Why is My Menopausal Vagina So Dry

Ask Barbie: What’s the Best Time to Start HRT for Menopause?

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Welcome to ‘Ask Barbie’

Welcome to Ask Barbie, where I answer your burning questions about menopause.

Today’s question is, “What’s the best time to start HRT for menopause?”

I’m in the habit of simplifying things. I see no benefit in giving you a complicated, confusing, and convoluted answer to something so simple. So as usual, I will go back to basics and put this into perspective so that you can see the logic in how to consider your options.

Your Reproductive Life

Think about your reproductive life.

It all begins with puberty. Puberty is when it becomes possible for you to get pregnant.

Next comes vaginal intercourse. Vaginal intercourse makes it likely that you will get pregnant.

If you get pregnant, your reproductive system is in full force, with your estrogen and progestogen at their zenith, its peak. 

If, at some point, you consider pregnancy undesirable, you will try to prevent pregnancy.

Next, you reach peri-menopause. During peri-menopause, you can still get pregnant if you don’t do something to prevent it. But you also begin losing the estrogen and progestogen that produced your reproductive potential in the first place. Peri-menopause is when your estrogen and progestogen are on a chaotic rollercoaster, trying to disappear … and ruining your life all the while.

Finally, you reach post-menopause. Post-menopause is when your estrogen and progestogen are gone, gone, gone forever. They have gone from zenith to zero.

Pregnancy Prevention

If I asked you, “What’s the best time to start using contraception to prevent pregnancy?” you would answer by designating initiation of sexual activity as the time to start using contraception. It would be simple, straightforward, and completely logical. There’s nothing complicated about it.

During your reproductive life, you can get pregnant any time you are not preventing pregnancy with some kind of contraception. And, unless there’s some kind of impediment to pregnancy, it’s almost inevitable.

So, with regard to unwanted pregnancy, the choice is between:

  • Preventing pregnancy before getting pregnant
  • Terminating pregnancy after getting pregnant

The more efficient of the two is preventing pregnancy before getting pregnant.

Finished With Childbearing

Once you have all the children you want, you are likely to do something to prevent future pregnancy. The contraception you use when you have finished your childbearing is likely to be permanent or long term in nature. You might choose an intrauterine device, tying your fallopian tubes, or long-term estrogen plus progestogen contraception. 

Once you know that you don’t ever want to get pregnant again, you would immediately do something to ensure that you don’t ever get pregnant again.

Again, if you don’t utilize a reliable contraceptive, getting pregnant might mean terminating the pregnancy. So rather than preventing the pregnancy before the fact, you would have to try to reverse the pregnancy after the fact.

So if you don’t want to get pregnant, you use pregnancy prevention.

Well, when your reproductive life is over, your next phase of life is going to be menopause. So why wouldn’t you handle it the same way?

Auto-Pilot

The phases of your reproductive life: puberty; pregnancy; post-partum; peri-menopause; and post-menopause, happen automatically. You could say that they’re on auto-pilot.

Some things in life are already on auto-pilot. Other things you put on auto-pilot. Auto-pilot is when you automate everything to take care of itself, and you don’t have to give it any thought. It’s a set-it-and-forget-it system.

And our question is, “What’s the best time to start HRT for menopause?”

So why not automate your preparation and protection for peri-menopause and post-menopause? You can prevent it and forget it.

When you lose your estrogen and progestogen at peri-menopause and post-menopause, there are detrimental consequences. Estrogen was your fountain of youth. It kept you young on the inside and on the outside. When you lose your estrogen, you start aging rapidly on the inside and the outside. 

The outside aging entails symptoms of estrogen deficiency that span from your head to your toes, from your home life to your work life, and from your physical well-being to your emotional well-being.

The inside aging involves aging of your heart, bones, and brain. And this rapid aging of your heart, bones, and brain puts you at very high risk for heart attack, osteoporosis, and Alzheimer’s Disease.

So the time at which you start HRT for menopause determines whether or not you begin developing these symptoms or these three diseases of estrogen deficiency. 

The earlier in your peri-menopause you start taking adequate hormone replacement therapy to prevent the symptoms, the fewer symptoms you endure. And the earlier in your peri-menopause you start taking adequate hormone replacement therapy to prevent the diseases, the fewer diseases you endure.

So the question, “What’s the best time to start HRT for menopause?” is really a question about prevention of bothersome symptoms and fatal diseases.

Peri-Menopause

Peri-menopause is when you start losing all your estrogen and progestogen. There’s no doubt it’s going to happen. It’s as certain as death and taxes. And it can happen at any age. 

Most women do not recognize peri-menopause as peri-menopause when it begins. They waste years and years failing to label it for what it is. For most women, the transition into menopause begins in their late 30s or early 40s. But the vast majority don’t acknowledge it as peri-menopause until their early 50s. This results in unnecessary symptoms of estrogen deficiency and unnecessary diseases of estrogen deficiency.

