Related Topics: Features, HRT, Treatments

A Doctor’s Guide To Coming Off HRT

Many women are looking for a natural alternative to HRT. Suddenly stopping can bring on severe symptoms so this handy guide from Dr Tony Coope tells you how to do it simply and easily.

Dr Tony Coope

Since the Women’s Health Initiative study ending in 2002, there has been an increasing number of studies confirming that bio-identical hormones are safer than, and superior to, their synthetic counterparts.

The important aspect of this is not so much the oestrogen component, as ‘synthetic’ versions of this are not dissimilar to the body’s own 17beta oestradiol, but in the progestin components, which are different in their molecular structure to bioidentical progesterone.

I have found that women respond better to the bioidentical form, with far fewer side effects.  Many women have no difficulty in deciding against synthetic hormones, either because of their experience of the contraceptive pill, or because of side effects (very common in women with a degree of ‘oestrogen dominance’ – a deficiency of progesterone in relation to levels of oestrogen).  Others have had no such problems, but are uneasy about the accumulating evidence.

However, for those women already on HRT for menopausal symptoms or bone density problems, there is often a dilemma. They may be uncertain of the effectiveness of the alternatives, and unsure of how to change from one to the other.

Their GP may have limited knowledge of these, or even be actively against them. What to do?

Before coming off HRT

Some women are able to stop their HRT suddenly prior to going on to their new regime, but in the main these are women who have not previously had severe symptoms, or are using it for bone protection.

Those who have had symptoms would be best advised to come off slowly, cutting tablets in half, then spacing them out, according to how they feel.

With patches you can then put a waterproof plaster between your skin and the patch to leave only a small part of the patch in direct contact with the skin so it is absorbing less hormone.

Types of HRT

Just to clarify, the main types of HRT are:

1. Continuous combined HRT; where either a patch or tablet containing both oestrogen and a progestin such as Femoston Conti, Climest, Premique and Evorel Conti. This type is used straight through a repeated 28 day cycle.

2. Sequential combined HRT; where an oestrogen patch or tablet is used to cover the 28 days of a cycle, and a progestin tablet added for the second half of it. A slight variation on this is with the former used only for the first 14 days, then a combined tablet or patch for the second 14 days. Examples of this type are Evorel Sequi, Prempack-C and Trisequens.

3. Oestrogen alone HRT; as either patch or tablet continuously, or an implant, prescribed for women who have had a hysterectomy. Examples of this type are Elleste Solo, Estradot, Sandrena and Evorel.

Many doctors now believe, however, that these women should be given the same protection as those with an intact uterus, as ‘unopposed’ oestrogen also has an unwanted effect on sensitive breast and ovarian tissues.

Getting started

Whatever the form of HRT, the practical way to come off it is not so difficult as it might first appear.

The important principle is to first add bio-identical progesterone to support the withdrawal and reduce the withdrawal symptoms from the HRT.

Generally, women who have been on HRT find it best to start using 20 to 1, which has the majority ingredient of progesterone with two natural oestrogens.

After a week or so on this they can begin to reduce their high-dose HRT supported by continuing with 20-1.

I find this can usually be done over one or two cycles of 28 days, rarely more than three, and it significantly reduces both the long-term cancer risk and that of cardiovascular events such as heart disease, stroke and blood clots.

In addition it may well improve other factors such as energy levels, depression, anxiety, mood swings and sense of well-being.

Without going into detail for each form of HRT, it is possible to keep the oestrogen part going continuously for each 28 day cycle, (eg by using oestrogen tablets or patches ‘borrowed’ from supplies for following months), while introducing progesterone as in 20-1.

In the case of combined HRT, because both the progestin and oestrogen components are at a fixed dose in the same patch or tablet, there is no alternative to gradually reducing the dose (by spacing out the tablets or reducing the size of the patches) while at the same time starting on 20 to one, the combined progesterone/oestrogen cream.

Begin on a low dose of this while gradually tailing off the HRT; as the full dose of 20 to one is reached, the HRT is stopped.

If necessary on combined/sequential forms of HRT, it is possible to use the 20 to one together with the synthetic progestin for a month or two. The two forms act on the same cell receptors, so the natural form will not exert its full effect while this is done, but stores will build up in the body and help to prevent ‘rebound’ symptoms occurring when the progestin is stopped.

Oestrogen only is perhaps the simplest, as you just reduce the amount of oestrogen gradually once using bioidentical hormones.

Once off HRT

Once off HRT, and if symptoms are then coming under control with 20 to one, you can make the decision as to whether to continue with the combined cream, if you still need a small amount of oestrogen, or you could then switch to Serenity if you feel your symptoms need progesterone only.

As natural bioidentical progesterone is the precursor to oestrogen, and so can be converted into oestrogen in the body, this may be an added source.

Women who have been deficient in progesterone may also not need additional oestrogen as the adrenals and fat cells continue to produce it as their ovarian function declines.

If needed, supplementation can be considered in the form of natural progesterone cream, or a bioidentical combination cream such as 20-1, containing both progesterone and oestrogen.

You could also consider adding phytoestrogens, supported by Vitamin E, omega fatty acids and a regime of bone support, which will have received a positive boost with the addition of progesterone itself.

Helpful information:

Please do be aware that stopping HRT suddenly can bring on quite severe withdrawal side effects so do always make this process as easy as possible by following Dr Coope’s advice.

