Women's and Health Care Professionals' Experiences of Discontinuing Hormone Replacement Therapy (HRT): A Systematic Review.

Abstract

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. To explore the experiences of women stopping HRT, why women restart HRT, and the HCPs advising them. Embase, MEDLINE, CINAHL, Web of Science and PsycINFO were searched from 2000 to February 2024. Quantitative, qualitative and mixed methods studies assessing experiences of HRT discontinuation. Quality was appraised using the Mixed Methods Appraisal Toolkit (MMAT). Data were narratively synthesised with weighted averages reported where possible. 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. This review provides insight into global HRT discontinuation experiences and highlights the need for future research to assess the best approach to discontinuation.