How Do You Stop Hormone Replacement Therapy After Menopause?

Menopausal hormone replacement therapy (MHT or HRT) works to replace the hormones that drop during menopause. You’ve probably heard of estrogen and progesterone, the reproductive hormones the ovaries make. These hormones are in charge of puberty, sex drive, menstruation, and pregnancy. They also contribute to bone health, sleep, and mood.  

Taking MHT during menopause can help to reduce the symptoms that some people experience. Common symptoms of menopause that improve with MHT are hot flashes, disturbed sleep, mood changes, and even joint aches and pains.

But MHT also comes with some risks and side effects. This is why most people don’t take it for more than 5 years. Stopping MHT can have its own set of challenges and risks. Read on to learn more about when and how to safely cut back on MHT. 

How does hormone replacement therapy work?

Menopausal HRT works by replacing your natural hormones that decrease with menopause. Menopausal HRT is either estrogen alone — or both estrogen and progesterone. You can take it as a pill, shot, implant, patch, or even vaginally. Your healthcare provider can help you understand your options and what type of MHT might be right for you.

How long does hormone replacement therapy last?

As with any medication, there are some risks with hormone replacement therapy. That’s why experts recommend using HRT at the lowest dose that works and for the shortest amount of time needed to improve symptoms. When the symptoms of menopause start to decrease, you can begin to lower your dose. This is generally after about 5 years of use, or around age 59.

There are a range of risks with menopausal HRT. And they go up as you get older. The risks also increase the longer you take HRT. Menopausal HRT can increase your risk of the following health conditions:

• Stroke

• Blood clots

• Uterine cancer

• Breast cancer

You’ll want to review your individual risks and benefits with your healthcare provider. There may be ways to decrease your risks from menopausal HRT, including: 

• Starting HRT within 10 years of menopause, before the age of 60

• Using a low dose of estrogen

• Using transdermal estrogen

• Using progesterone if you have a uterus

What are the side effects of hormone replacement therapy?

It’s possible you may experience side effects of menopausal HRT that make you think about decreasing your dose or stopping it completely. These side effects may include: 

• Headaches

• Nausea

• Bloating or diarrhea

• Breast tenderness

• Acne or skin changes

• Change in sex drive (libido)

The side effects of menopausal HRT will slowly ease off as you lower your dose of HRT. Once you stop the medication, the side effects will go away completely. But depending on how quickly you stop or lower your HRT, you may experience some other symptoms (more on this below). 

Does HRT cause weight gain?

No. The research shows that menopausal HRT doesn’t cause weight gain. That being said, it’s common to gain a small amount of weight during this time of life. Stopping HRT won’t make much difference for your weight. But other factors can affect your weight, including your diet and exercise habits. 

How do you know when you’re ready to stop HRT?

It can be hard to know when it’s the right time to stop hormone replacement therapy. When you start menopausal HRT, it’s a good idea to also start thinking about when you plan to stop. It can be helpful to monitor your menopausal symptoms over time. Your healthcare provider can also be a good source of support in making the decision to start lowering your dose. 

It may be time to consider decreasing your dose and starting to wean off menopausal HRT if any of the following apply:

• Your menopausal symptoms are decreasing

• You have been using HRT for close to 5 years or more

• You are approaching age 60

• You have been in menopause for close to 10 years

What side effects can you expect when you start reducing doses of HRT?

When you start to decrease your dose of menopausal HRT, you may notice some symptoms. The cause of these symptoms is usually a dropping level of estrogen. Symptoms may include:

• Hot flashes

• Night sweats

• Mood changes (anxiety and depression)

These symptoms should be mild and will decrease with time. 

What’s the safest way to stop hormone replacement therapy?

Be sure to discuss reducing or stopping your menopausal HRT with your healthcare provider. In many cases, you can limit the side effects by slowly lowering your dose over time. You may want to try switching to a lower dose and/or fewer days per week while paying close attention to your symptoms. If your symptoms return, it will be important to weigh the risks and benefits of continuing HRT. If you aren’t sure, a talk with your provider may help.

What happens when you stop HRT cold turkey?

If you stop HRT cold turkey, or suddenly, you will likely experience symptoms of estrogen withdrawal, including hot flashes and night sweats. You can manage these symptoms by slowly decreasing your dose over time. 

Are there risks to stopping HRT?

The most likely risk is that your menopausal symptoms return. Some research also suggests a rise in blood pressure and a slight increase in risk of heart attack or stroke in the year after stopping HRT. But overall, the risks of stopping HRT are low. And you can do it in a slow, comfortable, and safe way. 

How can I support my menopausal symptoms naturally?

As you think about lowering and stopping menopausal HRT, there may be some natural or over-the-counter treatments for menopausal symptoms. These include nutrition and dietary changes, certain  supplements, and exercise.

And depending on your symptoms, there are also some nonhormonal medications you may consider. Examples include:

• SSRIs or SNRIs, including paroxetine (Paxil) or venlafaxine (Effexor)

• Antiepileptics, such as gabapentin (Neurontin)

• Vaginal treatments, such as lubricants or vaginal estrogen