If you’re about to start estrogen replacement therapy for the first time, you likely have a LOT of questions—maybe even a few nerves. That’s normal.
Here at Antigravity Wellness, we specialize in helping women navigate this transition with clarity and confidence. We believe hormone therapy should feel empowering, not overwhelming. In this article, we’ll walk you through the most common questions our patients ask when starting estrogen:
- How long until I feel better?
- What side effects should I watch for?
- Where Do I Place the Patch or Apply the Cream?
- How often do I need labs?
- What if the dose isn’t working—or stops working later?
- Do I need progesterone too (even if I don’t have a uterus)?
- What if some symptoms improve and others don’t—can I ask about other hormones like DHEA or testosterone?
Let’s break it all down.
How Long Will It Take to Notice the Benefits?
Most women begin to notice subtle improvements within 1–3 weeks, with more noticeable changes by the 6–8 week mark. However, it can take up to 3 months for estrogen to fully stabilize in your body—especially if you’ve been depleted for a while.
A randomized trial published in Menopause (2013) showed that vasomotor symptoms (hot flashes, night sweats) improved significantly within 3 weeks of starting transdermal estradiol, with additional mood and sleep improvements by 8–12 weeks (Gordon et al., 2013).
Some early wins may include:
- Fewer hot flashes and night sweats
- Improved sleep quality
- Reduced vaginal dryness
- Less brain fog or irritability
- Increased energy and motivation
Consistency is key. Stay the course, and always reach out if something feels off.
What Are the Common Side Effects to Watch For?
Most women tolerate estrogen well, especially bioidentical transdermal estradiol (via patch, cream, or gel). But early on, your body may need time to adjust.
Temporary side effects can include:
- Mild breast tenderness
- Spotting or light breakthrough bleeding (especially if you still have your uterus)
- Mood swings or irritability (more common if progesterone is not properly balanced)
- Mild bloating or fluid retention
These usually improve within a few weeks. But if they persist or worsen, that’s your cue to check in.
Transdermal estrogen has a lower risk profile than oral forms, particularly for blood clotting and liver strain, according to The North American Menopause Society (NAMS, 2022).
Where Do I Place the Patch or Apply the Cream?
This is a great question, and it makes a big difference in how well your body absorbs the estrogen. The goal is to apply your estrogen to areas with thin skin and good blood flow, avoiding areas with excess fat.
If you’re using a patch (transdermal estradiol):
- Apply it to clean, dry skin on your lower abdomen, buttocks, or outer hip.
- Rotate sites with each application to prevent irritation.
- Avoid placing it near the breast or on broken/irritated skin.
- Make sure to press firmly and hold for 10 seconds to ensure good adhesion.
Research confirms that lower abdominal and gluteal areas provide consistent absorption and are less likely to experience displacement from clothing or activity (Buster et al., 2005).
If you’re using a cream or gel:
- Apply to areas like the inner forearms, inner thighs, or lower abdomen.
- Rub in thoroughly and allow it to dry completely before dressing.
- Do not shower, swim, or sweat heavily for at least 1 hour after applying.
- Avoid applying to breasts or mucous membranes unless instructed otherwise.
Transdermal estradiol is absorbed through the skin into the bloodstream, bypassing the liver, which helps reduce risk of blood clotting and other oral estrogen side effects (Menopause, 2012).
Be sure to wash your hands after applying to prevent unintentional transfer to others (especially children or pets), and always follow the specific instructions that come with your compounded or commercial prescription.
How Often Do I Need to Get Labs Done?
We typically recommend lab testing:
- Before starting to establish a baseline
- 6–8 weeks after starting to monitor response
- Every 3–6 months during the first year
- Annually once stable (unless symptoms change)
In functional medicine, we also look at cortisol, thyroid, insulin, and nutrient levels—because your hormone health doesn’t exist in a vacuum.
According to a 2020 review in Endocrine Reviews, monitoring estrogen levels alone isn’t enough—comprehensive evaluation improves patient outcomes and safety (Stuenkel et al., 2020).
When Should I Reach Out to My Provider?
Always reach out if you experience:
- Worsening symptoms
- Unusual side effects
- New or sudden emotional changes
- Vaginal bleeding after menopause
- Concerns about your patch/cream absorption
We encourage open communication at Antigravity Wellness—you are not “bothering” us. We expect you to have questions and want to work with you to adjust as needed.
What If My Dose Isn’t Working—Or Stops Working Later?
