Guidelines for Stopping Hormone Replacement Therapy (HRT)

General Principles for Women on HRT

The American College of Physicians recommends that 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, 2
Women who begin HRT for menopausal symptom relief should use the lowest effective dose for the shortest possible time, as recommended by the American Academy of Family Physicians 2

Women who have been on HRT should be evaluated for individual risk factors before continuing therapy, including the risk of breast cancer, coronary heart disease, venous thromboembolism, stroke, and gallbladder disease, as suggested by the American Heart Association and American College of Cardiology 1, 2, 3, 4

The American Heart Association recommends that women who are currently on HRT for secondary prevention of coronary events may continue, but HRT should not be initiated for this purpose 5
For women with bothersome menopausal symptoms, continuation of HRT should be based on whether benefits outweigh risks in their individual case, as recommended by the American Academy of Family Physicians 2
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, as suggested by the National Comprehensive Cancer Network 6

The American Society of Clinical Oncology suggests that men on testosterone replacement therapy should be monitored regularly for potential adverse effects and treatment should be discontinued if risks outweigh benefits 7

After discontinuation, monitor for changes in bone mineral density in patients at risk for osteoporosis, as recommended by the American Society of Clinical Oncology 7
Monitor for cardiovascular health, as suggested by the American Heart Association and American College of Cardiology 2

For cancer survivors with treatment-induced gonadal failure, HRT decisions should be made in consultation with specialists, as recommended by the American Society of Clinical Oncology 7

Using HRT solely for prevention of chronic conditions like osteoporosis without considering alternative therapies, as recommended by the American College of Physicians 1, 2

The American College of Physicians and the American Academy of Family Physicians recommend using the lowest effective dose and tapering slowly over time, rather than abrupt cessation, to minimize the return of vasomotor symptoms in women discontinuing hormone replacement therapy, with approximately 75% of women able to successfully discontinue with this approach 8, 9

The American College of Physicians recommends using the lowest effective dose for the shortest time necessary, and attempting cessation, rather than continuing hormone replacement therapy indefinitely 8, 9