Managing perimenopause and menopause symptoms can feel like a full-time job. Night sweats, mood changes, hot flashes—it’s a lot to deal with, at one of the busiest times of life. Many women turn to hormone therapy (HRT), also called hormone replacement therapy, to balance these changes and relieve symptoms.
Menopause is a natural part of aging when women stop having monthly periods and can no longer become pregnant. It usually happens in a woman’s early 50s. During this time, the body stops producing its regular amount of female hormones, such as estrogen. That change can cause a range of unpleasant and disruptive symptoms.
HRT is a personalized medication that replenishes those hormones to help manage menopause symptoms. As a Certified Menopause Practitioner by the the Menopause Society, I regularly talk with women about their hormone therapy options, including whether and when to stop taking it.
There is no explicit rule or guideline about when to stop HRT—every woman’s hormone therapy plan should be personalized to her needs.
Menopause-related symptoms can be significantly alleviated by taking HRT before the age of 60-64. After that, the possible risks may begin to outweigh the benefits. At that point, you may wish to stop taking HRT. Before making your decision, talk with a doctor about your:
Current symptoms and how much they affect your life
general medical history Personal risks and benefits for continuing HRT
Together with your doctor, you can determine the best next steps for your health. Use this list of questions as a starting point for your conversation with your women’s health care provider.
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1. What are the possible risks associated with long-term HRT?
Women who start HRT before age 60, and within 10 years of their last period, often have more benefits than risks associated with hormone therapy. Starting HRT after age 60 tends to come with a higher risk of health complications.
Most patients who choose to take HRT use it for four to five years before considering stopping due to potential health risks, such as:
- Blood clots
- Breast cancer
- Dementia
- Heart disease
- Stroke
- Uterine cancer
On the other hand, hormone therapy can provide protective benefits during certain times of a woman’s life, including:
- Better sleep
- Improved mood
- Less painful intercourse
- Less urination pressure Reduced risk of bone fragility
- Lower risk of heart disease and type 2 diabete
Systemic hormone therapy from pills, patches, gels, or vaginal rings is absorbed at higher levels in the bloodstream. This means they can have a greater positive impact but can also carry more risk. Low-dose therapies such as vaginal estrogen therapy are more localized and do not enter the bloodstream as much, bearing fewer risks.
As with most medications, the best strategy is to take the lowest effective dose of HRT for the shortest amount of time to manage your symptoms. Talk with your doctor about what that looks like for you based on your age, symptoms, personal and family history, and overall health.
2. Will my menopause symptoms come back after I stop HRT?
About half of women who stop HRT will have a temporary return of symptoms, even if they have been taking it for years. This can be frustrating, so talk with your doctor about ways to get ahead of symptoms. Your doctor may recommend:
Lifestyle changes: Nutrition or exercise modifications can help decrease inflammation and improve your overall health and mood.
Therapy or counseling: Talking through these changes can uplift your mood and help you feel less overwhelmed or isolated. In some cases, antidepressants or anxiety medications can help.
Over-the-counter options: Temporary sleep aids or women’s health products such as vaginal lubricants can provide relief. Talk with a doctor before taking any new products, especially herbal supplements. Supplement products are not regulated in the same way as prescription medications and may cause new health problems or counteract your other medications.
3. Should I taper off or go ‘cold turkey’ with HRT?
Your doctor likely will recommend slowly reducing your dosage over a few months or years. Taking your time to come off HRT may allow your body to adjust to the changing hormone levels. In general, it’s best not to stop a medication abruptly without first discussing it with your doctor.
In some cases, the provider may recommend changing the way you take HRT. For example, switching from a vaginal insert or patch to a pill form may make more sense for your lifestyle and symptoms over time.
4. Where can I get information about menopause and HRT?
First, talk with a doctor who knows you and your personal health history. Having that foundation can help you get started faster on the right HRT for you.
Here are a few more resources that we often recommend to patients:
Menopause Society: This organization shares evidence-based text and video resources for patients and healthcare providers. Its members include experts such as nurses, psychologists, medical doctors, and educational leaders who prioritize providing accurate women’s heath information. Visit the Menopause Society website
unPAUSED: The host of this podcast is Dr. Mary Claire Haver, a board-certified obstetrician and gynecologist and a Certified Menopause Practitioner. She covers a range of menopause-related topics including mental health, heart health, and living a full life in your 60s and beyond. Listen to the podcast.
The average woman will live three decades or more after menopause. By working with a doctor to manage menopause symptoms, you can kickstart those years feeling happy, healthy, and energized.
