In addition to breast cancer, when considering the effect of HRT on health risks:1

·       there is a greater risk of venous thromboembolism (VTE) from oral HRT compared to transdermal (which may be negligible at standard therapeutic doses);

·       baseline coronary heart disease and stroke risk varies depending on other cardiovascular risk factors, but HRT with oestrogen alone is associated with no or reduced CHD risk while combined HRT is associated with little or no increase in CHD risk;

·       oral oestrogen is associated with a small increase in stroke risk, but HRT started before the age of 60 is not associated with increased CVD risk;

·       ovarian cancer risk may mean about one extra case per 2,000 users after five years’ use;

·       there is a reduced risk of fragility fracture of bones while using HRT.

In POI, women are normally recommended to use HRT until the age of 51 and review the need to continue then, as some may still have symptoms. Among the perceived benefits are a reduced risk of chronic diseases including cardiovascular disease and osteoporosis.1

If a woman wishes to stop HRT, it can be done immediately or have doses gradually reduced; either way, there appears to be no difference to symptoms in the longer term. However, a gradual reduction in HRT dose may limit the short-term recurrence of symptoms.