Stopping HRT: when to consider it and how to do it

Reasons include feeling that symptoms have passed, concerns about risk, side effects, a new medical diagnosis, a wish to see how things are without treatment or practical factors such as cost. Some women are advised to stop because of new risk factors, such as a clot or certain cancers. Others continue for many years because they feel better and their risk profile remains acceptable.

NICE advises annual review of HRT, discussing benefits and risks, blood pressure, symptoms and whether to continue. There is no age at which you must stop. Some risks, such as breast cancer with combined therapy, increase with duration, while benefits such as bone protection continue only while treatment is taken. A clinician can help you weigh these in your own circumstances.

• Stopping at once: simple, and studies suggest long-term symptom outcomes are similar to tapering.

• Tapering: reducing the dose or frequency over weeks to months, which some find gentler and which may limit early symptom return.

• Switching to a lower-dose product, then stopping.

• Keeping vaginal oestrogen if you have local symptoms.

• Choosing a quieter time in your life, if possible, when sleep and stress are less pressured.

Some women notice no change. Others have a return of hot flushes, night sweats or sleep disturbance, usually within days to weeks. These often settle over weeks to months, and for some persist. If they are troublesome, you can restart HRT or try non-hormonal options. Joint aches and mood symptoms may also reappear. Keep a diary to see patterns and tell your prescriber how you feel.

Bone loss resumes after stopping, so women at higher risk may need bone-protective measures or a scan. Weight-bearing exercise, calcium, vitamin D and avoiding smoking support bones. Cardiovascular health remains a priority regardless of HRT: blood pressure, cholesterol, activity and weight matter.

Vaginal dryness and urinary symptoms often return after stopping systemic HRT, since the tissues are sensitive to oestrogen. Low-dose vaginal oestrogen is commonly continued, and moisturisers can help. Do not assume these symptoms should simply be tolerated.

If symptoms return and you decide that HRT is helping, you can restart. A prescriber will check your history again. Starting after a long gap may mean beginning at a lower dose. There is no failure in changing your mind.

Ask your prescriber how your symptoms and risks have changed since you started, whether a gradual reduction would suit you, what to do if symptoms return, whether you should keep vaginal oestrogen and whether your bone health needs checking. Ask also what to do if you are due surgery or a long period of immobility. Plan a follow-up a few months after stopping, so that you can discuss how you feel and decide together whether to restart or try other measures.