In short
An annual hormone review asks one question: is this still the right treatment for you at the age you are now?
Five things get re examined every year.
- Dose and whether it can come down
- Route, since tablet and patch carry different clot risk
- Endometrial protection, if you still have a uterus
- Bleeding pattern, which is the main safety signal
- Screening, mammogram and blood pressure
Treatment is not stopped on age alone. It is stopped when the balance changes.
Treatment Overview
Why does hormone therapy need an annual review at all?
Because the balance changes underneath you. The same dose that was clearly worthwhile at 51 may be a different proposition at 61, even though nothing about the prescription has changed.
Between 40 and 50 per cent of women who start hormone therapy stop within a year, and 65 to 75 per cent within two, very often with no medical input at all. A yearly review is there to make that a decision rather than a drift.
What is actually re examined?
| Dose | Can it come down? The first taper attempt is usually made between three and five years. |
| Route | Tablet or patch. Transdermal carries lower clot and stroke risk, and becomes more relevant as you age. |
| Progesterone | Still needed and still adequate, if you have a uterus. Quarterly regimens are not adequate protection at standard oestrogen doses. |
| Bleeding | The pattern, and whether any of it needs a biopsy. |
| Screening | Mammogram and blood pressure, which are recommended even for short term use. |
| Balance | Whether benefit still outweighs risk at your current age and duration. |
Should treatment stop at a fixed number of years?
The old standard was five years and not beyond age 60. That has softened, because hot flushes persist for 10 to 20 years after the last period in many women.
Both the Menopause Society and ACOG now say the decision should be individualised and not made on age alone. Over 40 per cent of women aged 60 to 65 still have flushes that disrupt sleep and quality of life.
What if you want to try coming off?
Stopping abruptly brings symptoms back for many women. In a survey of 8405 women from the WHI who were told to stop suddenly, 56 per cent of those who had flushes at baseline developed moderate to severe symptoms, against 22 per cent on placebo.
Tapering is therefore the usual approach, though the evidence is genuinely mixed: in one randomised trial, symptoms were worse in the abrupt group at three months but worse in the taper group at six, with no difference by a year.
What if symptoms come back?
Non hormonal options are tried first. If those are not enough, hormone therapy can be restarted, normally at a lower dose, with a plan for another attempt later.
Starting an SSRI or gabapentin during the taper can soften the return of flushes.
Who Is a Good Candidate?
- You have been on hormone therapy for a year or more and it has not been formally reviewed
- You are approaching 60 and want to know whether to continue
- You are on testosterone or thyroid replacement and want the whole picture looked at once a year
- Your prescription has been repeated without anyone re examining the dose
- You want to try coming off and want it done properly
- New bleeding after a long gap, which needs assessment now rather than at the next annual review
- A new diagnosis of breast cancer, heart disease, stroke or a blood clot since starting
- Chest pain, leg swelling or sudden breathlessness, which are emergencies
What Happens During the Consultation
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1
What you are on and how it is going
The exact preparation, dose and route, how well symptoms are controlled, and what side effects you are living with.
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2
Bleeding and endometrial safety
The bleeding pattern over the year. Bleeding that persists past six months on a continuous regimen, is heavy, or starts after a long gap needs a biopsy.
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3
Risk recalculated at your current age
Cardiovascular and breast cancer risk are recalculated, not carried over. Screening status is checked at the same time.
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4
The decision
Continue as is, lower the dose, change the route, or plan a taper. You leave with a named dose and a date for the next review.
Program Structure & Follow-Up
What does the year look like after a review?
For most women, nothing until the next one. The review exists so that the rest of the year can be uneventful.
If the dose is reduced
- The reduction is gradual rather than a step change
- Symptoms are checked at four to six weeks
- If flushes return badly, the previous dose is resumed rather than treated as a failure
If a taper is planned
- A gradual reduction, often over about six months
- A non hormonal option can be started alongside to soften the return of symptoms
- Expect symptoms to fluctuate for up to a year before settling
What happens between reviews?
Some things do not wait. New bleeding after a long gap, bleeding that becomes heavier, or any new diagnosis of breast cancer, heart disease, stroke or clot should be brought forward.
Does the timing of your mammogram matter?
Not in the way people expect. Stopping treatment for one or two months before a mammogram does not reduce the chance of being called back.
Benefits, Limits & Safety
What does a yearly review actually change?
Usually the dose. Lower doses are associated with less bleeding, less breast tenderness, less effect on clotting markers and a possibly lower risk of stroke and clot.
Sometimes the route. Moving from tablet to patch reduces clot and stroke risk without losing symptom control, and matters more as you get older.
What are the numbers behind the decision?
For 1000 women aged 50 to 59 on combined therapy for five years: about three extra breast cancers, two and a half extra heart events, two and a half extra strokes, three extra pulmonary embolisms, one and a half fewer hip fractures and five fewer deaths from any cause.
For oestrogen alone after hysterectomy the picture is more favourable: five and a half fewer heart events, two and a half fewer breast cancers and five and a half fewer deaths per 1000.
What are the limits of a review?
It cannot make a risk disappear. What it does is make sure you are carrying the smallest version of that risk that still controls your symptoms.
It also cannot predict who will do badly. Risk calculators give population estimates, and the breast cancer tool is not accurate for women with several close relatives affected.
When does treatment stop?
- A new contraindication appears, such as breast cancer, a clot or a stroke
- Symptoms have genuinely gone and a taper succeeds
- You decide the trade off is no longer worth it, which is a legitimate reason
Age alone is not on that list.
What a review delivers
The lowest dose that still controls your symptoms, the safer route where it applies, and a clear answer on whether to continue.
Checked every year
Dose, route, endometrial protection, bleeding pattern, blood pressure and mammogram status.
Reasons to stop
New breast cancer, coronary heart disease, stroke, blood clot, active liver disease, or unexplained bleeding that turns out to be significant.
Cost & Program Investment
The annual review is a single consultation and is quoted individually. Any tests, such as an endometrial biopsy or bloods, are quoted before they are done. You are not required to buy a yearly package, and the review can be booked as a one off even if you are prescribed elsewhere.
Frequently Asked Questions
No. The Menopause Society and ACOG both say the decision should be individualised and not based on age alone. Over 40 per cent of women aged 60 to 65 still have disruptive flushes.
There is no fixed ceiling. The usual approach is a first attempt to reduce between three and five years, and if you continue past five years or past 60, to restart at the lowest dose that works and plan another attempt later.
Tapering is the usual advice, though trial evidence is mixed. Abrupt stopping clearly brings symptoms back in the short term, so a gradual reduction over months is easier for most women.
Fewer than people expect. Hormone therapy is dosed by symptoms, not by levels. Levels are checked only where they help, for example with gels and sprays whose strengths are not directly comparable.
No. Ultrasound is not reliable enough to rule out hyperplasia in women on hormone therapy, and is not used as routine surveillance. Biopsy is the test that matters, and it is done when bleeding indicates it.
No. Monthly withdrawal bleeding on a cyclical regimen is expected, and irregular spotting in the first months of a continuous regimen is common. Bleeding that persists past six months, gets heavier, or starts after a long gap needs investigating.
Yes. Bring the exact name, dose and route of what you take and any recent results. The review is about the treatment, not about who wrote the first prescription.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.