Women's and Health Care Professionals detail Experiences of Discontinuing HRT: BJOG
Menopause is the cessation of menstruation due to loss of ovarian reproductive function. Symptoms include vasomotor symptoms (VMS), urogenital symptoms, sleep symptoms, musculoskeletal complaints and low mood. These may interfere with daily living and reduce quality of life (QOL). Hormone replacement therapy (HRT) is effective for the relief of VMS. HRT may improve sexual function, mood, sleep and urogenital symptoms. Women continue HRT for variable lengths of time, dependent on their individual circumstances and symptoms, but eventually most stop. The best approach to stopping HRT whilst minimising symptom resurgence needs to be determined. To do this, the experiences of HRT discontinuation must first be understood. Synthesising perspectives of women and HCPs will highlight challenges, inform tailored support strategies and ultimately guide evidence based clinical practice to improve patient outcomes during HRT discontinuation.
To explore the experiences of women stopping HRT, why women restart HRT, and the HCPs advising them; Embase, MEDLINE, CINAHL, Web of Science and PsycINFO were searched from 2000 to February 2024.
Electronic database searches identified 9444 reports, with 74 reports from 69 studies, including 32213 women and 2943 HCPs. Average age of the cohort analysed was 64.7 years. Discontinuation rate was 51.3%, with average HRT duration of 5.4 years. The majority of women abruptly stopped HRT (62.4%). Common reasons for discontinuation were HCP recommendation (31.2% of participants), fear about risks (26.0%) and preference for a natural approach (25.6%). Common symptoms upon discontinuation were unspecified menopausal symptoms (84.4%), sleep disturbances (51.9%) and VMS (45.4%). Four RCTs compared tapered and abrupt discontinuation; two found abrupt discontinuers had greater symptoms initially, but symptoms were comparable to those experienced by taperers after completion of the tapered withdrawal. Two RCTs found no difference. Average rate of restarting was 20.7%, with VMS commonly cited as a reason. HCPs cited health risks as a reason for discontinuation, and 91.6% recommended tapered discontinuation.
This is the first review to synthesise all available data collected from women with experience of stopping and/or restarting HRT and the HCPs advising them. The findings demonstrate that reasons for stopping HRT are varied, but fear of risks was most reported. Symptoms were common upon stopping HRT, most prominently general menopausal symptoms and VMS. RCTs assessing tapered versus abrupt approaches showed that tapering did not prevent symptoms upon complete cessation. One fifth of women restarted HRT. HCP experience of discontinuing HRT wasn't well reported, and only one study was published within the last decade. Most HCPs advised tapering HRT, and experience of managing symptom recurrence was poorly reported.
In summary, the best approach to HRT discontinuation that minimises symptom resurgence remains unclear, VMS recurrence is common, and many women restart HRT. Some women reported severe symptoms that significantly impacted sleep and QOL. Most women reported stopping HRT abruptly, whereas most HCPs recommended a tapered approach. HCP perspective of discontinuation and resumption is poorly documented; some HCPs reported that many patients stopped HRT independently, and others described the findings from the WHI significantly influencing their prescribing decisions. A greater understanding of women's preferences when stopping HRT is required to inform larger scale randomised studies assessing discontinuation approaches beyond the immediate post-WHI era.
Source: Sarah Bunnewell1 | Sabrina Keating2 | Jo Parsons3; BJOG: An International Journal of Obstetrics & Gynaecology, 2025; 0:1–14
https://doi.org/10.1111/1471-0528.70023
