The Procedure of Stopping HRT

If stopping of HRT is in mind, a high dose of oestrogen preparation for example a 2mg tablet oestradiol or 75 or 100mcg patch should be reduced for 2-3 months before completely stopping. This is done to minimise the chance of oestrogen deficiency symptoms from coming back. If one is already on a medium or low dose preparation that is about 1mg tablet oestradiol or 25 or 50mcg patch, the reduction is unnecessary. On cessation of therapy, initially symptoms may return fairly soon but then they generally tend to resolve. Ideally, staying off treatment for 2-3 months should be considered before making a decision whether or not to recommence.

If HRT is stopped without recurrence of systemic symptoms such as sweats, flushes, joint aches and mood changes, some oestrogen could still be required for vaginal and bladder symptoms.

Vaginal oestrogen pessary, cream, tablet or ring can be used when systemic oestrogen may not be appropriate and can be continued in a low dose for maintenance in the long term without any known harmful effect.

How Necessary Is Stopping?

�How long should one stay on HRT?� is a much discussed question. It is a general opinion that one cannot continue with the treatment forever. However, contrary to popular belief you can in fact stay on hormone replacement therapy forever if one wishes to, and if it is medically appropriate. Many women these days do this.

The general feeling is to wean off treatment after a few years, when the short-term symptoms of the menopause - such as hot flushes and night sweats - have abated. But the new thinking is that the benefits of the treatment really only start to kick in at later stages. These benefits include protection against osteoporosis, brittle bone disease, protection from heart diseases and Alzheimer's disease, improved muscle tones, delayed skin wrinkles and healthier hair. One must however weigh these against a slightly increased risk of breast cancer when one continues with treatment.

It is advised that if the treatment is suiting you then you could continue with it, provided you don�t have a family history of breast cancer and provided you undergo regular breast screening. But there are always pros and cons and one must find out as much as one can before deciding.