Quitting Hormone Replacement Therapy

From the WebMD Archives

If you’ve been on hormone replacement therapy (HRT) for a while to relieve menopause symptoms, you may be wondering, what now? Should you stop taking it? If so, when? And how do you go about it?

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

Who Needs Hormone Replacement Therapy?

Some women sail through menopause with only mild symptoms. But many have strong symptoms. Your doctor may have suggested hormone replacement therapy for moderate to severe menopause symptoms such as:

If you are healthy, hormone replacement therapy can offer good short-term relief of these symptoms.

Side Effects

The risks of hormone replacement therapy depend on your age when you started hormones and how long you've taken them.

  • Your chances of heart attack go up only if you are 60 or older when you start them or if you became menopausal more than 10 years ago.
  • Your chances of getting breast cancer go up when you've taken estrogen and progestin for 5 or 6 years.
  • Your chances of blood clots and stroke are still low if you are under age 59 and don’t smoke.

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Should You Quit? If So, When?

There is no set time a woman should be on HRT. "We ask a woman to go off hormones at 5 years," says Anne W. Chang, MD. "We talk about the reasons why she should go off. But it's a shared decision."

"Being on hormones longer doesn't raise your risk for blood clots, but age does," Chang says.

Isaac Schiff, MD, goes over the pros and cons of quitting of hormone therapy with his patients every year. He says he puts the cons, like breast cancer risk, in perspective.

"If you aren't on hormones, your risk of breast cancer is 3 out of 1,200 per year," Schiff says. "If you're on hormones, it's 4 out of 1,200." Some women are comfortable staying on hormones with that risk. "It's a very individual decision," he says.

Women who have had their uterus removed are often given estrogen only. They aren't more likely to get breast cancer, so many decide to stay on hormones longer.

You should stop hormones if you get certain medical conditions, like breast cancer or liver disease, while taking them.

Other Options to Relieve Most Common Symptoms of Menopause

When deciding whether to quit, think about why you started taking hormones. Maybe hot flashes drove you to it. Hot flashes can pass after a few years. If they don't, they usually get less intense over time. The following may be enough to bring relief:

There are three options for vaginal dryness, pain, itching, and burning:

  • Low-dose, prescription vaginal estrogen works best. You apply it as a cream, tablet, or ring into the vagina. Only a tiny bit is absorbed into the bloodstream, so the chance of health problems is much lower than with estrogen pills.
  • Water- or silicone-based vaginal lubricants are put in the vagina or on the penis just before sex to reduce discomfort. You can buy them over the counter.
  • Vaginal moisturizers, also available over the counter, keep tissues moist. You apply them three times a week, but not before sex.

For mood swings and depression:

  • Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), can help mood.
  • Daily exercise, plenty of sleep, and stress control techniques like yoga, deep breathing, or relaxation exercises can also help.

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Ways to Quit Hormone Replacement Therapy

There is no best way to stop HRT. "If you're on a low dose, you may be able to go cold turkey," Chang says. But in general, she and Schiff prefer that women taper off hormones slowly. You can do this by:

  • Lowering the dosage
  • Taking fewer pills per week

Work with your doctor to find the best plan for you.

Still Up in the Air?

If you're still undecided, Schiff has this advice: "Reduce the dose and see what happens. You can always start back up." But check with your doctor first.

WebMD Feature Reviewed by Neha Pathak, MD on May 29, 2017

Sources

SOURCES:

American College of Obstetricians and Gynecologists Practice Bulletin No. 141: "Management of Menopausal Symptoms."

Anne W. Chang, MD, medical director, women's health primary care, University of California, San Francisco.

Harvard Health Publications: "Dealing with the symptoms of menopause."

Medscape: “Clinical Take-Home Points From the WHI Hormone Therapy Trials."

NIH Research Matters: "More Guidance for Hormone Replacement Therapy."

North American Menopause Society: "The Experts Do Agree About Hormone Therapy."

Isaac Schiff, MD, chief of obstetrics and gynecology, Massachusetts General Hospital, Boston.

Up to Date: "Postmenopausal hormone therapy," "Menopause," "Nonhormonal treatments for menopausal symptoms," "Vaginal dryness."

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