Women should be prescribed the most suitable HRT based on their symptoms (usually indicated for vasomotor symptoms and low/labile mood):
- If women still have a uterus (even if they have undergone a sub-total hysterectomy) they should be offered an oral or transdermal combined HRT preparation (oestradiol and progesterone). The levonorgestrel-releasing intrauterine system (IUS) can be used along with oestrogen as the progestogenic component
- In women without a uterus, an oestrogen-only oral or transdermal preparation should be used
- In women with premature menopause, sex steroid replacement with a choice of HRT or a combined contraceptive can be offered (unless they have any contraindications)
It is useful to have some benchmark figures in our minds about how long HRT should be continued. Most women will require HRT for between 2-5 years however some might need longer. After individual discussion with each woman, regular attempts should be made to stop treatment and they should be told to expect some symptoms after stopping HRT. Women who have premature menopause should take HRT until 51 years of age and then discuss any need for continuation with a healthcare professional.
When stopping HRT, women can either stop immediately or gradually. There will be no difference to their symptoms in long-term but gradually weaning off HRT is likely to reduce recurrence of symptoms in the short-term.