There is some debate as to when HRT should be started. Some gynecologists prefer to wait until the menopause is well established (perhaps a year after the menses cease) before starting HRT. Many doctors disagree with this approach. Significant discomfort and irreparable system damage may take place during that time. And nothing is gained. Most begin HRT during the Perimenopause especially since new evidence indicates that loss of bone mass may begin well before the cessation of menses.