How long can you use BHRT and what happens if you stop?

"Do I have to take this for the rest of my life?" And: "What happens if I stop?" These are two of the most frequently asked questions about BHRT. They are understandable — and they deserve an honest, complete answer.

How long can you use BHRT?

There is no fixed maximum duration for BHRT. The former recommendation to stop hormone therapy after five years stems from the interpretation of the WHI study (2002) — and has since been abandoned by multiple professional organizations.

Modern guidelines — including those from the British Menopause Society, the International Menopause Society, and the Dutch NVvO — state that BHRT can be continued for as long as the benefits for the individual woman outweigh the risks. There is no arbitrary cutoff point.

In practice, this means an annual review with your doctor. Are there still symptoms that require BHRT? Has your risk profile changed? Are there any new medical conditions? The plan is determined based on that evaluation — not on a time limit.

Why many women continue for a long time — and why that makes sense

BHRT is not just about symptom management. Estrogen protects bones, blood vessels, the brain, and mucous membranes. That protection ceases as soon as you stop.

• Bone density: the bone-protective effect of estrogen disappears after stopping. In the first two years after discontinuation, bone loss accelerates again. Women who stop without alternative bone protection lose the gains they have built up.
• Cardiovascular health: the protective effect on blood vessel flexibility and cholesterol disappears after stopping.
• Vaginal health: GSM symptoms (dryness, atrophy) return and can worsen.
• Cognition: some women report that brain fog and memory issues return after stopping.

For women who entered menopause early (before age 45), continuing until at least the average age of menopause (51) is actually medically advised — to compensate for the increased risk of osteoporosis and cardiovascular disease.

What happens if you stop?

When you discontinue BHRT, your hormone levels adjust to your natural baseline. This has concrete consequences:

• Menopausal symptoms may return — hot flashes, sleep problems, mood swings. How quickly and how intensely this happens depends on how long you have been in postmenopause and how low your own hormone production is.
• Symptoms are more severe when stopping abruptly than when tapering off gradually. This is one of the reasons why we always advise against stopping suddenly.
• Vaginal symptoms persist — GSM does not improve without treatment. Local estrogen therapy can be continued even if systemic MHT is discontinued.

How to stop safely: tapering off gradually

Always stop MHT in consultation with your doctor and always do so gradually. A sudden stop is unnecessary — and leads to avoidable symptoms.

The most common approach:

• Reduce the dosage in steps over three to six months
• Lower the estradiol first (the most active component for hot flashes)
• Progesterone can be tapered off in parallel or afterwards
• Monitor symptoms at each step — if symptoms return strongly, the pace can be slowed down

If it becomes clear after tapering that symptoms return significantly and affect your quality of life, restarting or continuing at a low dose is a valid option.

Alternatives after stopping systemic MHT

After discontinuing systemic MHT, there are options to maintain specific benefits:

• Local estrogen therapy — for vaginal and urinary symptoms, with negligible systemic absorption
• Bisphosphonates or other bone medication — if bone protection is needed after MHT
• Statins or blood pressure medication — if cardiovascular protection is lost
• Lifestyle adjustments — strength training and nutrition as the foundation for bone density and metabolism

The fear of being "stuck on it forever" is unfounded

BHRT is not addictive. It is supplementation of hormones that your body no longer produces on its own. You can stop at any time, whenever you wish, in consultation with your doctor. There are no withdrawal symptoms in the classic sense — what returns are the symptoms that the hormones were suppressing.

The question "do I have to do this forever?" is essentially the same as asking "do I have to wear my glasses forever?" If you cannot see well without glasses but function perfectly with them — why would you stop? The same logic applies to BHRT.

At Menovia we discuss the duration of treatment on an individual basis — annually during an evaluation consultation. There is never an automatic end date. The decision is always yours, based on complete information. Read more about how the process works.