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Menopause - Management
When should I consider stopping HRT?

  • If systemic HRT is being used for symptom control consider a trial withdrawal (if a woman is symptom-free) after 1–2 years of hormone replacement therapy (HRT).
    • Advise the woman that symptoms may recur for a short time once HRT is stopped.
    • Counsel the woman about the possible risks of HRT if she wishes to continue treatment, particularly if treatment is being used for longer than 5 years.
  • Topical (vaginal) oestrogen may be required long term as symptoms can recur once treatment has stopped.
    • Stop treatment at least annually to re-assess the need for continued treatment.
  • Women with premature menopause usually take hormone replacement therapy up to the age of the natural menopause (50 years); at that time, therapy is reassessed. Some women will still be symptomatic.
Basis for recommendation
  • These recommendations are based on pragmatic advice and published expert opinion [RCPE, 2003; Rees and Purdie, 2006a].
  • Vasomotor symptoms usually resolve within 2–5 years, but some women experience symptoms for many years.
  • Topical oestrogens:
    • Endometrial effects should not be incurred with low dose oestrogens such as vaginal estriol (cream or pessary) or estradiol (tablet or ring). A progestogen is not needed with such low dose preparations [Rees and Purdie, 2006a].
    • The endometrial safety of long-term or repeated use of topical vaginal oestrogens is uncertain. The Medicines and Healthcare products Regulatory Agency (MHRA) have advised that treatment with topical oestrogens should be interrupted at least annually to re-assess the need for continued treatment [CSM, 2003b].

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