How long can you take HRT?

There is no set limit. US guidelines no longer tell women to stop hormone therapy at a particular age or after a particular number of years: The Menopause Society says it does not need to be routinely discontinued at 60 or 65, and ACOG advises revisiting the decision every year. How long makes sense depends on why you take it, which hormones you use, and how your risks change as you get older.

Where the “5 years” idea came from

The Women’s Health Initiative, the longest large blinded trial, gave estrogen plus progestin for a median of 5.6 years and estrogen alone for 7.2 years before both arms stopped early. Beyond that, there are no randomized data, and for two decades labels told women to use “the lowest dose for the shortest time.” In November 2025 the FDA asked manufacturers to remove that instruction from the boxed warning, as part of the broader label change explained in the WHI study explained.

Why many women need longer

Symptoms often outlast any short course of treatment. In the Study of Women’s Health Across the Nation, which followed 1,449 US women with frequent hot flashes or night sweats:

Group	Median duration of frequent hot flashes
All women	7.4 years in total; 4.5 years after the final period
Symptoms began before or early in perimenopause	More than 11.8 years in total; 9.4 years after the final period
Symptoms began after menopause	3.4 years
African American women	10.1 years

The Menopause Society adds that up to 8 percent of women still have hot flashes 20 years or more after menopause, and calls an arbitrary age-based stopping rule “not clinically appropriate.”

How the risks change with time

Two things change as you continue: years of use, and age. They affect combined and estrogen-only therapy differently.

	Estrogen plus a progestogen (women with a uterus)	Estrogen alone (after hysterectomy)
Breast cancer in the WHI	Risk detectable after 3 to 5 years	No increase after about 7 years
Breast cancer with longer use, observational data, women starting at 45 to 54	Relative risk 1.66 for 1 to 4 years, rising to 2.68 for 15 years or more	1.23 for 1 to 4 years, rising to 1.61 for 15 years or more
Estimated extra cases from 5 years of use starting at 50, women of average weight	About 1 in 50 users with a daily progestogen; 1 in 70 with an intermittent one	About 1 in 200 users

These observational estimates come from a 2019 pooled analysis of 108,647 women with breast cancer, which also found that 10 years of use roughly doubled the excess. Observational studies cannot fully separate the effect of the hormones from differences between the women who use them, and their figures are higher than the WHI’s. Both sources agree that duration matters most for combined therapy. Our guide to hormone therapy and breast cancer risk puts these numbers in context.

Age raises the background risk of heart disease, stroke, clots and dementia. The Menopause Society notes it is unknown whether women who start at menopause and continue into their 60s and 70s carry the same risks as women who start late, which the WHI showed to be the least favorable group. Its practical advice is to reduce risk as you age: use the lowest effective dose, and consider moving from a pill to a patch or gel, which bypasses the liver and was not linked to clots in observational studies. See our guide to the estrogen patch.

After 60 and 65

The Menopause Society’s position on extended use:

• Hormone therapy does not need to be routinely discontinued in women older than 60 or 65.
• The American Geriatrics Society’s Beers criteria warn against hormone therapy after 65, but a routine stopping rule is not supported by evidence and is not recommended by ACOG or The Menopause Society.
• For otherwise healthy women with persistent hot flashes, continuing beyond 65 is a reasonable option with counseling, regular reassessment and shared decision-making.
• It may also be considered for fracture prevention in healthy older women at elevated fracture risk when other treatments are not suitable.
• It is not appropriate for preventing heart disease or dementia.
• Longer use should include periodic trials of lowering the dose or stopping.

The Society also acknowledges the limit of the evidence: data on safety, risks and benefits of continued use in healthy women over 65 are insufficient.

Stopping

Hot flashes return in about half of women who stop. In the WHI, women surveyed 8 to 12 months after the combined-therapy trial ended, at an average age of 69 and after 5.7 years on study pills, reported moderate or severe hot flashes in 55.5 percent of cases if they had had them before starting treatment, against 21.3 percent of comparable women on placebo.

How to stop is less clear. The Menopause Society says studies comparing abrupt with gradual discontinuation are lacking, though experts generally advise lowering the dose over time. Two other effects deserve planning:

• Bone. Protection against bone loss is lost rapidly after stopping, although the WHI found no excess fractures afterward. If bone was a reason for treatment, discuss a bone density scan and alternatives; see osteoporosis prevention.
• Vaginal and urinary symptoms. Unlike hot flashes, these tend to worsen with time. Low-dose vaginal estrogen may be considered at any age and for extended periods, and The Menopause Society cites long-term observational data supporting its safety.

The yearly review

ACOG advises talking with your ob-gyn every year about whether to continue, based on your symptoms, risks and benefits, and notes that some women need longer therapy because their symptoms last longer. Useful questions:

• Are my symptoms still the reason I am taking this, and how would I know?
• Has anything in my health changed that shifts my risks?
• Should I lower my dose or switch to a patch or gel as I get older?
• If I stop, how should I do it, and what is the plan for my bones?

To find a clinician for this review, search our OB-GYN directory.