Not all women experience severe symptoms related to menopause, but for those who do, they can seriously affect their quality of life. If you have uncomfortable menopause symptoms, there are relief options. Hormone replacement therapy, or HRT, is a common treatment. Combination HRT, medicine containing both the hormones estrogen and progesterone, is the most common. But can you—and should you—keep taking HRT for years? Or does there come a time when you need to stop taking them? Waiting for HRT to Start Working If you’ve been experiencing serious menopause symptoms, you may be anxious to know how long it takes to work. You may have to wait a few weeks before you start to see any symptom improvement. Here’s why: When you go through menopause (12 months from the time of your last period), your ovaries have stopped producing estrogen. Your ovaries were the major source for the hormone. As you take estrogen in HRT, it will take a while for your estrogen levels to rise to the point it can help ease your symptoms. If you don’t feel any differences after a month or so, talk with your doctor. You may need a higher dose or a different formulation altogether. How Long You Can Take HRT Experts recommend that menopausal women only take HRT if their symptoms are seriously troublesome. Most women in this group can take HRT for up to five years. Other women who may have to take HRT are those who undergo surgical removal of their ovaries or have treatment that causes their ovaries to stop producing estrogen. Both situations can throw a woman into sudden menopause, no matter how young she is. And because ovarian hormones stop circulating so suddenly, the menopausal effects can be severe. Younger women who take HRT because of sudden menopause usually take it longer than women who take HRT after natural menopause. Most women in this group can take HRT until they would naturally expect to enter menopause, which is around 52 years of age. While HRT can be very effective, it does come at a risk for some serious side effects and health outcomes. Doses should be as low as possible to help ease the symptoms, and then taken for the shortest amount of time. For some women, this may be for a few months, for others, years. If you are taking HRT for serious menopause symptoms, you may be reluctant to stop taking HRT, for fear the symptoms will return. This concern is valid. For some women, the symptoms do return, but you may have some control over what happens by how you stop HRT. Easing off HRT Most doctors recommend that women who have been taking HRT for menopausal symptoms not suddenly stop, but do so gradually. You and your provider can gradually taper down the amount, either by dose alone or by lowering the dose and taking it less frequently. Another way of reducing the HRT dose slowly is by switching from pills to a patch. There are no specific guidelines for how to reduce the estrogen dosage, but one recommendation is to decrease it by about 10% every two weeks. If you experience menopausal symptoms while tapering off, your healthcare provider may suggest you stay at a slightly higher dose for a bit longer, then start dropping it again. You do not need to taper down progesterone like estrogen, but your doctor will advise you on the best method for your situation. HRT is not recommended for women older than 60, but this also depends on the individual. If you have been taking HRT for a while and are not ready to stop, your doctor may agree to continue the prescription. HRT Long-Term Effects and Risks As with any medication, hormone replacement therapy has some risks, which increase with the length of time you take it. The most common risks include: Deep vein thrombosis (DVT) Pulmonary embolism (PE) Heart disease Stroke Breast cancer Most women who take prescribed HRT for menopause symptoms do not develop these problems. Some women are at higher risk though. Before prescribing HRT, your doctor will need a thorough medical history and family history to judge your level of risk. Women who have a history of heart disease, breast cancer, ovarian cancer, endometrial cancer, liver disease, or unexplained vaginal bleeding generally should not take HRT. When you start hormone replacement therapy, speak with your doctor about your personal risk factors. Ask how often you should have checkups and, possibly, dose adjustments. Don’t stop taking your medication suddenly before discussing it with your doctor.