MHT timeline
As long as the benefits still outweigh the risks for you. Current guidelines set no fixed time limit. Duration is a shared decision, revisited regularly with your doctor or specialist.
What changes over time is the conversation: your age, your symptoms, your health history and the type of hormone therapy. Here's what that looks like, step by step. It's general information to bring to your doctor or specialist, not a plan for you.
Weeks 1 to 12
Most people notice changes within a few weeks, but it can take up to three months to feel the full effect. Spotting, breast tenderness and bloating often settle in this window. Doses and types can be adjusted.
Source: NICE NG23
Around 3 months
A check-in with your doctor or specialist on what's helping, any side effects, any bleeding, and whether the dose or delivery (patch, gel, tablet) suits you.
Source: NICE NG23
Every year after that
There's no arbitrary upper time limit. Each year you and your doctor or specialist look again at why you're on it, what's changed in your health, and whether the trade-off still works for you.
Source: The Menopause Society 2022; NICE NG23
Years 5 to 10
In the large SWAN study, hot flashes and night sweats lasted a median of about 7.4 years, and often longer when they began early in perimenopause. That's why some people choose to try coming off around here, and many don't.
Source: Avis et al., JAMA Internal Medicine 2015
Before 40 or 45
After premature menopause, and often after early or surgical menopause, hormone therapy is usually recommended until at least the average age of natural menopause, around 51, unless there's a reason it's unsuitable, such as some hormone-sensitive cancers. The benefits and risks before that age differ from starting after natural menopause.
Source: NICE NG23; The Menopause Society 2022
Age 60 and beyond
Starting MHT before 60 or within 10 years of menopause usually has a more favourable balance than starting later. Continuing treatment you already use is a different decision. The Menopause Society advises against routinely stopping at 65; ongoing symptoms or bone concerns can justify continued use after individual review. A 2024 Medicare study found outcomes differed by type, route and dose, but can't prove long-term safety or a survival benefit.
Source: The Menopause Society 2022; Baik et al., Menopause 2024
For as long as you need it
Low-dose vaginal estrogen for dryness, pain with sex or bladder symptoms can be used long term, with regular review. Symptoms often return when it stops. After breast cancer, especially during aromatase inhibitor treatment, suitability needs a separate discussion with your breast cancer specialist.
Source: NICE NG23, including survivorship recommendations updated 2024
Breast cancer risk rises with the duration of combined estrogen plus progestogen use and can remain raised for at least 10 years after stopping. Estrogen-only MHT carries very little or no increase according to NICE. Some observational studies suggest differences between progestogens, but NICE says there isn't enough evidence to establish that micronized progesterone or dydrogesterone has a lower breast cancer risk than other progestogens.
Source: NICE NG23, breast cancer recommendations updated 2024; guideline updated April 2026
Estrogen through the skin doesn't raise the risk of blood clots the way tablets can, which matters more as the years add up.
Source: NICE NG23
In the Women's Health Initiative 18-year follow-up, about 5 to 7 years of randomized hormone treatment wasn't linked to higher all-cause mortality. That doesn't establish the safety of taking MHT continuously for 18 years, or for life.
Source: Manson et al., JAMA 2017
Source: The Menopause Society 2022
Evidence checked 12 October 2026. Older landmark trials remain relevant alongside these updates.
Continuation after 60 should be individualized, considering symptoms, changing risks, bone health and preferences.
Lumsden et al.; recommendation R 3.1
A clinical guideline, not a new trial. It recommends a targeted approach to continuing MHT over 60, rather than an automatic age-based stop. Supported by the European Society of Endocrinology. Full text is also available in Imperial College London's research archive.
Read the sourceReview the benefits and risks of continuing MHT at every review.
Guideline updated 15 April 2026. Duration recommendation 1.4.3 was updated in 2024; review at 3 months, then annually (1.9.2). A newer guideline date doesn't mean every recommendation is new.
Read the sourceAfter 65, associations differ by hormone type, route and dose.
Baik, Baye and McDonald; 10 million Medicare women, 2007 to 2020
Prescription and claims study, not a randomized trial. Estrogen-only use was associated with lower breast cancer incidence; combined therapy with higher incidence. Prior treatment history and unmeasured health differences limit interpretation. It doesn't prove MHT prevents cancer or extends life. NIH-funded; no financial conflicts reported.
Read the sourceFor people who start hormone therapy before age 60 or within 10 years of menopause, the benefits generally outweigh the risks.
The 2022 hormone therapy position statement of The North American Menopause Society
The statement behind the 'timing window' idea: when you start matters more than age alone. The same statement advises against automatically stopping at 65. Starting or continuing after 60 is still an individual decision to weigh with your doctor or specialist, not an automatic yes.
Read the sourceA newer Norwegian cohort still found breast cancer associations with systemic MHT.
Støer et al.; 1,275,783 women aged 45 and over
Risk varied by formulation; oral estrogen with daily progestin had the highest association. Transdermal systemic treatment wasn't free of a breast cancer association. Observational, not proof of causation. The August 2025 correction changed detection-mode data, not the overall conclusions; this link shows the corrected article. Funding: none reported.
Read the sourceReferences & further reading
The guidelines and studies behind each step above.
Guidelines and studies
The Menopause Society
No arbitrary time limit; timing window; no routine stop at 65; stopping options.
VisitNICE (UK)
Review at 3 months then yearly; early menopause until around 51; transdermal and clot risk.
VisitAvis et al., JAMA Internal Medicine 2015 (SWAN)
Median hot flash duration of about 7.4 years.
VisitCollaborative Group on Hormonal Factors in Breast Cancer, Lancet 2019
Risk rises with years of combined use; little signal with vaginal estrogen.
VisitVinogradova et al., BMJ 2020
Observational study of estrogen-only and combined MHT; a lower association with dydrogesterone. This study didn't evaluate micronized progesterone.
VisitManson et al., JAMA 2017 (WHI 18-year follow-up)
No increase in all-cause mortality.
VisitThe Menopause Society
Low-dose vaginal estrogen can be continued long term.
Visit