Marcia Stefanick: Continue Hormone Replacement Therapy?

If a woman has been on hormone replacement therapy for two years and has had no problems, is there any danger in her continuing HRT?

Marcia Stefanick: The health risks of the combination of estrogen and progestin as menopausal hormone therapy—breast cancer, stroke, serious blood clots, and, in older women, dementia—have been proved to increase over time, relative to the benefits (reduced fractures), and it is highly recommended that women consider stopping after two or three years. Lowering the dose is an alternative to "cold turkey".  The story for estrogen alone, which is prescribed to women who do not have a uterus, is somewhat different, in that the risks (stroke, in particular) and benefits (reduced fractures) are more balanced; however, it is still reasonable to encourage a woman to stop taking menopausal estrogen after two years to determine if she still needs them. The primary reason to take them is to prevent hot flashes , which may no longer be present two to three years after they begin.

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