Related Topics: Features, HRT, Menopause, Osteoporosis

How to come off Hormone Replacement Therapy

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.

Dame Dr Shirley Bond

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.

What’s Involved

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:.

Tablets:

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.

Patches:

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.

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Please feel free to discuss this article in the comments section below, but note that the author cannot respond to queries made there.
Comments 33
Sorted by:  Date | Recommended
rosemary | 9:04 pm, January 14th, 2011

I have been taking bio-identical HR creams for 18 months but my uterine lining has become thick and my dr. wants me to come off them. She said to cut down the number of days I use it each week til I am down to once a week (creams) and then stop taking them.and she prescribed prometrium starting now for 3 months for me to reduce the lining thickness and the risk of uterine cancer, What is your opinion of the use of prometrium in this case and how to come off the bio-identical hormones.

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dawn | 10:31 pm, March 17th, 2011

my docter as took me of hrt wiv out cuttin me down i ave been on them for 16yrs and now gettin side effects wot can i do 4 this or sould i go back 2 my docter.

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Julie Larratt | 11:57 am, October 2nd, 2012

Hi I have been taking HRT for about 10 yrs as I was post menopausal at the age of 40. I feel really well on HRT but the Dr as advised i come off it as the risk increase after 10 yrs. I have no breast cancer in the family of DVT . I have started to take a pill every other day but found the first day without it I have flushes during the night I’m not sure if I’m doing the right thing when i feel so well taking it.

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HS | 5:20 pm, October 7th, 2012

i am also in a dilemna..i take them feel better, when i try to go off them , i get angry, hot flushes, and depressed! and if i go off them..and perhaps i could live a longer life? does one choose between the quality of life .or longer life? hmmm..that is the question for each of us eh!

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Maham | 4:22 pm, October 24th, 2012

Hi Liz and LindaI’m concerned about your avdcie Linda re livial. I had endometriosis and had six injections of decapeptyl before a hysterectomy on 3 oct. Almost as soon as my injections kicked in I had menopausal symptoms, so was given livial. Livial worked really well and did not bring back the endo. My consultant told me that because of the hormone ( synthetic) in the livial, it wouldn’t act like oestrogen and so wouldn’t affect the endo. The injections worked very well but had to have the hyst because the injections couldn’t be done indefinitely. Compared with the quality of life before livial, I would definitely give it a try. It might not work for everyone, but don’t make a decision based on worry about endo as I was assured there’d be no problem. Hope you get something sorted out soonHazel

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Rigor | 10:40 pm, October 24th, 2012

Ovarian Cyst Surgery-Partial Hysterectomy done?I had a hystorectomy on June 2005 my Gyn rednmmeoced to leave my ovaries so they won’t have to put me on medications so young (I don’t consider myself that young but anyways) after all this I have been having constant pain on my right side is sharp and dull and sometimes I did not know how to describe it..so I went back and behold a ultrasound detected a small cyst on my right ovary.I have an appointment with the Gyn but not soon enough..now my question: since I had a hysterectomy I wonder what is going to be their approach about this painful and bothersome little cyst medication? or is this probably a simple surgery in the future? Any one out there with the same experience would be a lot of help )thnks.Those answers helped thnks. I am extending the days on my question maybe a girl out there has also gone by hysterectomy and also had ovaries taken out due to this in all i think my histeria is due to know wheather or not I am going to be proposed another surgery (?)thks

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sue | 6:32 am, November 13th, 2012

I have been on ellestte. duet 1 mg for 6 months and feel great on it , hot flushes stopped almost right away which was a god send . But my hair has been shedding since i started the tablets now only have half the head of hair i had before i started taking them ,my hair is

all over the house and anywhere i visit

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Linda | 12:26 pm, December 10th, 2012

Hi
I was fine on hrt for 13 yrs,dident go on it for menopause,but for bones,as I had polio as a child,the doctor took me off the hrt,I am now a complete wreck ,arms,wrists aching pain,cant turn over in bed ,sleep disorder,which I never suffered before,cant walk far at all without help,not sure if the late effects of polio contribute,or its just comming off the hrt.just need advice on what suppliment to take,doctors do not realise post polio syndrome. linda

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Carol | 3:11 pm, January 18th, 2013

I reduced my level of HRT by half about six months ago but am experiencing terrible pain in my arms, shoulders and lower bag and legs. How long does this usually go on for?

