When is it safe to stop hormone therapy?

Hormone therapy (also known as menopausal hormone therapy, or MHT), can be a lifeline through the ups and downs of menopause, easing symptoms like hot flashes, night sweats, and helping protect bone health. But when is it safe to stop?

The answer isn’t as simple as ‘once symptoms fade.’ It depends on your personal risks and needs, and that’s exactly what you and your menopause service team should be discussing.

What happens when you stop hormone therapy?

A recent study found that those who stopped MHT after fewer than five years had a slight increase in fracture risk, especially shortly after discontinuation. It also showed that if 10,000 women aged 40 and up were followed for a year, there were about 14 extra fractures compared with women who never used hormone therapy.

Women who stayed on MHT for more than five years experienced a long-term protective effect. They’d have 13 fewer fractures per 10,000 women a decade after stopping.

What about cancer risk?

As with any hormone-based treatment, there are trade-offs. Past clinical trials linked combined oestrogen and progestogen therapy (especially in older women) to a slightly increased risk of breast cancer, blood clots, stroke, and heart disease. This is why many providers recommend stopping HRT eventually.

According to Breastcancer.org, while MHT can significantly improve quality of life for women with severe menopausal symptoms, any history of breast cancer, or a high risk of it, makes hormone therapy a no-go. The long-term risk of breast cancer increases with duration, particularly when progestogen is included alongside oestrogen.

Weighing the benefits and risks

It’s all about balance, and that balance looks different for everyone. If you’re younger (under 60 or within 10 years of menopause onset), have significant symptoms and low cancer risk, MHT may offer great benefits.

However, if you have personal or family history of breast cancer, a shorter course, or complete avoidance of hormone therapy, could be more appropriate.

Recent guidance emphasises that any decision around starting, continuing, or stopping hormone therapy must be highly personalised based on age, symptom severity, bone health status, and individual risks of osteoporotic fractures or hormone-sensitive cancers.

Helpful strategies when stopping hormone therapy

If you and your provider agree it’s time to stop hormone therapy, here’s what might help smooth the transition:

• Gradual tapering, if appropriate, to reduce sudden drops in oestrogen
• Monitoring bone health, especially in the first few years after stopping.
• Managing remaining symptoms, with non-hormonal options or lifestyle adjustments.

Deciding when, or if, to stop hormone therapy isn’t one-size-fits-all. It’s a careful, informed conversation that considers your symptom severity, bone health, and cancer risk, balanced by your personal values and goals.

At SureScan, our menopause service is here to guide you every step of the way. It’s personalised, responsive, and always in tune with your needs as they evolve. Book your menopause health check today.