Estrogens

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

Monitor

  • Hot flashes, weight gain, insomnia, anxiety