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Gerri | 8:20 pm, March 1st, 2013

I was on the Biohormones (compound). Iwas off of them for weeks, started not feeling well and had spotting so I started taking them again. Have been on them for 3 weeks and now I am spotting. Is this normal?

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AnnA Rushton | 11:02 am, March 2nd, 2013

Gerri – as your hormones rebalance old stored blood can be released, and the body can hold on to this for some time and can be linked to the degree of oestrogen dominance and how heavy your periods have been. Unless the bleeding is heavy or prolonged there is no cause for concern but if not then please see your doctor.

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Romy | 9:50 am, May 4th, 2013

Ive been on hrt tablets for three years,and wish to come off,Dr has advised to take one every other day,and then every two days,until I have weened myself off,I just want to know,will I start looking old,will my face start getting wrinkled,I get told I look young for my age,I know every one is talking about what will happen to the body,but no one is mentioning how you will look,please can anyone give me answers tahnk you

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AnnA Rushton | 1:44 pm, May 4th, 2013

How you age is dependent on many factors and coming off HRT is not likely to be a factor. If you are concerned then a cream such as 20-1 will give you both progesterone and oestrogen and it is oestrogen that increases the rate of cell turnover in the basal layer of the epidermis which makes skin appear plumper.

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Mary Hughes | 4:08 pm, June 7th, 2013

Hi, can you tell me where I can buy the
20-1 cream .I have come off HRT ,dont want to take pills .
Thank You
Mary Hughes

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AnnA Rushton | 9:41 am, June 18th, 2013

Mary you can buy 20-1 at http://www.wellsprings-health.com

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Cindy Maxwell | 6:57 pm, August 22nd, 2013

I am 57 yrs. old. stopped taking estrodiol 2 years ago, but have continued taking 200 mg. of prometrium since then. Can I just stop taking the prometrium “cold turkey” ? They are in gel form so I cannot cut them.

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AnnA Rushton | 3:50 pm, August 23rd, 2013

You would need to speak to your GP Cindy as Prometrium is a high dose progesterone and although the cream formulas can be stopped immediately we do not know what the withdrawal from a pessary like this would be.

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Julie E | 9:05 pm, July 16th, 2014

I have been on the Minivelle patch for one month, and have gained weight to the point where I am crawling out of my skin. I stopped taking it, and am now just using the vaginal cream. I would rather have hot flashes then feel like the Michelin man. For me, it was not worth it.

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carol walls | 1:32 pm, August 10th, 2014

Hi Shirley
I am 62 years old my Dr has taken me off hrt as my blood presser went up.she says i have got to come off it some time.the nurse has been taking my blood presser now with 10mg tablets it is back as it was.
I have been off hrt for one year before
nearly had a break down.could not coupe with anything at all.my gp put me back on it last year but has since left.
I now have a new gp who is very good
but wants me off the hrt because of the risks and my age. she says she will put me back on it when my blood presser goes down.I have to see my gp next week she says I will have to syn a form so she is not to blame if anything happens to me I am going to ask if I can go back on it for a while and then start to reduce them slowly and see if that will work. but I think I am one of those people who will never get rid of the menopause symptons long as I Live?

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kim | 7:40 am, August 13th, 2014

Hi I’m evorel 50 and two weeks I go I just stopped using the patches no reason just wanted to see if I could go without I’m now wanting to go back after realising I’m better on them my Dr put me on them because before I w as due a period I use to feel like crying my head felt really strange I didn’t feel ill but just couldn’t describe it I just felt rather strange before a period was due but now that j don’t get periods,and have a marina coil fitted as well was just wondering wether I could just start my patches again starting on a new day

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AnnA Rushton | 10:01 am, August 13th, 2014

Stopping HRT immediately is never a good idea as you can severe withdrawal. You need to speak to your doctor on how to manage your patches as you are having both oestrogen and synthetic progestins in the coil.

