Stopping hormone replacement therapy (HRT)

• there is study evidence that stopping HRT results in (1):
  • menopausal symptoms were present in 44% women
    • with 25% having vasomotor symptoms, 25% urogenital complaints, and 5% mood-related symptoms

Withdrawal from HRT (2):

• when the woman decides to stop taking HRT, practitioners should be proactive in assisting and advising women in their withdraw from HRT
• women who have been using HRT for flushes should be advised that slow withdrawal is important to avoid rebound flushes
• dose of estrogen should be gradually reduced over a period of 6 -12 weeks continuing with the dose of progestogen until the estrogen is stopped
  • some women may require a longer period of time to reduce the dose
• mild flushes that appear during the withdrawal of HRT may be self-limiting and of short duration
• not known how long it takes for the CVD and VTE risk to return to baseline after stopping combined HRT therapy
• increased risk of breast cancer disappears 5 years after unopposed estrogen therapy is discontinued. It is not known how long it takes for breast cancer risk to return to baseline after stopping combined HRT therapy

Strategies for reducing HRT doses gradually (2)

Using a lower dose HRT

• a lower dose of the existing HRT can be used or change to a lower strength brand. This lower dose can be used for 2 -3 weeks, then you should alternate the pills with one day on and one day off, then one pill followed by two pill-free days and so on until the reduction is complete

Cutting HRT pills in half

• some HRT brands (eg, Trisequens) can be cut in half and the regimen above for lowering the dose followed.

Using a patch with reducing doses

• the use of the matrix estrogen patch can be an effective way of reducing HRT. Small increments can be cut off the patch each week so lesser amounts of HRT are applied. This may be easier for some women than reducing oral HRT doses

Reference:

• 1) Ness J et al. Menopausal symptoms after cessation of hormone replacement therapy. Maturitas. 2006 Feb 20;53(3):356-61.
• 2) New Zealand Guidelines Group (2002). Hormone Replacement Therapy.