After trying HRT for a few months, or longer, many women wish to come off it due to side effects. However, stopping HRT is not as easy as starting it.
If you want to stop your HRT you should always talk to your doctor first.
Having made the decision, you can if you wish just stop it – but this is not advisable. Stopping suddenly can produce quite severe symptoms and it is better to wean yourself off the HRT over a period of time.
When you are taking HRT you are artificially increasing your levels of oestrogen and, with traditional HRT, this may or may not be combined with a chemical progestogen to protect the uterus.
It is often thought that after the menopause women no longer make any oestrogen, but this is not true. Another false belief is that women without ovaries do not make any oestrogen.
It should be remembered that women produce three different types of oestrogen: Oestradiol, Oestrone and Oestriol. In a woman’s reproductive years most of her oestrogens are made in the ovaries and the main oestrogen is the strong oestradiol. After the menopause, a woman’s oestrogens are made in muscle and fatty tissue by the conversion of another hormone androstenediol into oestriol. The amount of oestradiol produced at this time is very low.
The levels of oestrogen, usually oestradiol, in a woman taking HRT will be as high, or even higher, than the levels found in younger women. Certainly the levels will be much higher than would be normal.
If HRT is stopped suddenly the oestrogen levels will quickly drop to very low levels. This may not produce any symptoms at all, but in many women it causes most of the symptoms associated with the menopause to appear. These symptoms are sometimes more severe than they were before starting the HRT.
How To Come Off HRT
The best way to come off HRT is to do it slowly. The ways in which you do this will to some extent depend on the sort of HRT you are taking and the following are some suggestions:.
This will depend on whether your tablets are designed to produce a monthly bleed, which most women prefer, or not.
If you are having a monthly bleed then if the oestrogen tablets can be cut in half, or smaller, you can reduce the amount of oestrogen you are taking by doing this. It is always better to take a lower daily dose than to take the daily dose on alternate days. The progestogen should be kept at the same dosage.
You may find that when you reduce the oestrogen you do not experience a bleed in the usual way. This is not a cause for concern and is because the lower level of oestrogen has not built up such a thick lining to the uterus and it does not need to be shed. Eventually you will reach a very low level of oestrogen and you can then try stopping completely and evaluate how you are.
If the tablets cannot be cut into smaller pieces then try taking the oestrogen on alternate days. The progestogen should be taken every day as before. You may find that you do not have a period but this is not important. When you find that you are taking only one or two oestrogen tablets a week then you can stop.
If you are taking a continuous combined oestrogen and progestogen tablet then you are probably not having a monthly bleed. To reduce your dosage, try cutting the tablets in half. If this is not possible then take the tablets every other day and then every third day and increase the number of days between until you find that you can manage without them.
These have become quite popular over the past few years but it is more difficult to reduce the dosage you receive and it will depend upon your type of patch.
It is important to remember that a patch is designed to contain an amount of oestrogen to be absorbed over the period of time that you are instructed to leave the patch in place. If you leave it on longer you will not be getting less oestrogen. You will not be getting any oestrogen at all. Some people do reduce their patches like this but there are better ways.
There are two ways in which the oestrogen and progestogen can be administered by patch. One has oestrogen patches and is combined with tablets of progestogen taken for 12 days each cycle. The other type has both oestrogen and progestogen in patch form. There are usually patches just containing oestrogen for the first part of the cycle and then patches containing both hormones for the later part of the cycle.
Look carefully at your patch. There are two main styles: one is called a matrix patch and is very flat, and the other seems to have liquid or gel in it.
If you have matrix patches it is very easy to reduce the amount of oestrogen you take each day. Cutting slices off the patch and gradually reducing it can do this. You should continue to take your progestogen tablets or the progestogen part of your patch as usual. As with the tablets, as you reduce your oestrogen intake you may find that you no longer have a bleed if you have been experiencing one on your particular patch.
If your patches have gel in them you cannot cut them in half. The best way to reduce the amount of oestrogen that you absorb from the patch each day is to reduce the surface area of the patch. You can do this by sticking a small piece of waterproof sticking plaster over an area of the absorbing surface that goes next to your skin. You can then leave the patch on for an extra day because the oestrogen in the patch will take longer to absorb because you have reduced the area over which it is absorbed. You then increase the size of your piece of sticking plaster and leave the patch on longer and longer. Then eventually you will no longer use it at all.
If you have had a hysterectomy and as a result are taking oestrogen on its own then you can reduce your oestrogen in the ways described above, forgetting about the progestogen.
The speed at which you reduce your oestrogen is entirely up to you and you will be guided by how you feel.
When you decide to stop your HRT there are certain things you should do.
First, do start to take a supplement specifically designed for dealing with the menopause. There are a number of these on the market and you should be able to obtain advice in a health store or Chemists.
Next, if you have been advised to take HRT for osteoporosis, or indeed if you have been on HRT for several years, it is important that you have a Bone Mineral Density Screening. The reason for this is that the oestrogens in HRT do not build up new bone but stop bone from breaking down. The oestrogens can only do this while you take them. The problem that can then arise is that when you stop taking the HRT then the old bone that you have retained will start to break down.
To sum up: in order to help your bones at this time it is essential to take the correct supplement for your bone health, exercise in order to build up new bone, and consider using natural progesterone to help you to build up new bone.