What Happens When You Stop Hormone Replacement Therapy (HRT)?

If you have been on hormone replacement therapy (HRT) for a while to relieve the symptoms of menopause, you may be wondering, what now? Are you supposed to stop taking it? If so, when is that? And how are you going about it?

If you are healthy, most experts agree that HRT is safe to use at the lowest dose that helps in the shortest time needed. If you are 59 or older or have been on hormones for 5 years, you should talk to your doctor about quitting.

Duration of HRT

Some women stay on HRT for years, others stay on HRT for a few months to stabilize their symptoms of menopause. In general, the shorter the duration of HRT, the better to reduce the risk of drug-related complications. The usual recommendation is not to stay on HRT for more than five years and not after you turn 60.

Longer therapy is possible, depending on the type and severity of symptoms of your menopause and why you started treatment first. Younger women who have had hysterectomy with ovarian removal may be on estrogen-only HRT much longer than a woman who has had a combination of HRT and natural menopause, for example. (Women without the uterus do not need to take progesterone.) HRT experts recommend the continuation of estrogen-only hormone therapy until the natural menopause age of 52.

Quitting Hormone Replacement Therapy

Studies show that about half of women who take HRT will stop treatment within a year, and up to 75% will stop treatment within two years. Most do not have any problems while they stop, but stopping suddenly increases the risk that menopausal symptoms will return, so you should not stop taking your HRT without consulting your doctor.

Doctors may differ in how they get their patients out of HRT. Some gradually decrease the dose of estrogen and progesterone over time. Others decrease the number of times a week when patients take HRT along with lower doses. Depending on what type of HRT you are taking and how high the dose, it may take 3 to 6 months to completely stop. It can be as long as a year, especially if symptoms of menopause recur during the process.

If you stop taking HRT and your symptoms, such as a return of hot flashes, your doctor may first recommend that you try non-hormonal therapy before returning to HRT. For women with vaginal symptoms, keep in mind that low doses of estrogen in the vagina do not increase the risk of breast cancer, heart attack or stroke. Continuing vaginal estrogen (rather than oestrogen pills or patches) does not pose a health risk, according to studies.

Effects of Stopping Hormone Replacement Therapy

Side effects of stopping hormone replacement therapy include the return of symptoms of menopause, especially hot flashes. If symptoms occur, they may be more manageable than before HRT. After stopping HRT with little relief, some women experience uncomfortable symptoms. Unfortunately, it's impossible to tell who will be the most affected in the future.

Stopping HRT may have an impact on your bone health. Estrogen in HRT helps protect your bones by preventing bone loss that can lead to osteoporosis. You may develop brittle bones once you stop taking estrogen. However, lifestyle, dietary and non-hormonal medications can be very effective in preventing bone loss and osteoporosis.

Women who stop taking HRT may be at a lower risk of developing breast cancer. The effect of stopping HRT on the risk of heart disease is not clear, but there is a lower risk of developing blood clots.

If you need help deciding when to start or stop HRT, ask your gynecologist about the most up-to-date HRT guidelines and how they relate to your personal and family health history.