Stopping HT 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 HT, or if your healthcare provider is recommending it, 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 HT?
There is no definite length of time you should be on HT. The length of your treatment will depend on how well HT is working for you, how long it has been since menopause for you, any side effects, and your general health.
You should have an annual review with your healthcare provider while on HT. In this appointment, they will assess how well your HT 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.
The North American Menopause Society (NAMS) has said, “…benefits of hormone therapy use generally outweigh risks for healthy women with bothersome menopause symptoms who are aged younger than 60 years or within 10 years of menopause onset.”
NAMS also says that HT does not need to be routinely discontinued in women aged older than 60 or 65 years, but also points out that “because increasing risk is observed with advancing age and extended duration of use women are advised to use the appropriate dose for the time needed to manage their symptoms.”
How do you know when it’s time to come off HT?
You may conclude that it’s time to stop for several reasons, such as:
- Having been on HT for a few years and wanting to see how you would feel 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 you are wondering if HT may no longer be suitable for you
- You no longer want to use hormones for any reason
But then what?
For most people, stopping HT can feel like guesswork. Your menopause symptoms are likely to be minimal or absent while on HT, 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 HT doing its job.
The only way to tell is to have a trial period off HT.
Your healthcare provider 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 three to five years on HT. In addition, both NAMS and the British Menopause Society say that there is no hard and fast rule about when a person should stop HT.
How should you come off HT?
Where possible, it is better to slowly reduce your dose rather than stop overnight. This allows your body to slowly adjust to the lower levels of estrogen.
If you take a pill or patch, your healthcare provider 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, it may be time to stop altogether.
Are there side effects when coming off HT?
If it has been several years since menopause, you may not notice anything at all. Some people find that stopping HT is unremarkable, with no symptoms at all.
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 HT.
Can you restart HT after stopping?
You may also find that your menopause symptoms come back to the extent that you want to restart your HT. This is quite common and your healthcare provider will be able to advise you about how to get back onto HT. This does not mean that you need to be on HT for the rest of your life – simply that you should wait a little longer before stopping.
It is also common to need vaginal HT after stopping your patch, pill, or another systemic form of HT. 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 vaginal HT alone without needing to use hormones for the whole body.
Learn more about the different types of HT.
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What are the risks of being on HT for a prolonged time?
Just like any other medication, HT comes with certain risks. These depend on the type of HT you take but can include increased chances of breast cancer and blood clots (including deep vein thrombosis and pulmonary embolism). The longer you take HT, and the older you are, the greater your risk of developing one of these conditions as a result of your HT use. Overall, these risks are small but as time goes on the possibility of adverse effects of HT may start to outweigh the benefits of getting effective treatment for their menopause symptoms.
The risks of taking HT can change as we age. For example, we know that some types of HT can increase your risk of blood clots. Whether you take HT or not, your baseline risk will be much higher as you age and have more years on HT.
We generally consider the increased risk of a health problem as a per cent increase. That means that if the baseline risk is higher, then the effect of the HT risk is more important. This is probably true for most HT-related risks with respect to age and number of years taking HT. Breast cancer and stroke are also examples.
For this reason, your healthcare provider will regularly review your prescription and discuss your personal risk-benefit profile.
Read more about the risks and benefits of taking HT.
What if you want to continue with HT?
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 estrogen (if you still experience symptoms of genitourinary syndrome of menopause, including dryness, tightness, and pain)
- You could swap to non-hormonal therapies. Some anti-depressants, such as Paxil (paroxetine), and the medicine gabapentin have been shown to reduce the symptoms of hot flashes but they are not as effective as HT
While there is no strict limit to how long you can take HT, the continuing treatment depends on your circumstances and the judgment of your healthcare provider.
While there is no maximum amount of time you can take HT, it is important to keep reviewing the balance of risks and benefits for your personal circumstances.
If it’s time for you to stop HT, there are plenty of other treatments available for menopause symptoms.