By starting at the lowest dose likely to control your symptoms, given how severe they are and what your history allows, then reviewing at twelve weeks. Age, whether menopause was early or surgical, and the form chosen all feed into the starting point.
Starting point
Las Vegas patient guide: why we start low
A first prescription written in Las Vegas is a starting point, not a verdict: the lowest effective dose is found by moving up, not down. The lowest dose that controls symptoms carries the lowest risk, and for oral preparations clot risk rises with dose. Starting high and reducing wastes twelve weeks and exposes you to more than you needed.
Younger women and those with early or surgical menopause are the exception. They generally need more, because the goal is a normal physiological level for their age rather than a minimal postmenopausal one.
Where you start also depends on how severe your symptoms are. Someone waking five times a night starts differently from someone with occasional daytime flashes. More on that in patient guides, hot flashes and night sweats and early and surgical menopause for the rest of it. So describe the worst of it plainly at your first Las Vegas appointment, because how often you wake at night changes where the starting dose sits.
