The Investigation · Volume 06
Tracking hormone replacement therapy — the first 90 days
Starting HRT is rarely a single decision — it is a sequence of small dose adjustments that play out over weeks. The clinicians who manage it well rely on one thing: a patient who walked in with notes. This is what to track.
Why the first 90 days matter
Most HRT regimens — estrogen patch or gel, with cyclical or continuous progesterone — take 8 to 12 weeks to settle. In that window your body is adjusting to a new hormonal baseline, and side effects can mimic the very symptoms you started treatment for. Without a log, it is almost impossible to tell which is which at the next appointment.
What to log every week
| Field | Why your clinician needs it |
|---|---|
| Dose + delivery (patch / gel / pill) | Side effects differ by route — oral vs transdermal matters. |
| Day in cycle (for cyclical progesterone) | Mood and bleed changes often map to the progesterone week. |
| Hot flush count + intensity | The cleanest signal that estrogen dose is working. |
| Sleep quality + night sweats | First symptom to improve when the dose is right. |
| Mood, anxiety, brain fog | Often improves last; tracks separately from flushes. |
| Breast tenderness / bloating | Most common transient estrogen side effect. |
| Spotting / breakthrough bleeding | Expected in first 3 months; flagged after that. |
| Headaches or migraine pattern | Can shift with hormonal route; dose-dependent. |
What "working" actually looks like
A useful rule of thumb: vasomotor symptoms (hot flushes, night sweats) tend to ease first, often within 4–6 weeks. Sleep follows. Mood, joint aches, and cognitive symptoms usually take the full 12 weeks to shift. If your flush count has not moved at all by week 8, that is data — bring it to the follow-up; it usually means the dose needs to go up or the delivery route should change.
When to call sooner, not wait
Don't wait for the 3-month review for: new chest pain or one-sided leg swelling (call urgently), persistent heavy bleeding, severe new headaches or visual changes, or any sudden mood collapse on starting progesterone. Everything else — the bloating, the tender breasts, the spotting — log it and bring it.
Build the case
Walk into your HRT review with 90 days of evidence.
Log doses, symptoms, side effects, and bleed days — Desperate Healthwives turns it into a one-page summary your prescriber can read in under a minute.