Guidelines for Stopping Hormone Replacement Therapy (HRT) in Men and Women
For women using HRT, it should be used for the shortest possible time at the lowest effective dose that provides symptom relief, with regular reassessment to determine if continued use is necessary.
General Principles for Women on HRT
- HRT should not be used for primary or secondary prevention of cardiovascular disease as it does not reduce and may actually increase the risk of coronary heart disease 1
- Women who begin HRT for menopausal symptom relief should use the lowest effective dose for the shortest possible time 2, 3
- Regular reassessment of the woman's health status is mandatory to determine if continued HRT is necessary 4
Considerations for Discontinuing HRT in Women
For short-term menopausal symptoms, HRT should generally not be recommended for treatment durations of more than five years 5
Women who have been on HRT should be evaluated for individual risk factors before continuing therapy, including:
HRT should be discontinued in women who develop contraindications or are at high risk of complications 5
Specific Recommendations for Postmenopausal Women
- Women who are currently on HRT for secondary prevention of coronary events may continue, but HRT should not be initiated for this purpose 1
- For women with bothersome menopausal symptoms, continuation of HRT should be based on whether benefits outweigh risks in their individual case 1, 4
- Women who have been on combined estrogen-progestin therapy for extended periods should be informed of the increased risk of breast cancer with longer-term use 2
Recommendations for Men on HRT
- Current guidelines do not provide specific recommendations for men to stop hormone replacement therapy
- Men on testosterone replacement therapy should be monitored regularly for potential adverse effects and treatment should be discontinued if risks outweigh benefits
Approach to Discontinuation
- Consider gradual tapering rather than abrupt discontinuation to minimize rebound symptoms 4
- After discontinuation, monitor for:
Special Populations
- For women with premature menopause who begin HRT before age 50, longer duration of therapy may be appropriate as they appear to have significant advantages in terms of longevity 4
- For cancer survivors with treatment-induced gonadal failure, HRT decisions should be made in consultation with specialists (endocrinology/gynecology) 1
Common Pitfalls to Avoid
- Continuing HRT indefinitely without periodic reassessment of risks and benefits 4
- Abrupt discontinuation which may lead to severe rebound symptoms 4
- Using HRT solely for prevention of chronic conditions like osteoporosis without considering alternative therapies 1
- Failing to consider age and time since menopause when evaluating risks and benefits of continued HRT 6, 7