Increases risk of breast and endometrial cancer. They should not be used to prevent dementia or cardiovascular disease in older women. Use of vaginal estrogens for vaginal dryness is safe and effective in older women; women with a history of breast cancer unresponsive to nonhormonal therapy should discuss the use of low-dose vaginal estrogen with a healthcare provider. Oral and transdermal formulations should be avoided in women with urinary incontinence.

Taper Guide

Approach – if used daily for more than 1-2 months

  • Reduce dose by a maximum of 25% every week initially (i.e. week 1 75%-50%-25%) and this can be extended if needed
  • If intolerable withdrawal symptoms occur (usually 1-3 days after a dose change), go back to the previously tolerated dose until symptoms resolve and plan for a more gradual taper with the patient
  • Dose reduction may need to slow down as one gets to smaller doses (i.e. 25% of the original dose)
  • Overall, the rate of discontinuation needs to be controlled by the person taking the medication


  • Hot flashes, weight gain, insomnia, anxiety

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