GP says HRT can be continued long term if benefits outweigh risks; annual review advised
Dr. Ellie Cannon tells patients age alone should not determine stopping hormone replacement therapy and outlines questions to ask a GP before continuing
General practitioner Dr. Ellie Cannon said women who find hormone replacement therapy (HRT) improves their quality of life do not have to stop at a particular age and can continue treatment long term after discussing risks and benefits with their doctor.
In a column for You magazine, Dr. Cannon cited guidance from the British Menopause Society that stopping HRT on the basis of age alone is not supported by evidence and that decisions should be made on an individual basis. She said many menopausal symptoms can persist for years and that HRT can address a range of problems beyond hot flushes, including vaginal dryness, bladder symptoms, low libido, joint pain and cognitive complaints such as "brain fog." HRT is also an established treatment option for preventing and treating osteoporosis.
Dr. Cannon said the main risks of prolonged HRT use — notably breast cancer and stroke — increase with age and with longer duration of use, although the absolute risks for most women remain small. She recommended annual reviews with a GP for anyone continuing HRT, so treatment can be adjusted to minimise risk. Options to reduce risk include lowering the hormone dose, switching to a transdermal patch rather than oral tablets, or using vaginal oestrogen, which is considered low risk and may be suitable for long-term use in treating local symptoms.
She described discussing HRT with a 79-year-old patient who had taken HRT for many years and experienced symptom recurrence when she stopped. Because the patient had no other major health issues and was on a low-dose transdermal preparation, Dr. Cannon said it was reasonable to continue treatment while monitoring risk factors.
Dr. Cannon urged women and their clinicians to weigh individual health, symptom burden and personal priorities. She said some women continue HRT primarily for symptom control, such as persistent night sweats or insomnia, while others use it because it reduces the risk of fractures from osteoporosis. The decision to continue or stop should consider family history of cancer, blood pressure, smoking status and other cardiovascular risk factors.
She advised patients to discuss modifiable risks with their GP as part of any ongoing HRT plan, including managing high blood pressure, cholesterol and alcohol use. Regular review can identify whether dose reduction or a change in formulation would be prudent as age and health status change.
Dr. Cannon recommended five questions women should raise with their doctor when reviewing long-term HRT: what is my stroke risk given my blood pressure and smoking status; how are my bones and do I need a bone density scan; whether vaginal oestrogen alone might address my symptoms; whether a lower dose would still be effective; and whether I am at increased risk of breast cancer and how that should affect HRT choices.
She concluded that while advice about HRT has changed over the years, current guidance supports a pragmatic, individualised approach. For many women, long-term HRT is acceptable provided risks are assessed and managed through shared decision-making with a clinician and routine annual review.