Stopping HRT can be a tricky decision. While for many it can be an easy transition, others could find their menopause symptoms bouncing back. If you’re considering coming off your HRT, this article will help you find out what to expect and how to manage it.
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How long should you be on HRT?
There is no definite length of time you should be on HRT. The length of your treatment will depend on how well HRT is working for you, any side effects and your general health.
You should have an annual review with your doctor while on HRT. In this appointment, they will check how well your HRT is working for you and discuss the benefits and risks of continuing. This is a good time to ask about stopping your prescription if this is something you are considering.
An exception to this is if you went through the menopause early (before the age of 45). In this case, you should plan to be on HRT until at least the average age of menopause (51 years old in the UK).
How do you know when it’s time to come off HRT?
You may come to the conclusion that it’s time to stop for a number of reasons. Common ones include:
- Having been on HRT for a few years and wanting to see how life is without it
- No longer having breakthrough symptoms if you miss a dose or two
- Getting fed up with needing to take regular medication – especially if you are also taking other tablets
- Your general health has changed and HRT is no longer suitable for you
- You no longer want to use hormones
But then what?
For most people, stopping HRT can feel like guesswork. Your menopause symptoms are likely to be minimal or absent while on HRT, which makes it difficult to know whether you have passed through the most difficult parts of your menopause journey, or whether it is simply the HRT doing its job.
The only way to tell is to have a trial period off HRT.
Your doctor will be able to guide you if you are unsure. As a general rule, it is reasonable to think about reducing your dose or stopping after 3-5 years on HRT.
How should you come off HRT?
Where possible, it is better to slowly reduce your dose rather than stopping overnight. This allows your body to slowly adjust to the lower levels of oestrogen.
If you take a pill or patch, your doctor may be able to prescribe a lower dose of the same product. If you use a spray or gel, they may recommend using less.
If you manage okay on a lower dose (or if you only needed a lower dose to begin with), it may be time to stop altogether.
Are there side effects when coming off HRT?
If you have passed menopause, you may not notice anything at all. Some people find that stopping HRT is unremarkable, with no symptoms at all.
However, it is common for menopause symptoms (including flushes and night sweats) to come back in the months after stopping HRT. These are often temporary and tend to fade away after a few months.
Because of this possible flare-up, it’s important to think carefully about when to stop. If you would struggle to cope with menopause symptoms on top of your current lifestyle, or if you are preparing for a big event (like a wedding or special holiday), you may choose to wait until later to wean off your HRT.
Can I restart HRT after stopping?
You may also find that your menopause symptoms come back to the extent that you want to restart your HRT. This is quite common and your doctor will be able to advise you about how to get back onto HRT. This does not mean that you need to be on HRT for the rest of your life – simply that you should wait a little longer before stopping.
It is also common to need vaginal HRT after stopping your patch, pill or other systemic form of HRT. This is because the changes of genitourinary syndrome of menopause – including tightness, dryness, itching and urinary changes – do not disappear in the same way as other menopause symptoms. In this case, you can consider taking low-risk vaginal HRT alone without needing to use hormones for the whole body.
Learn more about the different types of HRT.
Start your free online menopause assessment to see if HRT is right for you
What are the risks of being on HRT for a prolonged time?
Just like any other medication, HRT comes with certain risks. These depend on the type of HRT you take, but can include increased chances of breast cancer and blood clots (including deep vein thrombosis and pulmonary embolism). The longer you take HRT, the greater your risk of developing one of these conditions as a result of your HRT use. For most women using HRT, these risks are still small and thought to be outweighed by the benefits of getting effective treatment for their menopause symptoms.
However, the risks of taking HRT can change as we age. For example, we know that some types of HRT can increase your risk of blood clots. That baseline risk will generally be much lower at age 40 compared to age 60. An increased risk because of HRT at 60 is much more significant than it would have been when you were in your 40s.
For this reason, your doctor will regularly review your prescription and discuss your personal risk-benefit profile.
Read more about the risks and benefits of taking HRT.
What if you want to continue with HRT?
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 symptoms of genitourinary syndrome of menopause, including dryness, tightness and pain)
- You could swap to non-hormonal therapies
The British Menopause Society advises that there is no strict limit to how long you can take HRT, and that continuing treatment depends on your individual circumstances.
Read more about taking HRT after your periods have stopped.
Final word
While there is no maximum amount of time you can take HRT, it is important to keep reviewing the balance of risks and benefits in your personal circumstances.
If it’s time for you to stop HRT, there are plenty of other treatments available for menopause symptoms.
Difference between bioidentical hormones and body identical hormones
Hamoda H, Panay N, Pedder H, Arya R, Savvas M. The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women. Post Reproductive Health. 2020;26(4):181-209. doi:10.1177/2053369120957514
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