Stopping systemic menopausal hormone therapy: Why, when and how

Despite the lack of clinical trial data to inform decisions regarding long-term use of MHT, this issue is commonly encountered and remains important for clinicians who care for menopausal women. Indications for extended use of MHT include treatment of VMS, perceived enhanced quality of life and prevention of osteoporosis. For women with a uterus who require the use of a progestogen with estrogen, the modest increased risk of breast cancer after about five years of therapy (equivalent to the elevated risk associated with between 1 and 2 glasses of wine daily) remains a concern, and should be reviewed with patients [2]. For women without a uterus, the use of estrogen alone provides more flexibility in terms of duration of use. Transdermal estrogen may offer safety benefits (lower VTE and stroke risk) over oral estrogen, particularly in obese women, and may be a better option for those who wish to continue MHT long-term. Finally, as women lower their dose of or discontinue systemic MHT, use of low dose vaginal estrogen therapy may become appropriate.