How to Use These Worksheets
These worksheets are designed as prompts and reassurance tools—to support conversations during your appointment and to guide reflection at home. They can help you and your clinician talk through important details like where to start in your cycle, what dose to use, and what side effects to expect.

There’s space to write down your specific plan, which can be helpful to refer back to later. Using this sheet together during your consult can reduce confusion and help avoid some of the common issues people experience when starting or adjusting HRT.

How to Use This Sheet:
It can be hard to remember or take in everything during an appointment—especially when starting a new treatment like HRT. If you're a patient, print this sheet and bring it with you to help guide the conversation. You can circle what applies, jot down notes, or use it to follow up later.

If you're a healthcare provider, consider printing this for patients or saving it in your patient management system to use as a quick, practical support tool when prescribing or reviewing HRT. It's designed to make the process clearer, more collaborative, and easier to revisit.

Starting Continual MHT

If you're within one year of your last period, it's generally recommended to start with sequential (or cyclical) hormone therapy, which mimics a natural monthly cycle and helps reduce the risk of irregular bleeding. However, the right type of menopausal hormone therapy (MHT) depends on your individual circumstances. This includes whether you’ve had a hysterectomy and no longer need progesterone, whether you're already postmenopausal, or if you’re using contraception like the Mirena, Cerazette, or another progestogen-only pill that suppresses bleeding and you wish to continue.

If you haven’t had a period for a while but it’s been less than 12 months, irregular bleeding is common—this is why continuous MHT isn’t usually recommended initially. Instead, you may start with a sequential (cyclical) regimen, and if irregular bleeding occurs, switching to sequential can help manage it more predictably.

Irregular or unexpected bleeding while on hormone therapy matters because it can mask or delay the diagnosis of underlying issues. If medication causes abnormal bleeding, it becomes harder to tell whether it’s a side effect or a sign of something more serious—such as endometrial hyperplasia or endometrial cancer, which often present with abnormal bleeding. That’s why we aim for predictable bleeding patterns and investigate any unexpected changes.

Longer term, once you’re postmenopausal, it’s considered safer for the endometrium (the lining of the uterus) not to induce regular bleeding. In these cases, a continuous (no-bleed) MHT regimen is typically preferred. Choosing the right approach ensures your treatment is both effective and aligned with your stage of life and medical needs.

How to Use the Hormonal Hikoi Worksheet

The Hormonal Hikoi worksheet is designed to help identify whether your symptoms may be hormonally driven. In the course, we’ll explore how and why certain factors matter, and how this tool can support that process. It’s especially useful when things aren’t going to plan—whether symptoms persist, side effects arise, or treatment doesn’t seem to be working. By mapping your experiences, this worksheet can help guide more personalised and practical prescribing decisions.