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Menopause - Management
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When should I consider stopping HRT?
- If systemic Hormone replacement therapy (HRT) is being used for symptom control consider a trial withdrawal (if a woman is symptom-free) after 1–2 years.
- 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.
In depth
How should HRT be stopped?
- Some women do not notice any symptoms even with abrupt cessation of hormone replacement therapy (HRT), while others may experience a recurrence of hot flushes and sweats.
- Some experts suggest that HRT should be gradually reduced rather than stopped abruptly. Suggested strategies are:
- Oestrogen-only tablets: reduce from a 2 mg to a 1 mg tablet for 1–2 months, then use 1 mg on alternate days for a further 1–2 months.
- Oestrogen-only patches: reduce the dose gradually to 25 micrograms daily (e.g. step the dose down a patch strength each month). Half a matrix-type patch (12.5 micrograms daily) can be used for a further 1–2 months.
- Cyclical combined HRT tablets: reduce to a cyclical HRT pack containing 1 mg estradiol for 1–2 months. Cut the tablet in half for the next 1–2 months; this will ensure that the woman still receives oestrogen combined with a progestogen.
- Cyclical combined HRT patches: reduce the dose as for oestrogen-only patches, but ensure that the woman still uses the oestrogen-only patches for 2 weeks of the cycle followed by the combined patches for a further 2 weeks, to ensure endometrial protection.
- Continuous combined HRT tablets or patches: reduce the dose gradually every 1–2 months to the lowest strength tablet or patch. Then, take half a tablet or patch daily for a further 1–2 months.
- If symptoms are severe after HRT is stopped or persist for several months after stopping, the woman may wish to restart HRT after reassessment and counselling. Often a lower dose of HRT can be used (e.g. estradiol 1 mg) if HRT is restarted.
In depth
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