Stopping HRT: estrogen withdrawal symptoms

Mainly the return of menopause symptoms: hot flashes, night sweats, broken sleep and sometimes aches and stiffness. In the WHI follow-up, former HRT users were more likely than former placebo users to report moderate or severe hot flashes and pain or stiffness.

Often a few weeks to a few months. If they haven't settled after 3 months, the NHS suggests seeing your doctor about other treatments or restarting a low dose of HRT.

Yes. NICE says you can choose to stop immediately or reduce gradually. Stopping suddenly may bring symptoms back sooner, but in the longer term there's no difference between the two approaches.

There's no fixed limit. Most women take it for 2 to 5 years, but you can continue as long as the benefits outweigh the risks, reviewed each year. Vaginal estrogen can be used for as long as needed.

Some women do stay on HRT long term if the benefits still outweigh the risks for them, with a yearly review. After 60, the balance may shift for some, because symptoms tend to ease and breast cancer risk rises with longer use of combined HRT.

There's no age at which you must stop. If you keep taking HRT after 60, a doctor may recommend a low dose and patches or gel rather than tablets to reduce the risk. If symptoms return when you try stopping and the benefits still outweigh the risks, you can continue.

There's no good evidence that estrogen makes you put on weight, so stopping HRT isn't a weight-loss strategy. Weight gain is common around menopause itself; a balanced diet and regular exercise help most.

Bone protection fades, with bone loss resuming at a similar rate to early menopause. The small breast cancer risk from combined HRT falls after stopping, though some excess can persist for years after long use. In 18 years of WHI follow-up, HRT didn't change overall death rates.

Estradiol levels fall fast: FDA labeling says blood levels return to baseline within 24 hours of removing the patch. Hot flashes and night sweats can come back within days, which is why some women step down to a lower-strength patch first.

On sequential HRT, a withdrawal bleed usually happens at the end of each progestogen course; after you stop HRT these bleeds stop. Any unexpected bleeding after you've stopped should be checked by a doctor.

Talk to your doctor, then either stop or step the dose down over 3 to 6 months. Keep a symptom diary, and if symptoms return and don't settle within 3 months, go back to discuss options.