Withdrawal from HRT:
A trial of withdrawal of HRT could be considered in those women symptom-free on HRT after one to two years, in women who have been on HRT for longer than five years and after the age of 51 for women who were started on HRT for premature menopause.
When stopping HRT, it is generally recommended that the dose of HRT should be reduced gradually over three to six months, to minimise the chance of oestrogen deficiency symptoms returning.
- when the woman decides to stop taking HRT, practitioners should be proactive in assisting and advising women in their withdraw from HRT
- women who have been using HRT for flushes should be advised that slow withdrawal is important to avoid rebound flushes
- the dose of estrogen should be gradually reduced over a period of 6 -12 weeks continuing with the dose of progestogen until the estrogen is stopped
- some women may require a longer period of time to reduce the dose
- mild flushes that appear during the withdrawal of HRT may be self-limiting and of short duration
- not known how long it takes for the CVD and VTE risk to return to baseline after stopping combined HRT therapy
- increased risk of breast cancer disappears 5 years after unopposed estrogen therapy is discontinued. It is not known how long it takes for breast cancer risk to return to baseline after stopping combined HRT therapy
Strategies for reducing HRT doses gradually
Using a lower dose HRT
- a lower dose of the existing HRT can be used or change to a lower strength brand. This lower dose can be used for 2 -3 weeks, then you should alternate the pills with one day on and one day off, then one pill followed by two pill-free days and so on until the reduction is complete
Cutting HRT pills in half
- some HRT brands (eg, Trisequens) can be cut in half and the regimen above for lowering the dose followed.
Using a patch with reducing doses
- the use of the matrix estrogen patch can be an effective way of reducing HRT. Small increments can be cut off the patch each week so lesser amounts of HRT are applied. This may be easier for some women than reducing oral HRT doses
Reference
- NICE. Menopause: identification and management. NICE guideline NG23. Published November 2015, last updated November 2024