Stopping systemic MHT

There is no specific recommended duration of systemic menopausal hormone therapy (MHT). The decision to stop systemic MHT should be based on informed choice; consider the benefits and harms at each yearly review. Consider stopping therapy when the benefits of continuing systemic MHT (symptom relief and osteoporosis prevention) are likely to be outweighed by risk of breast cancer (which increases with longer duration of use) and other comorbidities (which increase with age).

MHT can be stopped abruptly or tapered. Although tapering the dose over 3 to 6 months does not seem to reduce the likelihood of symptom recurrence, it may help determine a lower dose at which symptoms can be controlled. It may be prudent to stop systemic MHT during the cooler months to avoid potential exacerbation of symptoms with summer weather, and to make it easier to assess recurrence and severity of vasomotor symptoms. For individuals using both systemic MHT and intravaginal estrogen, the need to continue intravaginal estrogen can be considered separately; see Intravaginal estrogen therapy.

Up to 50% of individuals experience a recurrence of symptoms after stopping systemic MHT, usually within 4 to 6 weeks. If vasomotor symptoms persist after stopping MHT, consider restarting (possibly at a lower estrogen dose) or using nonhormonal therapy.

If systemic MHT is stopped, consider the need for alternative treatment for osteoporosis prevention.