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.
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.
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.
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:
- A low dose of an antidepressant such as Celexa, Effexor, or Prozac
- Gabapentin, an anti-seizure medicine
- Dressing in layers, drinking cool drinks, avoiding spicy food and alcohol, and exercising daily
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:
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.