What type of study is this?

This is a Systematic Review study (also classified as: Mixed-Methods).

September 28, 2025Open Access

Women's and Health Care Professionals' Experiences of Discontinuing Hormone Replacement Therapy (HRT): A Systematic Review

Key Points

Discontinuation rate of hormone replacement therapy was found to be 51.3% among women, highlighting a significant trend.
Of the women studied, 62.4% abruptly stopped HRT due to recommendations from health care professionals and concerns about risks.
Data were collected through systematic searches and mixed methods analysis of 74 reports from 69 studies across diverse populations.
Recommendations for tapered discontinuation were emphasized by 91.6% of health care professionals, underlining the need for better guidance.

Abstract

ABSTRACT Background Hormone Replacement Therapy (HRT) is used to manage menopausal symptoms, particularly vasomotor symptoms (VMS). HRT prescribing rates are rising, but most women will eventually discontinue. Objectives To explore the experiences of women stopping HRT, why women restart HRT, and the HCPs advising them. Search Strategy Embase, MEDLINE, CINAHL, Web of Science and PsycINFO were searched from 2000 to February 2024. Selection Criteria Quantitative, qualitative and mixed methods studies assessing experiences of HRT discontinuation. Data Collection and Analysis Quality was appraised using the Mixed Methods Appraisal Toolkit (MMAT). Data were narratively synthesised with weighted averages reported where possible. Main Results Electronic database searches identified 9444 reports, with 74 reports from 69 studies, including 32 213 women and 2943 HCPs. Average age of the cohort analysed was 64.7 years. Discontinuation rate was 51.3%, with average HRT duration of 5.4 years. The majority of women abruptly stopped HRT (62.4%). Common reasons for discontinuation were HCP recommendation (31.2% of participants), fear about risks (26.0%) and preference for a natural approach (25.6%). Common symptoms upon discontinuation were unspecified menopausal symptoms (84.4%), sleep disturbances (51.9%) and VMS (45.4%). Four RCTs compared tapered and abrupt discontinuation; two found abrupt discontinuers had greater symptoms initially, but symptoms were comparable to those experienced by taperers after completion of the tapered withdrawal. Two RCTs found no difference. Average rate of restarting was 20.7%, with VMS commonly cited as a reason. HCPs cited health risks as a reason for discontinuation, and 91.6% recommended tapered discontinuation. Conclusions This review provides insight into global HRT discontinuation experiences and highlights the need for future research to assess the best approach to discontinuation.

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