Sooner or later, almost every woman on HRT wonders whether she should stop. Sometimes it's a birthday, sometimes a friend who came off hers, sometimes a doctor who mentions it at a review, or simply a feeling that you've been on it "long enough". Plenty of women are still told there's a five-year limit.
There isn't. Deciding when, and whether, to stop HRT is a personal choice, and the right answer is different for every woman. What matters is what the evidence actually says, how to come off it gently if you decide to, and what to expect when you do.
No. UK guidance from NICE and the British Menopause Society doesn't set an upper age or a maximum number of years for HRT. The idea of a five-year limit came largely from the way results from older studies were reported in the early 2000s, and it has stuck around long after the evidence moved on.
What guidance does say is that you should have a review at least once a year, to check whether HRT is still helping, whether your dose and type are still right, and whether anything about your health has changed the balance of benefits and risks. Some women stop after a few years; others continue into their sixties, seventies and beyond because their symptoms come back without it and the benefits still outweigh the risks for them.
If side effects are the main reason, it's worth knowing that changing the type of oestrogen or progestogen often helps. Our guide to HRT side effects covers what can be adjusted before you give up altogether.
For most women who start HRT before 60, the benefits outweigh the risks. Two risks are worth understanding when thinking about how long to continue:
Breast cancer. Combined HRT, with oestrogen and a progestogen, is linked to a small increase in breast cancer risk that grows with the length of use. Oestrogen-only HRT, used by women who have had a hysterectomy, carries a smaller increase, and in clinical trials little or none. After stopping, the extra risk falls, but a large analysis published in The Lancet in 2019 found that some of it may persist for more than ten years in women who had used HRT for more than five. Our article on the latest HRT research puts the numbers in context.
Blood clots and stroke. HRT tablets slightly increase the risk of blood clots. Patches, gels and sprays applied to the skin don't appear to have the same effect at standard doses, so switching to one of these can be an alternative to stopping altogether, especially as you get older.
On the other side of the scale, HRT keeps bones stronger and lowers the risk of fractures for as long as you take it. That protection fades over the years after stopping.
Both are fine. NICE says that gradually reducing HRT or stopping it straight away makes no difference to symptoms in the long term. Tapering may mean fewer symptoms coming back in the short term, so many women prefer it.
A common approach is to reduce slowly over three to six months, for example:
Talk to your GP or menopause specialist before you start, because your progestogen needs to be planned too. If you have a womb, the progestogen protects the lining from oestrogen, so you need to keep taking it until you have stopped the oestrogen completely. If you have a Mirena or similar hormonal coil, it can stay in place for as long as it's licensed.
There's no blood test that tells you whether your menopause symptoms have finished. Hormone levels after menopause are low whether or not you'd still have symptoms without HRT, so the only real way to find out is to reduce or stop and see what happens.
A few questions can help you decide whether it's a good time to try:
Keep a simple diary for a couple of weeks before you start reducing and while you taper. Noting hot flushes, sleep and mood gives you something concrete to look back on, rather than relying on memory on a bad day.
Many women find their symptoms don't return at all, or only mildly. Others find hot flushes, night sweats, joint aches, poor sleep or low mood come back within weeks. That isn't a sign of "withdrawal"; it simply means the symptoms hadn't finished yet. Menopause symptoms last much longer than most of us expect, often seven years or more. (See how long menopause symptoms last.)
Give yourself a few months before deciding how it's going. Returning symptoms often settle after the first few weeks. If they're still affecting your life after three to six months, it's completely reasonable to restart HRT, possibly at a lower dose, and review again later.
Bleeding: you may have a light withdrawal bleed in the weeks after stopping, particularly if you were on a cyclical regime with a monthly bleed. Any bleeding that happens later, or that's unexpected, should be checked. Bleeding after menopause explains why it always needs checking.
Because bone protection fades after stopping, this is a good time to think about your bones. Ask your GP whether a bone density scan is a good idea, especially if you have risk factors such as an early menopause, a previous fracture, long-term steroid use, a low body weight or a family history of hip fracture. Weight-bearing and strength exercise, enough calcium and vitamin D, and not smoking all matter. There's more in protecting your bones. If your risk is high, there are bone-specific medicines that can be used instead.
Heart health is worth a check too. Blood pressure, cholesterol, blood sugar and weight all tend to drift after menopause, whether or not you take HRT. Menopause and heart health covers what to look out for.
Vaginal dryness, soreness, painful sex and bladder symptoms tend to get worse, not better, as the years go by after menopause. Low-dose vaginal oestrogen treats these directly, very little is absorbed into the bloodstream, and it can be used safely for as long as you need it, alongside systemic HRT or on its own. You don't need to stop it when you stop your HRT, and many women start it at this point. Our article on vaginal dryness after menopause explains the options.
Do I need to stop HRT at 60 or 65?
No. There's no fixed age. Women who want to continue past 60 should have a careful annual review, and a patch or gel is often preferred to tablets at that age because of the lower blood clot risk.
Will I gain weight when I stop HRT?
Stopping HRT doesn't directly cause weight gain, just as HRT itself doesn't cause it. Poor sleep from returning night sweats can make weight management harder, though. (The evidence is in does HRT cause weight gain?)
Do I need contraception after stopping HRT?
HRT is not a contraceptive, and it can mask when your natural periods would have stopped, so if you're under 55, check with your doctor whether you still need contraception. Without HRT, the usual rule is one year after your last period if you're 50 or over, two years if under 50, and contraception can stop at 55 for everyone. (More in can you get pregnant in perimenopause?)
Can I go back on HRT after stopping?
Yes. Many women restart if symptoms return. The same benefits and risks apply as before, based on your age and health at the time.
Sources: NICE, Menopause: identification and management (NG23), updated 2024 · Hamoda H et al, Post Reproductive Health, 2020, British Menopause Society and Women's Health Concern recommendations on HRT in menopausal women · Collaborative Group on Hormonal Factors in Breast Cancer, The Lancet, 2019, on HRT type, duration and breast cancer risk · Medicines and Healthcare products Regulatory Agency, HRT and breast cancer risk update, 2019 · Educational only, not medical advice. Plan any change with your doctor.
Keep reading: The truth about HRT · HRT side effects · Choosing your progestogen · How long menopause symptoms last · Protecting your bones · All about HRT