One of the scare statements often repeated is that hormones will only put off the inevitable. "A woman who starts on hormones will have to stay on forever because if she stops, all the menopausal symptoms will return with a vengeance," a prominent New York gynecologist told a new patient. This "express train" scenario is false, says Dr. Lila A. Wallis, a New York internist with forty years of clinical experience and many older patients who have grown into their sixties under her care as users of hormone replacement therapy.

"In the very early menopause, women require larger doses of estrogens in order to control their symptoms," says Dr. Wallis. "As they get older, the estrogens can be cut down and the patient is more tolerant of the decreased dose."

The one action to avoid is to go off hormones "cold turkey." The operative generalization is this: The more abrupt the drop in estrogen, the more severe are the symptoms. This explains the severity of symptoms often reported after a hysterectomy or during a sudden, stress-related menopause, just as it explains the flare-up of symptoms that may occur if a woman who's been suppressing them for a decade with HRT abruptly discontinues the hormone bath to which the body is accustomed. There is a simple way to avoid this problem: tapering off. Dr. Wallis advises her older patients to watch the "pause" at the end of the month and note whether or not hot flashes or any other symptoms resurface. As symptoms subside, the regimen of replacement hormones can be gradually reduced. The body has time to adjust over time.

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Women’s health