Because of the link between using hormone replacement therapy (HRT) and increased breast cancer risk, HRT should be used at the lowest possible dose and for the shortest period of time possible to help manage menopausal symptoms.
When a woman stops taking HRT, menopausal symptoms may come back. Stopping HRT can be done suddenly or gradually. When HRT is stopped gradually, the dose is tapered down to nothing over time. A study found that most family medicine, internal medicine, and obstetrician-gynecologist (ob/gyn) doctors recommend gradually stopping HRT over time instead of suddenly stopping it.
More than 480 doctors were surveyed about stopping HRT, including 432 family medicine or internal medicine doctors, and 60 ob/gyns:
- 91% recommended gradually stopping HRT
- 8% recommended suddenly stopping HRT
To gradually stop HRT, most doctors surveyed recommended both gradually lowering the HRT dose AND gradually reducing the number of days per week HRT is taken.
Female doctors were more likely than male doctors to aggressively encourage their patients to stop HRT as soon as possible. Family medicine and internal medicine doctors were more likely than ob/gyns to aggressively encourage their patients to stop HRT as soon as possible.
When menopausal symptoms developed after women stopped HRT:
- Family medicine and internal medicine doctors were more likely than ob/gyns to recommend lifestyle and diet changes instead of restarting HRT or using a non-hormonal medicine to treat the symptoms.
- Female doctors were less likely than male doctors to recommend restarting HRT.
The side effects of menopause can dramatically reduce some women's quality of life. These women have to weigh the benefits of HRT against the risks. If you're having severe hot flashes or other menopausal side effects and are considering taking HRT, talk to your doctor about:
- how to minimize your breast cancer risk -- research shows that taking combination HRT for fewer than 3 years doesn't significantly increase breast cancer risk
- the pros and cons of different types of HRT -- estrogen-only HRT appears to increase breast cancer risk less than combination HRT
- a plan so you take HRT for the shortest time possible
Together, you and your doctor can decide if HRT or another treatment to ease menopausal side effects might be right for you. If you decide to use HRT, try to make healthy lifestyle choices that can lower your breast cancer risk. When you're ready to stop using HRT, talk to your doctor about a way to gradually stop that makes the most sense for you. If some bothersome menopausal symptoms come back after you stop HRT, ask your doctor about all of your options, including non-hormonal options, to manage these symptoms. During and after you take HRT, make sure to follow recommended breast cancer screening guidelines, including monthly breast self-exams, annual mammograms, and annual physical exams by your doctor.
On the All About Hot Flashes page, you can read more about other medical and non-medical options for managing these symptoms.
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