What Happens When You Stop Taking HRT?

If you’ve ever experienced menopausal symptoms like hot flashes and night sweats, you know that they can impact your day-to-day life.

For some women, the impact can be major. According to a 2021 global survey study, about one-third of U.S.-based respondents reported their symptoms as moderate to severe.

Hormone replacement therapy, or HRT, is one way to reduce symptoms and boost quality of life during menopause. But what happens when you stop HRT?

Below, we cover why you might stop HRT, what happens if you stop, and your alternatives.

HRT is a treatment for menopause and perimenopause symptoms. 

During perimenopause, your ovaries make less estrogen and progesterone. This leads to symptoms you probably associate with menopause, like hot flashes.

HRT works by replacing the hormones your body is producing less of during menopause.

There are two types of HRT: 

• Estrogen-only

• Estrogen plus progestin, also called combined HRT

Your doctor will likely prescribe HRT as a pill, transdermal skin patch, or gel. They might also suggest topical HRT treatments to help manage vaginal dryness.

Starting HRT can help with:

• Hot flashes and night sweats. Some research has shown that HRT can reduce these symptoms by about 75%.

• Vaginal dryness. HRT can help with vaginal dryness due to lower estrogen levels and make sex more comfortable.

• Bone health. Estrogen replacement can lower your risk of menopause-related bone loss and osteoporosis. 

Now that we’ve covered why your doctor might prescribe HRT, let’s dive into what happens when you stop taking it.

What actually happens when you stop HRT? And what are the side effects of stopping HRT suddenly?

Stopping HRT might mean the return of symptoms like hot flashes, vaginal dryness, and mood swings. This happens in around 50 percent of women. According to a 2023 review, symptoms can come back whether you gradually end HRT or stop suddenly.

Bone density also starts to decrease again when you stop HRT. This can once again increase your risk of osteoporosis and bone breaks.

Will I lose weight if I stop HRT?

There’s no good evidence that links HRT with significant weight gain. If you lose or gain weight after HRT, it’s likely due to other factors. 

There are many reasons why people decide to stop taking HRT. Let’s explore them now.

Changes in Symptoms

Some women stop HRT simply because they no longer need it to manage menopause symptoms. While symptoms like hot flashes and night sweats can continue for several years after your last period, they do tend to improve with age. 

On the flip side, some women stop HRT because they find their symptoms aren’t getting any better and want to try alternatives.  

Risk of Cancer

According to the National Institutes of Health (NIH), a lot of the evidence on menopausal hormone therapy and cancer risk comes from two Women’s Health Initiative (WHI) clinical trials. 

Breast cancer

The WHI found a link between combined HRT use and increased breast cancer risk. These cancers were often found at a later stage, possibly because combined HRT can make breasts denser and harder to read on a mammogram. 

The good news? Breast cancer risk began to drop after stopping HRT.

Interestingly, using estrogen-only therapy was linked to a lower risk of breast cancer.

Endometrial cancer

Estrogen-only HRT can raise the risk of endometrial cancer in women who still have their uterus. But combined HRT can actually lower that risk.

If you’ve had your uterus removed (like with a hysterectomy), estrogen-only HRT won’t increase your risk of endometrial cancer.

Ovarian cancer

A 2024 long-term follow-up of the WHI trials suggests a link between estrogen-only HRT and a higher risk of ovarian cancer. But researchers found no link between combined HRT and ovarian cancer risk. 

Other Health Risks

HRT also comes with other potential health risks, which may make some people hesitant to continue treatment. 

According to the American College of Obstetricians and Gynecologists, HRT can slightly increase your chances of:

• Blood clots and stroke (with any type of HRT)

• Heart attack (mainly in older women using combined HRT, though it may lower heart disease risk in women under 60)

• Gallbladder disease (with any type of HRT) 

Wondering if hormone replacement therapy is right for you? It depends on several factors — your age, your menopause symptoms, and your health history.

According to the The Menopause Society, HRT is the most effective treatment for hot flashes and vaginal dryness, and it can also help protect your bone health.

But HRT isn’t for everyone. The risks can vary based on the type of HRT, the dose, how long you take it, and when you start.

Generally, the benefits outweigh the risks for women who:  

• Are under 60 when they start 

• Begin HRT within 10 years of menopause

• Don’t have a history of blood clots, stroke, breast cancer, or endometrial cancer

Choosing HRT is a personal decision. Talk with your healthcare provider to find out what’s best for you.

There’s no set time limit for taking HRT.

A 2023 review suggests it’s reasonable to use a lower dose or stop HRT after a few years — many women choose to stop after four to five years, according to the Menopause Society.

Whenever you decide to stop, it’s best to taper off gradually over three to six months, rather than quitting suddenly. Always talk to your doctor before making changes to your treatment.

The FDA has approved the following non-hormonal treatments for menopausal symptoms:

• Paroxetine (Brisdelle^®) to manage moderate to severe hot flashes

• Fezolinetant (Veozah^TM) to treat moderate to severe hot flashes

• Ospemifene (Osphena ^®) to help with painful sex due to vaginal dryness

The following non-hormonal treatment options may also help alleviate common menopausal symptoms:

• Gabapentin, a type of epilepsy medication that doctors may prescribe off-label to help with symptoms like hot flashes

• Oxybutynin, an overactive bladder medication that doctors may prescribe off-label for symptoms like hot flashes

• Cognitive behavioral therapy (CBT), which may help with mood changes, sleep problems, and some physical symptoms

• Over-the-counter (OTC) vaginal moisturizers or lubricants to reduce vaginal dryness

There’s there’s still a lack of evidence supporting the following remedies, but some people find them helpful:

• Supplements and herbal remedies

• Dietary changes

• Yoga

• Mindfulness-based practices

• Acupuncture

• Chiropractic treatments

• Cannabis

If you want to explore a non-hormonal treatment for your menopause symptoms, meet with a healthcare professional to talk about your options. They can suggest a treatment plan that meets your needs.

For some women, HRT is a helpful way to manage menopause-related symptoms, but it’s not for everyone. Let’s recap what happens when you stop HRT:

• Stopping HRT may lead to the return of your symptoms. That’s whether you stop gradually or suddenly.

• There are many reasons people choose to stop taking HRT. For example, changes in symptoms and concerns about health risks.

• There’s no set time limit for taking HRT. However, many women take it for a few years before stopping.

• HRT alternatives exist. If HRT isn’t right for you, non-hormonal menopause treatment options are available.

If you’re thinking about stopping HRT, it’s best to consult a healthcare professional. They can help you understand what to expect when stopping treatment and recommend alternatives.