Starting or continuing HRT many years after your menopause Factsheet
When should you start taking HRT? Is it ever too late to start? If you have been taking it for years, when should you think about stopping HRT? These are common questions that are often asked by women who have had their menopause some time ago. Some women take HRT for a few years to help improve their worst symptoms of the menopause. Some women find that when they stop taking HRT after just a few years, they have no more symptoms. Other women have a return of their symptoms when they stop taking HRT. There is no set length of time you should take HRT for; it is an individual decision between yourself and your doctor or nurse. This factsheet includes information that will help you to decide if now is the right time to start or stop taking HRT, even if your menopause happened several years ago.
Is it ever too late to start HRT?
Many women are not given HRT when they develop symptoms of the menopause. Reasons for this might have been because your symptoms were not too bad, or you felt that you had to simply grin and bear your menopausal symptoms. You may have had significant concerns over the safety of HRT, or other health care professionals may have advised you against it. Perhaps, years later, you are revisiting this possibility and HRT is becoming more of an attractive option for you.
There is very little evidence regarding starting HRT for older women because this research has not been undertaken. However, most women who are otherwise fit and well do still gain benefits from taking HRT even if it has been more than 10 years since their menopause.
You may decide to start HRT now because your symptoms have worsened, or you were expecting them to have gone by now but they haven’t. You may be concerned about the longterm risks associated with low levels of hormones that occur during the menopause in later life such as the risk of cardiovascular disease (disease of the heart and blood vessels) and osteoporosis (boneweakening disease), as well as diabetes, dementia and depression. These are all valid reasons for wanting to take HRT at this point in your life.
It is important that you seek individualised advice from your doctor, or another healthcare professional, and discuss all the treatment options available to you. If your regular doctor will not consider HRT for you, you may wish to find a doctor or nurse who has a special interest in the menopause.
The information already discussed also applies to those of you who were on HRT but reluctantly and under doctor’s advice stopped taking it. If you want to start HRT again, see another doctor if you have to, and explain your reasons for wanting to start taking it again. The NICE guidelines are clear (https://www.nice.org.uk/guidance/ng23) that women can continue to take HRT as long as the benefits outweigh the risks, and for most healthy women, this is for ever.
HRT for older women
Older women often need smaller doses of estrogen than younger women, and there are preparations of lower doses specifically for older women. The safest way to take replacement estrogen is through the skin in a patch, gel or spray. Even a small amount of estrogen replacement can often alleviate your symptoms effectively and provide you with the bone and heart protection you need. If you still have your womb (uterus) you will also need to take a progestogen, such as micronised progesterone, to protect the lining of your womb.
Does taking HRT just delay the menopause?
Many women think that taking HRT just delays the natural duration of the menopause in your body. This is not the case. If your symptoms return when you stop taking HRT it is not because you have been taking hormones, this is because you would still be having symptoms of the menopause at that time even if you had never taken HRT. A natural, untreated menopause can cause symptoms for many years; the average length of time is four years but for many women, symptoms can last for decades.
I have taken HRT for several years so, when should I stop it?
Many women decide to take HRT for a much longer period of time than a few years. This is often because they feel better and have more energy when they take HRT; they also want to protect their future health from long term conditions associated with low levels of estrogen, such as osteoporosis and cardiovascular disease.
All women taking HRT should have an annual review with their doctor or nurse. If you continue to be healthy and feel the benefits of taking HRT, there is no reason for stopping it. Women are often surprised when their menopausal symptoms return after coming off HRT, even those women that have taken it for many years. Symptoms of the menopause can last over a decade, as we have discussed.
There has been some evidence that showed a small increased risk of heart attack or stroke during the first year after stopping HRT. As always, decisions around your health should be made weighing up all the relevant information and deciding what is best for you, and in discussion with your health professional.
I want to stop taking HRT, what is the safest way to come off it?
If you have weighed up the information in this factsheet and decide coming off HRT is the right decision for you, it is usually recommended that you decrease the dose of estrogen gradually, every few days, over a few weeks. An abrupt stop to your estrogen replacement can sometimes cause some ‘withdrawaltype’ menopausal symptoms, temporarily.
Menopause is a longterm hormone deficiency
As a postmenopausal woman, you have to live with a longterm hormone deficiency and so there is every reason to treat that by replacing those lost hormones not only to alleviate any unpleasant menopausal symptoms but more importantly, protect your future health.