Do Hot Flashes Return If You Stop HRT? It Depends On Several Factors

Menopausal symptoms can become more manageable with treatments including hormone replacement therapy (HRT). In this treatment, low levels of hormones such as estrogen and progesterone are replenished to ease the severity of symptoms. You can take HRT through tablets, skin patches, or estrogen gel to reduce hot flashes and mood swings. While HRT is beneficial for many women, treatment may need to end if you experience certain side effects. In some cases, the process of ending HRT is gradual instead of immediate to lessen withdrawal symptoms. When one of our readers was concerned about the aftereffects of ending HRT, she asked our medical expert Barbara DePree, MD, for advice. Here’s what she had to say.

HRT Withdrawal Symptoms

Q: I’m 61 and started taking hormone replacement therapy (HRT) at 56 to ease severe hot flashes and mood swings. I’ve always heard you can only stay on HRT for a few years, but I’m afraid my symptoms will return if I stop. Help!

A: If the treatment is working for you, the latest research shows hormone replacement therapy (HRT) doesn’t have to be routinely discontinued in older women. In fact, women who are over age 60, healthy and at low risk for cardiovascular disease and breast cancer can continue to take HRT to help manage symptoms like hot flashes, low mood, and vaginal dryness — but it’s important to check in regularly with a doctor. And if you’re at risk for blood clots, I suggest substituting oral medication with a transdermal patch, which can help mitigate that risk.

That said, women who have breast swelling or tenderness, bloat, or spotting, which can develop as side effects of HRT, may need to discontinue it. The way you stop — tapering off versus cold turkey — makes no difference in the long run, although my patients who fear a return of symptoms are often more comfortable tapering off. But even if you do experience a return of symptoms, they may be less severe and will eventually diminish, suggests a study published in the journal JAMA. And you can always go back on a very low dose of HRT if necessary.

If you’d like to go off HRT, consider nonhormonal options that ease hot flashes and don’t require a prescription, such as Relizen (a pollen extract) and Equelle (a soy-derived product). And the antidepressants like paroxetine (Paxil) and venlafaxine (Effexor) help bring hot-flash relief for a significant number of women who take them by reducing blood flow to the skin and lowering body temperature.

Meet Our Expert

Barbara DePree, MD, is a gynecologist in private practice and director of Women’s Midlife Services at Michigan’s Holland Hospital. A Certified Menopause Practitioner, she is the founder of MiddlesexMD.com, an educational resource for women’s sexual health in perimenopause and beyond. To ask her a question, send an email to health@firstforwomen.com.

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

A version of this article originally appeared in our print magazine, First for Women.