Sometimes, your starting dose isn’t quite right. That doesn’t mean hormone therapy isn’t for you—it just means your body needs fine-tuning.
Hormone needs can shift with:
- Stress
- Weight changes
- Aging
- Seasonal changes
- Illness or medications
If your symptoms return or plateau after a few months, it’s okay to adjust your plan.
Research shows that individualized dosing yields better symptom relief and patient satisfaction than standard-dose protocols (Sarrel et al., 2022).
Should I Be on Progesterone Too?
Yes—even if you don’t have a uterus.
While conventional medicine often only prescribes progesterone to protect the uterine lining, functional and integrative medicine recognizes its many additional benefits.
Progesterone helps with:
- Sleep quality
- Mood regulation and anxiety reduction
- Bone and breast tissue protection
- Balancing the effects of estrogen
A 2018 study in The Journal of Clinical Endocrinology & Metabolism showed that progesterone improves sleep latency, reduces night awakenings, and may reduce the risk of estrogen dominance-related symptoms, even in women without a uterus (Prior et al., 2018).
Want to dive deeper? Check out our companion blog post here: https://antigravitywellness.com/the-truth-about-hormone-therapy-why-progesterone-matters-even-without-a-uterus/
What If Some Symptoms Improve, But Not All?
This is very common! Hormone therapy isn’t always a one-and-done solution—it’s part of a bigger picture that includes your:
- Adrenal health
- Thyroid function
- Blood sugar stability
- Nervous system balance
- Nutrient stores
If estrogen alone doesn’t address everything, we may explore:
- Bioidentical progesterone (if not already included)
- DHEA to support libido, brain function, and mood
- Testosterone for motivation, strength, and sexual health (yes, women need it too!)
- Nutrient repletion (iron, vitamin D, B12, magnesium, etc.)
DHEA and testosterone have shown positive outcomes in energy, libido, and cognitive function in select women with deficiencies, according to research in Menopause (Wierman et al., 2010; Labrie et al., 2009).
Case Study: Meet “Tanya”
Tanya, 46, came to us after struggling with fatigue, low libido, and worsening night sweats. She was nervous to start hormone therapy because of past negative experiences with birth control pills and had been told by her primary care doctor that estrogen wasn’t “necessary” since she didn’t have a uterus.
After reviewing her labs and symptoms, we started Tanya on low-dose transdermal estradiol and oral micronized progesterone at night. She was also borderline for low DHEA and testosterone, which we kept an eye on.
Within a few weeks, her sleep began to improve. By week 8, her energy was back and her hot flashes had dropped from 10 per day to 2. At her 3-month follow-up, we adjusted her progesterone dose slightly and added a small amount of DHEA for mood and libido support.
“I didn’t know I could feel this good again,” she told us. “I’m still me—but now I can show up for my life.”
You Deserve Individualized, Compassionate Hormone Care
Starting estrogen doesn’t mean giving up control—it means stepping into the next phase of your life with support, clarity, and confidence.
At Antigravity Wellness, we don’t push hormones. We educate, listen, test thoroughly, and co-create a plan that works for you.
Ready to Take the First Step?
If you’re curious about hormone therapy—or just want to understand what’s going on in your body—we have two ways to get started:
Try our FREE 5-Day Hormone Reset Mini-Course
Get clarity on your symptoms, discover your hormone patterns, and learn how to reset naturally.
Get it here: https://social.antigravitywellness.com/mini-course-freebie
Book a Brief Initial Consult with Dr. Nicole Smith
We’ll review your history and goals and create a customized plan—whether that includes BHRT or not.
Book a call here: https://l.bttr.to/6lFHL
References:
- Gordon, C. M., et al. (2013). Menopausal hormone therapy and symptom relief: timing matters. Menopause, 20(4), 386–392.
- North American Menopause Society (NAMS). (2022). Nonoral hormone therapy and individualized care recommendations. NAMS Position Statement.
- Stuenkel, C. A., et al. (2020). The care of postmenopausal women: An integrative approach. Endocrine Reviews, 41(3), 364–394.
- Prior, J. C. (2018). Progesterone for symptomatic perimenopause treatment. The Journal of Clinical Endocrinology & Metabolism, 103(5), 1827–1834.
- Wierman, M. E., et al. (2010). Androgen therapy in women: A reappraisal. Menopause, 17(4), 693–705.
- Labrie, F., et al. (2009). Benefits of DHEA replacement on wellbeing, mood, and sexual function. The Journal of Steroid Biochemistry and Molecular Biology, 116(1–2), 3–7.
