Many women have been told that they can’t stay on hormone replacement therapy (HRT) for too long.

There’s no “right” number of months or years to use hormone therapy. The U.S. Food and Drug Administration (FDA) recommends using hormone therapy at the lowest dose possible for the shortest time required.

In this article, we’ll cover why there’s no one right time frame for hormone therapy, what doctors consider when prescribing HRT, and how to know when it might be time to stop.

Why Is There No Set Time Frame for Hormone Therapy?

There’s no standard length of time to take hormone therapy. It’s generally taken for five years or less, but the right duration varies from person to person.

How long you use hormone therapy depends on several factors, including:

• Your age
• Length of time since your last period
• Your health history
• Your family history
• Your overall health

Your doctor will also consider your symptoms, the type of hormone therapy you use, and your treatment goals when deciding how long to recommend treatment.

🗳️ How long have you been on hormone therapy for menopause symptoms?

Less than 1 year

1 to 5 years

More than 5 years

I haven’t used hormone therapy.

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What Key Factors Determine How Long You Stay on HRT?

How long you take hormone therapy will depend on your symptoms and treatment goals, as well as how well the treatment is working for you. It will also vary based on your age and individual risk factors.

Symptom Severity

Hormone therapy may be used to treat menopause symptoms that are severe enough to disrupt your daily life. For example, waking up with night sweats most nights can make it hard to get enough sleep and could affect your quality of life.

Although hormone therapy can’t address every menopause symptom, research has found that hormone therapy may help with:

• Moderate to severe hot flashes and night sweats
• Insomnia or disrupted sleep
• Mood changes

How long you need hormone therapy may depend partly on how long your symptoms continue and whether treatment is still helping.

Age and Time Since Menopause

Your age and how much time has passed since menopause can affect the benefits and risks of hormone therapy. The benefits are generally more likely to outweigh the risks when you start treatment before age 60 and within 10 years of menopause.

However, early or premature menopause is an exception. If your ovaries stopped working before age 40 or were removed before age 45, lower estrogen levels at a younger age can raise certain health risks. Hormone therapy may help lower the risk of conditions such as heart disease, osteoporosis, and cognitive decline, and treatment may be recommended until around the typical age of menopause.

Health and Family History

Your health and family history can affect whether hormone therapy is appropriate for you and which type may be recommended. Certain health conditions may make systemic hormone therapy unsafe or change its risks and benefits.

Talk with your doctor before using hormone therapy if you have a history of conditions such as:

• Unexplained vaginal bleeding
• Certain hormone-sensitive cancers
• Liver disease
• Gallbladder disease
• Blood clots
• Heart attack
• Stroke
• Coronary artery disease

Systemic hormone therapy can increase the risk of blood clots and stroke. Combination hormone therapy (estrogen plus a progestogen) may also increase your risk of breast cancer after five years of treatment. Your doctor can help you weigh these risks against the benefits of treatment based on your personal and family health history.

How Do Doctors Reassess HRT Over Time?

When you start hormone therapy, your doctor will see you regularly for in-person or telehealth appointments to monitor your symptoms and side effects. Your doctor may adjust your dose or medication based on how well your treatment is working and any side effects you experience.

In the past, health experts often recommended stopping hormone therapy around age 65. Currently, the American College of Obstetricians and Gynecologists and the North American Menopause Society don’t recommend routinely stopping systemic hormone therapy at 65.

For people who are healthy and still have bothersome hot flashes, hormone therapy may remain an option after age 65. Because research on long-term use in this age group is limited, you and your doctor should regularly discuss whether the benefits continue to outweigh the risks.

Your doctor may consider changing your hormone therapy prescription as you get older. To lower certain risks, they may recommend lowering your dose or switching from oral hormone therapy to a transdermal form, such as an estrogen skin patch.

How Will You and Your Doctor Decide if You Should Stop HRT?

If you decide to stop taking hormone therapy, talk with your doctor before making any changes. They can help you understand what to expect and how to lower your risk of uncomfortable side effects. Hormone therapy experts usually recommend tapering off medication, rather than stopping it abruptly.

About half of women who use hormone therapy to treat hot flashes will experience this symptom again after stopping treatment. Hot flashes tend to get better over time.

If you use hormone therapy for bone health, talk with your doctor about how to protect your bones once you stop treatment. The protection against bone loss decreases quickly after hormone therapy is stopped.

Low-dose vaginal estrogen may be used long term if needed. Vaginal estrogen is highly effective for vaginal and urinary symptoms of menopause, and observational studies support its long-term safety.

What Questions Should You Ask Your Clinician About HRT Duration?

You may find it helpful to write down a list of questions before your next appointment. Consider keeping a log of your menopause symptoms so that you and your healthcare provider can determine which type of hormone therapy is right for you.

Some helpful questions may include:

• Given my personal and family history, which type of hormone therapy do you recommend?
• If I’m still experiencing symptoms, is it possible to increase the dose?
• What happens if I stop hormone therapy and my symptoms come back?
• Is it possible to switch to another type of hormone therapy that has fewer risks?
• Am I a candidate for vaginal estrogen therapy?

There’s no set timeline for stopping hormone therapy, so keep talking with your clinician about your symptoms, treatment goals, and any changes in your health.