Choosing when to stop with your HRT is a very personal decision. The simple answer would be to stop taking your HRT once your symptoms finish; however, it can be very difficult to know when this happens. You also need to be prepared that your symptoms might 'reappear' as you begin to wean yourself off your medication. Whilst on HRT you're likely not to have many (if any) symptoms, so you only really know how you feel when you stop it. It is not unusual to stop HRT for 3 months, find that you still have symptoms, and decide to restart it.
There is no definite answer for when you should stop HRT. It will depend on how your symptoms are progressing during menopause, what is going on in your life, and whether you are happy to stop and see how you feel without HRT. However, you should have at least a yearly review appointment whilst on HRT.
As a general rule of thumb, you could begin discussions around lowering your dose of HRT gradually around 5 years of being on it. But again, this time line will be different for everyone and will depend when you started HRT. Therefore, it is vital to discuss stopping HRT with a healthcare professional to understand the best time and way to do it.
Additionally, rather than stopping altogether, it may be better to wean yourself off HRT slowly - this is done by gradually reducing your dose over time. This way, your body will not experience a drastic change in a matter of days; instead, your body can begin to adjust to the lower dosage until you have decided to stop completely. Another possibility is to stop your patch or tablets but continue with local vaginal estrogens longer term.
What are the risks of being on HRT for a prolonged time?
If you are still on HRT at the age of 60, you should be aware that overall cardiovascular risk may slightly increase after this point. This includes risk for heart disease, stroke, and blood clots. Many women can safely stop HRT at this point without getting troublesome symptoms. However, some women still experience symptoms off HRT, and may choose to continue with it. Before making a decision, we urge you to have a discussion with your clinician about your risks to benefit ratio of continuing on medication. Your personal medical history will determine your overall risk of continuing HRT. If you do not have any individual risk factors for taking HRT, then it would be acceptable to continue if you choose to do so.
There are other options if you want to continue treatment but are concerned about the added risks:
- You could lower your dosage
- You could discuss vaginal oestrogen (if you still experience vaginal dryness)
- You could swap to non-hormonal therapies
What will happen once I stop taking HRT?
If you have passed through menopause, you may not notice any change in symptoms after stopping HRT. However, some women will have a flare-up of symptoms, such as flushes and night sweats, but these may subside after a few months. So, you must be aware of whether or not this may be problematic for you. Life can be busy - you may not be in a position to cope with recurring symptoms. If your symptoms do persist and are severe after you have stopped HRT, you may need to restart it for a while. Possibly at a lower dosage than before.
Something to keep in mind - for musculoskeletal protection through HRT (for bone protection against osteoporosis), HRT should be continued for 5-10 years to reap the full benefits. Additionally, your bones will become vulnerable to bone loss again as soon as you stop taking HRT. As such, if you do stop taking HRT, you may want to consider taking some other protective measures to prevent osteoporosis.
What does recent science say about stopping HRT?
There is a growing consensus that women may never need to stop their HRT. Recent studies show that the benefits of HRT can often outweigh the risks, even after 5, 10, 15 or even 20 years. This includes healthier bones, brains, digestive tracts and skin to name a few. If you are considering whether to stop or continue your HRT, you can book to see a Bia menopause specialist who will review your treatment options.
If you want to know more about the other side of the coin, read our guide on when to start HRT.