Women's and Health Care Professionals' experiences of discontinuing Hormone Replacement Therapy (HRT): a systematic review

Sarah Bunnewell; Sabrina Keating; Jo Parsons; Martha Hickey; Sarah Hillman

doi:10.1111/1471-0528.70023

Women's and Health Care Professionals' experiences of discontinuing Hormone Replacement Therapy (HRT): a systematic review

Sarah Bunnewell
, Sabrina Keating
, Jo Parsons
, Martha Hickey
, Sarah Hillman^*

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

137 Downloads (Pure)

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.

Original language	English
Number of pages	14
Journal	BJOG: An International Journal of Obstetrics & Gynaecology
Early online date	26 Sept 2025
DOIs	https://doi.org/10.1111/1471-0528.70023
Publication status	E-pub ahead of print - 26 Sept 2025

Bibliographical note

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

discontinuation
hormone replacement therapy
menopause

Access to Document

10.1111/1471-0528.70023Licence: Creative Commons: Attribution (CC BY)

BunnewellS2025WomensFinal published version, 1.16 MBLicence: Creative Commons: Attribution (CC BY)

Cite this

@article{7322a78a9af743c482e712caf2df3ab7,

title = "Women's and Health Care Professionals' experiences of discontinuing Hormone Replacement Therapy (HRT): a systematic review",

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.",

keywords = "discontinuation, hormone replacement therapy, menopause",

author = "Sarah Bunnewell and Sabrina Keating and Jo Parsons and Martha Hickey and Sarah Hillman",

note = "{\textcopyright} 2025 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley \& Sons Ltd.",

year = "2025",

month = sep,

day = "26",

doi = "10.1111/1471-0528.70023",

language = "English",

journal = "BJOG: An International Journal of Obstetrics \& Gynaecology",

issn = "1470-0328",

publisher = "Wiley",

}

TY - JOUR

T1 - Women's and Health Care Professionals' experiences of discontinuing Hormone Replacement Therapy (HRT)

T2 - a systematic review

AU - Bunnewell, Sarah

AU - Keating, Sabrina

AU - Parsons, Jo

AU - Hickey, Martha

AU - Hillman, Sarah

PY - 2025/9/26

Y1 - 2025/9/26

N2 - 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.

AB - 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.

KW - discontinuation

KW - hormone replacement therapy

KW - menopause

U2 - 10.1111/1471-0528.70023

DO - 10.1111/1471-0528.70023

M3 - Review article

C2 - 40999909

SN - 1470-0328

JO - BJOG: An International Journal of Obstetrics & Gynaecology

JF - BJOG: An International Journal of Obstetrics & Gynaecology

ER -

Women's and Health Care Professionals' experiences of discontinuing Hormone Replacement Therapy (HRT): a systematic review

Abstract

Bibliographical note

UN SDGs

Keywords

Access to Document

Fingerprint

Cite this