Coming off HRT safely

There are no time limits as to how long you should take HRT for. This should be an individual decision together with yourself and your doctor/prescriber, with at least an annual review of risks vs benefits, and the choice to continue on it as long as the medication remains helpful and safe.  

There may be circumstances where you need to come off HRT, such as for medical reasons or personal choice. Hormone and menopause specialist Dr. Katie Hodgkinson provides her expert advice on coming off HRT safely.

What happens when you stop HRT?

After stopping HRT, your natural hormonal levels will gradually return, and the symptoms that HRT was managing, such as mood swings, ‘brain fog’, sweats and vaginal dryness, may recur. Loss of bone density may progress if protection from HRT is stopped. 

The time it takes for these changes and the intensity of symptoms can vary depending on whether you are perimenopausal or have reached menopause, which dose of HRT you are taking and for how long, and your overall health.

How long does it take for hormones to stabilise after stopping HRT?

It can take weeks to months for hormone levels to return to natural levels. 

In the first 1-2 weeks as oestrogen and progesterone levels decline, a return of menopausal symptoms may occur. Symptoms gradually stabilise around 6 weeks to 3 months, with the body adjusting to lower hormone levels, and from 3-6 months onwards there can be an adjustment of hormone-dependent processes such as changes in cardiovascular markers and bone density, which may be permanently reduced if not managed adequately. 

How can I come off HRT safely? 

It is usually advisable to come off HRT gradually rather than abruptly to minimise withdrawal side effects (unless advised to stop immediately for medical reasons). This should be an individualised approach (usually under the advice of your doctor / prescriber), with the process depending on factors such as how long HRT has been used for, your age, the type of HRT (oral vs. patch vs. gel), any symptoms, and underlying health risks e.g. bone health, cardiovascular health and cancer risk. 

It is important to have a healthy lifestyle anyway, but if coming off HRT, diet, exercise and stress management should be addressed. Alternative medication or supplements may be suggested to support management of menopausal symptoms or health risks.

When should I come off HRT? 

The decision on when to stop HRT depends on different factors:

• Personal choice
• Health risks: those with a cancer history, such as breast, ovarian, or womb, may need to stop sooner, or if they have heart disease or clotting risk, they may be advised to change to a different type of HRT or stop.
• Medical advice: A doctor can evaluate bone density, cardiovascular health, and personal risk factors to determine the optimal time to take HRT or when to stop – for example a woman that has undergone premature menopause should be advised to take HRT at least until the natural age of menopause (average is 51) in particular for bone protection reasons. 

What are the side effects of coming off HRT? 

Although side effects can be reduced if coming off HRT gradually rather than suddenly stopping it, they can still occur. 

Common side effects are:

• Recurrence of menopausal symptoms like sleep problems, mood swings, anxiety, hot flushes, night sweats, mood swings, vaginal dryness and sleep issues.
• Physical changes: dryness of skin, mild breast tissue decrease, redistribution of fat, headaches, bloating or breast tenderness may appear.
  
• Long-term health: Bone density may gradually decline, and cardiovascular disease risk can increase. 

Short-term symptoms tend to peak in the first 2–6 weeks after stopping HRT and, over a few months, gradually stabilise. Continue reading about common side effects of HRT.  You may also be interested in reading 'Top 10 questions about HRT answered'.

When and how to come off HRT should be an individual and medical decision and carefully done where possible to minimise symptoms recurring and to address any health risk factors. Understanding the common side effects of HRT and strategies to help manage menopause — whether taking HRT or not — can help women to make informed decisions about their treatment and support quality of life at the time of menopause and onwards. 

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