Stopping Hormone Replacement Therapy (HRT): Managing Side Effects

Menopausal hormone replacement therapy (HRT) works to replace the hormones that drop during menopause. You’ve probably heard of estrogen and progesterone, the reproductive hormones the ovaries make. These hormones are in charge of puberty, sex drive, menstruation, and pregnancy. They also contribute to bone health, sleep, and mood. 

Taking HRT during menopause can help to reduce the symptoms that some people experience. Common symptoms of menopause that improve with HRT are hot flashes, disturbed sleep, mood changes, and even joint aches and pains.

But HRT also comes with some risks and side effects. This is why most people don’t take it for more than 5 years. Stopping HRT can have its own set of challenges and risks. 

Let’s take a closer look at when and how to safely cut back on HRT and how to manage the side effects. 

How does hormone replacement therapy work?

Menopausal HRT works by replacing your natural hormones that decrease with menopause. Menopausal HRT is either estrogen alone — or both estrogen and progesterone. The treatment comes in various forms:

• Pill

• Shot

• Implant

• Patch

• Vaginal insert 

EXPERT PICKS: WHAT TO READ NEXT

• Is it safe to take HRT for menopause? Here’s what the research says about the safety of hormone replacement therapy (HRT).

• Menopause treatment savings: Learn more about how you can save on menopause treatments.

• Non-hormonal treatment options for menopause: Find out more about non-hormonal treatments for menopause.

A healthcare professional can help you understand your options and what type of HRT might be right for you.

What are the side effects of hormone replacement therapy?

You may experience side effects of menopausal HRT. And these can make you think about decreasing your dose or stopping it completely. These side effects may include: 

• Headaches

• Nausea

• Bloating or diarrhea

• Breast tenderness

• Acne or skin changes

• Change in sex drive (libido)

The side effects of menopausal HRT will slowly ease off as you lower your dose of HRT. Once you stop the medication, the side effects will go away completely. But depending on how quickly you stop or lower your HRT, you may experience some other symptoms (more on these below). 

Does HRT cause weight gain?

No. The research shows that menopausal HRT doesn’t cause weight gain. That being said, it’s common to gain a small amount of weight during this time of life. Stopping HRT won’t make much difference for your weight. But other factors can affect your weight, including your diet and exercise habits.

What are the risks of hormone replacement therapy for menopause?

As with any medication, there are a range of risks with menopausal HRT. And they go up as you get older. The risks also increase the longer you take HRT. Menopausal HRT can increase your risk of the following health conditions:

• Stroke

• Blood clots

• Uterine cancer

• Breast cancer

This is why experts recommend using HRT at the lowest dose that works and for the shortest amount of time needed to improve symptoms. When the symptoms of menopause start to decrease, you can begin to lower your dose. This is generally after about 5 years of use.

You’ll want to review your individual risks and benefits with a healthcare professional. There may be ways to decrease your risks from menopausal HRT, including: 

• Starting HRT within 10 years of menopause, before the age of 60

• Using a low dose of estrogen

• Using transdermal estrogen (patch or gel)

• Using progesterone if you have a uterus

What side effects can you expect when you start reducing doses of HRT?

When you start to decrease your dose of menopausal HRT, you may notice some symptoms. The cause of these symptoms is usually a dropping level of estrogen. Symptoms may include:

• Hot flashes

• Night sweats

• Mood changes (anxiety and depression)

These symptoms should be mild and will decrease with time as you slowly wean off the hormones. 

How long does HRT stay in your system after stopping?

It depends. While it can take up to a week or so for HRT medication to leave your system, you may still feel the effects. How long you’ll feel the effects of HRT after stopping will vary, depending on the type of HRT you’re taking and how long you’ve been taking it. 

In general, you should take 2 to 4 months to gradually decrease your current dose so your body can adjust to the changes. 

How do you know when you’re ready to stop HRT?

It can be hard to know when it’s the right time to stop HRT. When you start HRT for menopause, it’s a good idea to also start thinking about when you plan to stop. It can be helpful to monitor your menopausal symptoms over time. Your prescriber can also be a good source of support in making the decision to start lowering your dose. 

It may be time to consider decreasing your dose and starting to wean off menopausal HRT if any of the following apply:

• Your menopausal symptoms are decreasing

• You’ve been using HRT for close to 5 years or more

• You’re approaching age 60

• You’ve been in menopause for close to 10 years

What’s the safest way to stop hormone replacement therapy?

Be sure to discuss reducing or stopping your menopausal HRT with a healthcare professional. In many cases, you can limit the side effects by slowly lowering your dose over time. You may want to try switching to a lower dose and/or fewer days per week while paying close attention to your symptoms. 

If your symptoms return, it’ll be important to weigh the risks and benefits of continuing HRT. If you aren’t sure, a talk with your prescriber may help.

What happens when you stop HRT cold turkey?

If you stop HRT cold turkey (suddenly) rather than tapering off the dose, you may be more likely to experience symptoms of estrogen withdrawal. These can include:

• Hot flashes

• Night sweats

• Insomnia

• Anxiety

• Mood disturbances

• Vaginal dryness 

Are there risks to stopping HRT?

The most likely risk is that your menopausal symptoms return. Some research also suggests a rise in blood pressure and a slight increase in risk of heart attack or stroke in the year after stopping HRT. But overall, the risks of stopping HRT are low. And you can do it in a slow, comfortable, and safe way. 

What are the best HRT alternatives to support menopausal symptoms naturally?

As you think about lowering and stopping menopausal HRT, there may be some natural or over-the-counter (OTC) treatments for menopausal symptoms. These include nutrition and dietary changes, certain supplements, and exercise.

And, depending on your symptoms, there are also some nonhormonal medications you may consider. Examples include:

• Selective serotonin reuptake inhibitors (SSRIs) or Serotonin-norepinephrine reuptake inhibitors (SNRIs), including paroxetine (Paxil) or venlafaxine (Effexor)

• Antiepileptics, such as gabapentin (Neurontin)

• Vaginal treatments, such as lubricants or vaginal estrogen

• Veozah (fezolinetant)

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Written by:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a special interest in chronic care management, women’s health, mental health, and preventive care. She has over 10 years of experience in primary care research, innovation, and practice.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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