Stopping HRT safely

Why stop HRT?

The first decision to make if you are considering stopping HRT is whether stopping is the right choice for you. In general, women and people AFAB take hormone replacement therapy (HRT) to help with symptoms of the perimenopause and menopause. The perimenopause, leading to the menopause, is a time of change and transition in your hormones that can cause many different symptoms. As HRT is generally prescribed to improve your quality of life, starting and stopping HRT is a personal decision for you to make together with your doctor. The bottom line is you can continue HRT for as long as the benefits to you in terms of how you feel outweigh the small risks of HRT treatment. So, you may choose to stop if: 

• You aren’t getting enough benefit (for example if you are struggling with side effects, find HRT is not treating your symptoms effectively or want to see how you feel off HRT)
• The risks of taking HRT outweigh potential benefits to you.

How long can I take HRT for?

The good news is that you can take HRT for as long as you find it makes you feel better, so long as you have annual checks and your risks of taking HRT stay low. Some individuals find HRT most useful during the period of transition and flux of the perimenopause and want to stop afterwards. However, some people also find they continue to feel a lot better taking HRT even after they have transitioned into the post-menopausal period and therefore want to continue HRT treatment in the longer term. This is reflected in The Lowdown’s review community – people writing reviews on HRT are in their 60s and 70s as well as their 40s and 50s. We now know HRT, particularly when started before the age of 60, is generally safe to take in the longer term (your doctor can advise you further, or you can book an appointment with a menopause specialist here). The latest UK guidelines (2022) on the menopause  make it clear that ‘there is no arbitrary limit for duration of HRT use.’¹ Having spent time working in a specialist menopause clinic, I know first-hand that the experience of perimenopause, menopause and postmenopause varies hugely between individuals, and some people benefit from HRT for much longer than just the years around the menopause. My own grandma still takes HRT and feels great for it – and she is now in her 90s! 

When to stop HRT?

It’s personal! So let’s look at a common scenario where you might consider stopping HRT. Let’s imagine a woman, aged 53, who has been taking combined HRT primarily for relief from disabling hot flushes and night sweats. She has found HRT very effective at managing those symptoms, thankfully with few side effects, but she is now wondering if she could stop HRT as this would be her preference. Current UK guidelines suggest most women taking HRT primarily for hot flushes and night sweats (also known as vasomotor symptoms), will need 2-5 years of treatment.² Hot flushes and night sweats are just one of over 30 symptoms that can be experienced during the perimenopause and menopause.  

Let’s say she has been taking HRT for around 4 years and is keen to try and stop. So, this is a reasonable time for her to try coming off and seeing what happens. The key thing to know is that everyone is different. She might try coming off and find that she no longer experiences her disabling symptoms and feels well off HRT. However, her symptoms might recur and she may want to take HRT for longer. 

If you have POI, however, it’s recommended that you take HRT until at least the average age of natural menopause in the UK, which is 51.³

How to stop HRT

If you have chosen to stop HRT, you have two main options. You can stop HRT suddenly, or gradually reduce your HRT dose down over 3-6 months. The evidence from studies to date suggests that there will be no difference to your long-term symptoms with either way of stopping.⁴ However, if you stop HRT suddenly, your symptoms are likely to return faster than if you stop gradually. So again, this is a personal choice. If you are really struggling with side effects from HRT itself, stopping suddenly may feel like the best option. If you are curious to see how you might feel off HRT, it may feel that gradually lowering the dose may be the best way to investigate this without running the risk of a sudden rebound in your symptoms. Your healthcare professional can provide you with more advice or you can book an appointment with a menopause specialist.

What to expect while coming off HRT and after

To understand what to expect as you stop HRT, it might be helpful to think about where your body is in the menopause journey. Some symptoms of the perimenopause arise from oestrogen levels ping-ponging up and down as the number of eggs in your ovaries reduces. Typically this can cause mood changes, headaches, hot flushes and night sweats. As your body enters the menopause and post-menopause, these fluctuations will settle down, and you will have stable, but lower levels of oestrogen and progesterone. Other symptoms of the perimenopause and post-menopausal period, such as genito-urinary syndrome of menopause, are mainly caused by these lower oestrogen levels in the run up to and after the menopause. 

So if your symptoms have primarily been related to ping-ponging hormones in the perimenopause, if you stop HRT and you have reached a post-menopausal state, you may well find your symptoms are improved, hooray! However, if your symptoms are primarily driven by low oestrogen levels, then unfortunately these symptoms are likely to recur when you stop HRT.

Is there hope? Of course! Think about whether stopping HRT is the right choice for you, and you can consider restarting HRT if you have stopped it. If you are getting really challenging side effects from HRT, HRT is no longer safe for you to take, or you don’t want to take HRT any more there are also several medical, non-hormonal treatments as well as lifestyle measures that your doctor can discuss with you. Remember even if full HRT (e.g. tablets, patches) is no longer an option for you, vaginal oestrogen (known as ‘topical’ HRT) is often still safe and can be really helpful with symptoms of genito-urinary syndrome of menopause. There is a wealth of information and treatment options for the perimenopause and menopause – so it really is worth seeing a menopause specialist through your GP or privately if you are suffering.

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