How long should I stay on HRT for?

There is no black and white answer to this. The length of time should be based on symptoms and ongoing risks and benefits.

Stopping HRT leads to recurring symptoms for up to 50% of women.

Therefore, you need to discuss with the woman the potential impact of these symptoms on her life.

Remember the lowest dose of HRT which controls symptoms should be used.

When the woman is post-menopausal (they have received sequential combined HRT for at least one year) or it has been at least one year since their last menstrual period.

Cyclical HRT can be changed to continuous combined HRT.

This is advantageous as it removes the risk of endometrial hyperplasia.

Women should be prescribed sequential combined HRT if their last menstrual period was less than one year previously.

How should the woman be advised to stop HRT?

Menopausal symptoms usually last between 2 and 5 years, however, symptoms may last decades in some women.

A trial of withdrawal of HRT could be considered in;

  • those women symptom-free on HRT after one to two years
  • women who have been on HRT for longer than five years
  • after the age of 51 for women who were started on HRT for premature menopause

Abrupt cessation or gradual withdrawal of HRT?

When stopping HRT, it is generally recommended that the dose of HRT should be gradually reduced over three to six months.

This can help to minimize symptoms due to oestrogen deficiency.

After the cessation of therapy, symptoms may return fairly soon but then resolve, therefore, it is best to encourage the woman to stay without HRT for at least 12 weeks.

However, if the vasomotor symptoms are severe after stopping HRT, restarting treatment may be the most appropriate course of action. The lowest dose to improve symptoms should be given.