{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T08:02:43Z","timestamp":1790928163598,"version":"4.1.0"},"reference-count":105,"publisher":"Wiley","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To explore the experiences of women stopping HRT, why women restart HRT, and the HCPs advising them.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search Strategy<\/jats:title><jats:p>Embase, MEDLINE, CINAHL, Web of Science and PsycINFO were searched from 2000 to February 2024.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection Criteria<\/jats:title><jats:p>Quantitative, qualitative and mixed methods studies assessing experiences of HRT discontinuation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection and Analysis<\/jats:title><jats:p>Quality was appraised using the Mixed Methods Appraisal Toolkit (MMAT). Data were narratively synthesised with weighted averages reported where possible.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Results<\/jats:title><jats:p>Electronic database searches identified 9444 reports, with 74 reports from 69 studies, including 32\u2009213 women and 2943 HCPs. Average age of the cohort analysed was 64.7\u2009years. Discontinuation rate was 51.3%, with average HRT duration of 5.4\u2009years. 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This review provides insight into global HRT discontinuation experiences and highlights the need for future research to assess the best approach to discontinuation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.70023","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T08:05:12Z","timestamp":1758873912000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Women's and Health Care Professionals' Experiences of Discontinuing Hormone Replacement Therapy (<scp>HRT<\/scp>): A Systematic Review"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6590-5415","authenticated-orcid":false,"given":"Sarah","family":"Bunnewell","sequence":"first","affiliation":[{"name":"Warwick Medical School, University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6720-6693","authenticated-orcid":false,"given":"Sabrina","family":"Keating","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6542-8492","authenticated-orcid":false,"given":"Jo","family":"Parsons","sequence":"additional","affiliation":[{"name":"Centre for Evidence and Implementation Science University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3941-082X","authenticated-orcid":false,"given":"Martha","family":"Hickey","sequence":"additional","affiliation":[{"name":"Obstetrics, Gynaecology and Newborn Health University of Melbourne and the Royal Women's Hospital  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3560-2074","authenticated-orcid":false,"given":"Sarah","family":"Hillman","sequence":"additional","affiliation":[{"name":"Applied Health Sciences, School of Health Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"NICE \u201cNG23: Menopause: Identification and Management \u201dNational Institute for Care and Excellence (NICE) (2015) accessed November 20 2024 https:\/\/www.nice.org.uk\/guidance\/ng23\/resources\/menopause\u2010identification\u2010and\u2010management\u2010pdf\u20101837330217413."},{"key":"e_1_2_10_3_1","unstructured":"British Menopause Society (BMS) \u201cWhat is the Menopause?\u201d(2022) https:\/\/thebms.org.uk\/wp\u2010content\/uploads\/2023\/08\/17\u2010BMS\u2010TfC\u2010What\u2010is\u2010the\u2010menopause\u2010AUGUST2023\u2010A.pdf."},{"issue":"11","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1089\/jwh.2012.3719","article-title":"The Impact of Menopausal Symptoms on Quality of Life, Productivity, and Economic Outcomes","volume":"22","author":"Whiteley J.","year":"2013","journal-title":"Journal of Women's Health (Larchmt)"},{"issue":"7","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1097\/GME.0000000000000120","article-title":"Health\u2010Related Quality of Life in Women With or Without Hot Flashes: A Randomized Placebo\u2010Controlled Trial With Hormone Therapy","volume":"21","author":"Savolainen\u2010Peltonen H.","year":"2014","journal-title":"Menopause"},{"issue":"3","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1001\/jama.288.3.321","article-title":"Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women's Health Initiative Randomized Controlled Trial","volume":"288","author":"Rossouw J. 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