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susan mcpartland | 7:58 pm, August 13th, 2014

Hi i have stopped taking HRT Livial but seem to be gaining lots of weight is this normal ?

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AnnA Rushton | 11:48 pm, August 14th, 2014

When you stop HRT, particulately if done suddenly, then symptoms can be severe and in this case production of oestrogen switches to the fat cells in the abdomen, stomach and thighs.

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Sarah Fuchs | 10:12 am, August 31st, 2014

Hi. I am very confused. I had a total hysterectomy when I was 32 years old and was on Premarin for many years. I started taking Livial 9 years ago and I’m now 65. I look 10 years younger and am still sexually active. I go to a specialist once a year to have him check my breasts and I also have a mammograph and ultrasound once a year now. He thinks that I should stop all HRT. My GP doesn’t see why I should come off Livial. I ran out of my pills 4 days ago and am thinking maybe I should stop taking Livial now. I don’t know what to do. Overall I am healthy besides high cholesterol (medicated). I’ve been getting a lot of leg cramps recently – more than a month now. What should I do?

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AnnA Rushton | 1:49 pm, September 1st, 2014

Sarah we can’t comment on your doctors recommendations. Certainly 5 years is now the maximum time suggested for women to be on HRT because of the risks but no HRT should be stopped suddenly because of the risk of severe side symptoms on withdrawal. For women with such a long history of HRT use you would be better if you intend coming off HRT to use a combination cream such as 20-1 which has both progesterone and oestrogen.

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Mickey | 11:05 am, October 3rd, 2014

I have been on bio-identical HRT for over a year now. Will be 50 this month. My OB Gyn suggested I was having a hard time with depression prior to it so she was coming at it from that angle.
I want to get off of it due to lack of finances. I read in all the comments that going off cold turkey has severe symptoms what are some of the symptoms to be expected? How does one combat them? Please help

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AnnA Rushton | 5:36 pm, October 3rd, 2014

As Dr Coope’s article explains, coming off HRT suddenly is never a good idea as severe menopausal symptoms such as flushes and sweats usually result. Slow withdrawal and supplemention with bioidentical progesterone is the best route.

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Amanda | 10:31 pm, October 23rd, 2014

I am weaning off my oestrogen patches slowly, I have been on them for about 10 or more years, I am now having difficulty with getting to sleep at night, is this a side effect !

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AnnA Rushton | 8:54 am, October 24th, 2014

Amanda slowly is best and so increase your progesterone cream as this is the hormone that helps you sleep. Stay on the dosage of patch you have reduced to until you get your sleep under control and then reduce again.

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Joan | 4:05 am, October 29th, 2014

I am weaning off bio-identical hormone cream. I was on 4 “clicks” of the dispenser per day. Doc suggested I do 3 clicks and if symptoms occur go back up for a couple of days, 3 for a couple of days, etc, then when no symptoms use just 3 clicks for a while, if no symptoms keep reducing. However, he gave me no time frame. So far I have had a few hot flashes, but am doing ok. How quickly can I move off? multiple weeks at each level, one week at each level? I am confused how to proceed.

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AnnA Rushton | 7:39 am, October 29th, 2014

We don’t know this form of HRT Joan but your doctor is correct, there is no time frame, you just reduce gradually until you are symptom free but generally a week at each level would be average.

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Joan | 3:02 pm, October 30th, 2014

Thank you for responding. I have had some symptoms, so am going back to 3 clicks a day. Also, I read where sometimes one had gut symptoms, and I am feeling slightly nauseous. Do you suggest a pro-biotic?

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AnnA Rushton | 4:57 pm, October 30th, 2014

Many practitioners do advocate using a probiotic as it can certainly improve the gut health.

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