Discontinuation of HT

© In appropriately selected women, HT should be recommended at the lowest dose for the shortest duration and should be tapered before discontinuation in order to prevent the recurrence of hot flashes. Although vasomotor symptoms in most women will subside within 4 years, approximately 10% of women continue to experience symptoms that interfere with their QoL. Therefore, it is important to continually reassess a woman's vasomotor symptoms while taking HT and to try to taper the therapy after 1 year. Literature suggests that one of every four women needs to be reinitiated on HT due to persistent and bothersome symptoms.34-36

Limited evidence is available to guide health care providers regarding the most effective, safe, and least disruptive way to taper HT. Slowly discontinuing HT over time may be associated with less risk of symptom return. The time frame for tapering HT is unknown but can take up to 3 to 6 months or longer in some cases. Tapering HT may be done in one of two ways: dose taper or day taper. The dose taper involves decreasing the dose of estrogen over several weeks to months and monitoring closely for a return of symptoms. If symptoms recur, the next reduction in dose should not occur until symptoms resolve or at least stabilize on the current dose. The day taper involves decreasing the number of days of the week that a woman takes the HT dose, for example, decreasing a daily dose of 0.3 mg estrogen to 0.3 mg estrogen 5 days a week. Again, if symptoms recur, continue on the current dose until symptoms resolve or stabilize before trying a subsequent decrease. These tapering regimens have not been studied in clinical trials and may not prove to be beneficial in individual wo-

men.

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