, HRT often runs longer and may need closer follow-up around bone health and fertility planning. Bone density scans can guide care. Many choose transdermal routes when migraine aura or raised clot risk sits in the background. If contraception is still needed during perimenopause, ask which HRT choices pair cleanly with it.
Genitourinary symptoms can linger even with systemic treatment. Local vaginal oestrogen can be added at any time and can be used long term with routine checks. If sex pain or bladder urgency hangs on, mention it. Small, steady changes can add up.
Transdermal Or Oral: Does Route Change Follow-Up?
Route doesn’t change the three-month and yearly schedule, but it can shape what you talk through at each visit. With tablets, the chat leans toward headaches, nausea, or blood pressure trends. With gels and patches, it often turns to where to place product, how to stop patches lifting, or how to space gel doses. If the blood pressure runs high, many switch to a patch or gel and feel better on that track.
When To Think About Stopping Or Pausing
There’s no set age when HRT must end. Many aim to taper when symptoms stay mild for a stretch. Some pause before planned surgery that carries high clot risk, then restart when safe. If you do try a taper, book a review to plan it and to set a fallback if flushes roar back.
Trusted Sources
For a clear clinican guide on timing and what each visit should include, see the British Menopause Society HRT guide. It states a review at three months after starting or a change, then at least yearly once stable. For broad care advice on menopause, see the NICE recommendations page. Both pages are written for health care teams and align with mainstream care.
They reflect mainstream recommendations and are updated on a schedule by the publishers for clinical use.
HRT Review Prep Checklist
| Item | Why It Matters | Quick Notes |
|---|---|---|
| Symptom log | Shows trends and dose response | Bring 4–12 weeks of notes |
| Bleeding record | Guides regimen choice | Note any bleed on no-bleed plans |
| Blood pressure | Flags route choice | Transdermal may suit raised values |
| Medication list | Checks interactions | Include over-the-counter items |
| Screening dates | Keeps recall on track | Mammogram and smear dates |
| Lifestyle notes | Bone and heart health | Exercise, calcium intake, vitamin D |
Putting It All Into A Simple Plan
Here’s a plain plan that fits most users of HRT. Start or change therapy, then book a three-month review. Bring a symptom log and your questions. Adjust dose, route, or progestogen as needed. Once you feel steady, book a yearly visit and keep the door open for earlier care if red flags pop up or life shifts. Keep screening on time. Keep a spare box or patch pack so supply snags don’t force a break.
This rhythm is simple, flexible, and easy to follow. It keeps relief front and center and lowers risk while you use the treatment that helps you feel like yourself again.
References in plain language: BMS HRT guide on review timing; NICE menopause recommendations.