There’s usually a lot of discussion and consideration given to starting HRT (or at least there SHOULD be), but when should you stop HRT?
Women often have discussions with a health professional and a weigh up their treatment options for symptoms in the menopausal transition before deciding to start HRT (Hormonal Replacement Therapy, now known as Menopausal Hormone Therapy- MHT). Often one concern is “will I be on this for ever?” or “am I just putting off menopause symptoms til later?”
Will I Need To Continue HRT For Ever?
Not usually. The average length of time that women use MHT to ease menopausal symptoms is around 6 years. There are some women who still find they need some estrogen therapy into their older years to manage hot flushes though; as long as they started MHT around the age of menopause and used it continuously, this is usually ok.
Am I Just Delaying My Menopausal Symptoms Until Later?
No. Think about menopausal symptoms as withdrawal symptoms from lower estrogen and progesterone. Like most of the body’s systems, we gradually adapt to hormonal changes over time so symptoms lessen. MHT reduces these symptoms and gives your body more time to adapt to a lower-hormone environment. In most cases, when women try stopping their MHT every year or so they eventually find that their symptoms either don’t return, or can be managed with a lower MHT dose.
Do I Need To Stop HRT/ MHT After Five Years?
No, not unless your symptoms are gone or you don’t want to use it any more. This myth comes from the fact that SOME types of MHT can slightly increase your breast cancer risk after five years of use (to about the same extent as drinking 2 glasses of wine per day). This is not the case with all MHT however, for example micronised (body-identical) progesterone and Mirena IUD’s as part of an MHT regimen don’t have this effect.
In reality, lifestyle factors like obesity, a sedentary lifestyle and excessive alcohol are MUCH bigger risk factors for breast cancer than any MHT products. Ultimately, if you function and feel better on MHT, and you haven’t had breast cancer or any other contraindications (which are few) then you can continue your MHT as long as you need it.
Confusion Amongst Medical Professionals
Our doctors recently attended Australia’s biggest menopause forum, the annual congress of the Australasian Menopause Society (AMS). Topics discussed included the issue of how long women can or should use MHT. From WellFemme doctor Lynda Newman:
“I have been looking out for data about when to stop MHT. In the past the consensus statement has been that in using hormone therapy “the benefits outweigh the risks until age 60” [but beyond that] we are not prepared to say”.
Lynda was keen to put the newest consensus statements on our Blog page; in general they all say similar things, ie. no need to stop at age 60, but have a discussion with your menopause doctor regarding the risks and benefits.
What Do Experts Say About Stopping HRT?
Here are the latest International statements about stopping MHT:
- The International Menopause Society Global Consensus Statement on MHT 2106: “Duration of treatment should be consistent with the treatment goals of the individual, and the benefit/risk profile needs to be individually reassessed annually.”
- European Menopause and Andropause Society (EMAS) position statement 2020: “… no evidence regarding the length of time for which either systemic or low-dose vagin*l MHT should be taken… any limits on duration of use are arbitrary, and treatment should continue for as long as the woman feels the benefits outweigh the risks for her, and decision must be made on an individual basis.”
- 2020 Statement from AMS, IMS, BMS (British), EMAS and RCOG (Royal College of O&G’s, UK) about MHT and breast cancer risk: “No arbitrary limits should be placed on the dose or duration of usage of MHT.”
- North American Menopause Society 2022: “Hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 years and can be considered for continuation beyond age 65 for persistent VMS [vasomotor symptoms, ie. flushes and sweats], quality of life issues, or prevention of osteoporosis after appropriate evaulation and counselling of the benefits and risks.
How To Decide When To Stop HRT
If you start MHT, ideally start it early (at around the age of menopause or not long after); if you do then it’s considered fairly safe to continue for as long as you need it to manage your symptoms, provided you don’t develop a contraindication (like breast cancer).
Talk to a health professional who has good knowledge about MHT and choose the safest possible products. Use the lowest effective dose, continuously for as long as it’s needed. Do a trial off it every year or so to see if you still need it. Ultimately, make the decision that feels right for you by assessing if the benefits outweigh the potential risks in your personal situation.
What is WellFemme About?
If you can’t find the professional help you need for your menopause or perimenopausal symptoms then book a Telehealth consultation with an expert WellFemme menopause doctor.
WellFemme is Australia’s first dedicated Telehealth menopause clinic, servicing locations nationwide including: Melbourne, Sydney, Adelaide, Darwin, Perth, Hobart, Brisbane, Dubbo, Bendigo, Broken Hill, Broome, Alice Springs, Launceston, Cairns, Mildura, Lightning Ridge, Kalgoorlie, Albany, Toowoomba, Charleville, Port Headland, Katherine, Ballarat, Coober Pedy, Bourke, Albury… and your place! 🙂
Tags
hormone replacement therapy, HRT, menopausal hormone therapy, MHT, when to stop hormonal treatment, when to stop HRT, when to stop MHT,
