Wait…How Long Can You Be On Hormone Therapy?

One of the most hotly debated and misunderstood topics surrounding menopause is…drum roll, please…menopausal hormone therapy, or MHT for short. (You may have also heard it referred to as hormone replacement therapy or HRT). While we’ve come a long way in our understanding of this treatment modality, the sheer amount of *noise* on the topic can make decisions around MHT feel daunting for patients. One question we hear in particular is “how long can I be on hormone therapy?” We’re digging into this question and what you should know about long-term use of MHT here.

But first, a brief history on the hormone therapy controversy

Before we dive in, we need to set the stage…In 2002, the Women’s Health Initiative published a study suggesting that MHT can lead to an increased risk of breast cancer, heart disease, and blood clots. The media hyped the findings and alarmed the public, including women and their providers. However, subsequent studies found several problems with the WHI methodology and the interpretation of their findings. Specifically, the study recruited older and less healthy women, skewing the results (which were also published prematurely), and then overgeneralized to apply to all women and all types of MHT. Despite this, the bad reputation stuck, and millions of women remain confused about MHT’s risks and benefits.

Since 2002, hundreds of follow-up studies and clinical trials have been conducted by reputable institutions on the safety and efficacy of MHT for treating menopause symptoms. Today, The Menopause Society considers MHT to be safe and effective for most women, especially when started prior to age 60 or within 10 years of menopause.

How long can I safely take MHT?

Historically, the recommendation for MHT prescribing has been “lowest dose for the shortest amount of time,” to maximize benefit from treatment while limiting risk of side effects. While this approach may work for many women, prescribing for menopause is never one-size-fits-all.

Take hot flashes and night sweats, for example — many women experience these symptoms as a result of fluctuating estrogen levels during perimenopause and declining levels postmenopause. It’s well-established that hormone therapy is THE gold standard for managing these symptoms. It’s also the most effective treatment for vaginal dryness caused by genitourinary syndrome of menopause, which can lead to painful intercourse and pelvic pain. While these symptoms often begin in midlife, they can persist for years — some women continue to experience hot flashes well into their 70s.

In fact, a retrospective analysis presented at the 2024 Annual Meeting of The Menopause Society found that hot flashes were a major reason that the participating cohort of women continued MHT into their 70s, and even 80s. The reality is, symptoms of menopause can significantly impact quality of life, and they are unfortunately not easily mapped over a specific number of years.

The highly variable nature of menopause requires an individualized approach to treatment, which is why working with a menopause-trained clinician is so important. They will take into account your symptoms, individual risk factors, and overall health status to develop a treatment plan that is evidence-based and specifically designed to relieve your symptoms and support your long-term health goals.

Are there signs that indicate I should stop taking MHT?

As we know, how long one should take MHT depends on the individual and their unique health history, as well as their tolerance for risk. But here are a couple signs that may indicate you should stop:

1. Onset of new health conditions. You’ve had a significant change in your health risks, such as heart disease or estrogen or progesterone-positive breast cancer.
2. You no longer experience symptoms. Menopause symptoms may abate over time as you experience less intense hormone fluctuations, and hormone therapy may no longer be necessary.

How do I safely come off of MHT?

If you’re interested in coming off MHT, it’s important to do so with the guidance of a healthcare professional. They’ll work with you to develop a tapering plan to limit risk of side effects like mood swings and sleep difficulties. Depending on where you are in the menopause transition, your symptoms may temporarily come back but should abate over time on the lower dose or different treatment modality.

In addition to relieving hot flashes, hormone therapy may also offer cardioprotective and osteoprotective benefits—meaning it can help reduce the risk of cardiovascular disease, heart attack, high blood pressure, and osteoporosis (a condition caused by significant bone loss). Because these protective effects may diminish after stopping hormone therapy, it’s important to talk with your healthcare provider about alternative strategies to support heart and bone health when transitioning off menopausal hormone therapy.

READ MORE:

• Estrogen Therapy Deep Dive (Creams, Gels, Moisturizers…)
• Elektra Guide to Menopause Hormone Therapy (MHT)
• The Benefits of Testosterone for Menopause
• Non-Hormonal Hot Flash Treatment Options