And because recognizing peri-menopause is so difficult, it’s much easier to just start covering your bases for enduring future menopause at the same time you cover your bases for preventing future pregnancies. 

The two hormones that will disappear on auto-pilot are estrogen and progestogen. And, when they disappear, you’ll need to replace them. But the problem is that you won’t know when you need to replace them until some damage is done.

The whole idea of hormone replacement for menopause is to bridge the gap between having your own hormones and replacing them with hormone replacement so that your body never knows they disappeared.

So, if you know you’re going to lose your estrogen and progestogen, why not replace them as soon as you’re finished with childbearing?

Think about pairing birth control after your last child with HRT before your last period. It’s simple. It’s straightforward. It’s auto-pilot.

When you have your last child, make preparations and plans to ensure that it’s your last child. And when you have your last child, make preparations and plans to ensure that you have adequate hormone replacement when you have your last period.

Two Preventions in One

When I was a kid, there was a television commercial about Doublemint Gum. And the tag line was “Two, two, two mints in one.”

The idea was that you got two flavors in one gum.

Doublemint Gum: Two mints in one.

Well, why not apply that tag line along with the auto-pilot idea for answering “What’s the best time to start HRT for menopause?”

Think about it:

When you get to the point in your life when you no longer want any children, you’re likely to choose some form of birth control that is permanent or long lasting. In other words, you’ll put your pregnancy prevention on auto-pilot. You might get your fallopian tubes tied. You might get an intrauterine device. Or, you might start estrogen and progestogen hormonal birth control.

Well, estrogen plus progestogen hormonal birth control is the same thing as hormone replacement therapy for menopause. It’s just a difference in dosage, with birth control being the higher dosage of the two. 

And, alas! That’s precisely what you need for peri-menopause.

So why not use estrogen plus progestogen birth control as a way to start your HRT for menopause?

It would be two, two, two preventions in one.

The two hormones that will disappear during peri-menopause and post-menopause are estrogen and progestogen. They will go from zenith to zero. You’ll need both if you want hormone replacement therapy for menopause. And, if you use them as permanent birth control as well as hormone replacement for menopause, you’ll accomplish two preventions in one. You’ll prevent pregnancy, and you’ll prevent all the ravages of peri- and post-menopause.

No woman can predict when her peri-menopause will begin. It can happen at any age.

The fact is that a fall in your estrogen and progestogen from “zenith to zero” prevents pregnancy, but also augments your risk for three fatal diseases. Additionally, this zenith to zero drop in estrogen and progestogen also creates a zenith to zero drop in your quality of life.

So, since peri-menopause is the time when you can still get pregnant, why not make your automatic pregnancy protection double as automatic peri-menopause protection?

Post-menopause

Post-menopause is when your ovaries stop producing both eggs and sex hormones. Post-menopause makes it impossible for you to get pregnant. But, this does not occur overnight. There are two to ten years of peri-menopause between fertility and infertility.
Peri-menopause is the process of becoming infertile. And it can take two to ten years. That entire two to ten years is rife with horrible symptoms that disrupt every aspect of your life. And while these two to ten years are ongoing, the loss of your estrogen is also putting you at risk for heart attack, osteoporosis, and Alzheimer’s Disease. This is because estrogen prevents these three fatal diseases of estrogen deficiency.

When you stop having your periods, you start having the symptoms and diseases of menopause. So why not start automatic disease prevention when you start automatic pregnancy prevention?

The cold hard fact is that waiting to start HRT for menopause means running the risk of enduring a long list of miserable symptoms, as well as putting yourself at risk for three fatal diseases … when you could have planned and prevented all of that.

So, just as you use pregnancy prevention if you don’t want to get pregnant, why don’t you start HRT when you don’t want to get pregnant? That would be equivalent to saying, “If you don’t want the consequences of losing your estrogen, go ahead and start replacing your estrogen.” The earlier the better.

Why wait?

Why not employ two, two, two preventions in one?

The Answer

So the short answer to this question, “What’s the best time to start HRT for menopause” is, “After you’ve had your last child and know that you never want to get pregnant again”. That way, you cover all the bases, bridge all the gaps, and avoid any untoward consequences that would ensue when menopause creeps up on you unexpectedly, little by little, wrecking damage to your heart, bones, and brain all the while.

In essence, when you finish your childbearing and choose permanent contraception, start your HRT for menopause right then and there. That way, you’ll be prepared for everything.

Fortunately, many of your best HRT options for your early peri-menopausal life are estrogen plus progestogen hormonal contraceptive options. And that constitutes two, two, two preventions in one.

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