HRT Or Bioidentical Hormones For You?

  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -
  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -

New comments are now closed on this article
Comments 100
Sorted by:  Date | Recommended
AnnA Rushton | 6:19 pm, June 13th, 2021

Cathy Please email for individual help with your symptoms as they will be able to go into more detail than is possible here.

Cathy | 10:13 pm, June 10th, 2021

So I have pmdd and have a merina coil and take 2.5mg of sandrena gel.
I’d like to come off and replace with natural progesterone and herbal hormone help .
Could you advise how to do this please ?

AnnA Rushton | 3:47 pm, June 2nd, 2021

As your oestrogen was increased, and not balanced by progesterone, this could have been the cause of your sleep lessons. Progesterone is certainly helpful for sleep as it is a relaxant but if you require further information email for individual help with your symptoms as they will be able to go into more detail than is possible here.

Elisa Tyrer | 1:20 pm, June 2nd, 2021

I’m 51 and had a full hysterectomy 2 years ago due to overgrown fibroids. They put me on tibolone for 7 months, I was sleeping ok then. However I started itching in the middle of the night and found it hard to sleep, my HRT was changed to 1 mg Elleste Solo an estrogen only HRT. I took this for nearly a year then suddenly insomnia kicks in. I was only getting less than 6 hours broken sleep. Thinking this was due to low estrogen my HRT was up to 2 mg. After taking 21 tablets my insomnia got worse, this time struggle even an hour sleep without sleeping tablet.
I am a very happy and active person, I eat heathy and take very minimal caffeine, I eat healthy and walk 2-3miles to exercise.
I stopped the 2mg Elleste solo 3 days ago, I took this for the main reason of avoiding insomnia. I can cope with other symptoms but not bad insomnia.
Doctors please could you give me an advice? I am due to see my GP and will ask to be tested if I have an imbalanced hormones. And hopefully be given the right medication.
I had insomnia before but this was due to a family member dying. After the grief is over I was ok. This time no grief or anxiety so I hope this insomnia will go away soon. Any help will be great.
Thanks in advance.

AnnA Rushton | 2:16 pm, March 22nd, 2018

It depends on what type of HRT to you are on Amber, Dr Coope’s article does give you information on this and generally you are advised to cut down your HRT very slowly and when using bioidentical hormones as well. Please email for individual help with your symptoms as they can give you more help than we are able to here.

Amber | 6:22 pm, March 21st, 2018

I have been on HRT for about a year now it has really helped me with night sweats ect. However lately I do have uncomfortable bloating 24 /7 and weight gain . I generally feel uncomfortable so confidence goes ect. I am going to try the serenity cream the progesterone and oestrogen one. I just wanted some advice about the best way to cut down slowly.
Thank you

AnnA Rushton | 6:13 pm, December 27th, 2016

Christine dr coope’s article outlines how best to do this with Serenity and it is very important you do not just stop your HRT but cut Down gradually while also using serenity to avoid withdrawal symptoms.

Christine Stephen | 3:35 pm, December 27th, 2016

Hi. I have been taking estelle duet conti since Feb. It helped hot flushes but nothing else. Since July I have had such bad anxiety I can barely go out. I would like to come off hrt to see if this lessens anxiety. I have wellsprings serenity cream. Can you advise should I use this with tablets while weaning off hrt? Thank you. Christine

AnnA Rushton | 9:34 am, August 28th, 2016

Dr Coope is unable to reply personally to post on this page. Please send this information to for assistance or for a consultation with Dr Coope please see the information below:

christine | 9:10 pm, August 25th, 2016

Dear Dr. Coope, I am 54 and post menopausal. I have come out the other side of a traumatic menopause where I have been on and off HRT.but when I stayed off HRT found I suffered from vaginal atrophy. My doctor gave me 10mcg vagifem which helped a little but not enough and after 5 months changed to evoril conti patches which cured the problem but they wouldn’t stay on and so i got breakthrough bleading. I am now on elleste duet conti 2mg tablets but these caused extremely sore breasts after a couple of weeks so I have cut these in half and am taking them every other day which seems ok up to now but I have only been doing this for a week so not sure if the dose is too low as yet. Do you think I should continue with this or do you think if I revert back to vagifem they could now work as i have got on top of the problem. If so what is the best way to change over. Also which is the safest long term option as I have been told vaginal atrophy is unlikely to resolve itself without HRT. Many thanks.

AnnA Rushton | 7:50 pm, August 4th, 2016

Helen we cannot answer this medical question as you need to discuss stopping Femoston with your doctor. Sometimes, itching can be a symptom of conditions such an overactive or underactive thyroid but it is also a common symptom of menopause. The changes in the levels of hormones that occur during the menopause are thought to be responsible for the itching but the exact reason for this is not known.

Helen | 10:10 am, August 3rd, 2016

Hi I’m 39 and Chemotherapy brought on the menopause so I have been taking femoston for about 1 year. I have been suffering with severe itching I’ve been to my gp he has tried lots of different creams but nothing is working! The itching is making my life hell. I then thought it could be the femoston so I’ve stopped taking it. Is it ok just to stop to see if it is this. Please could u help

adriana | 9:00 am, June 28th, 2016

I am 28 taking femoston i stopped for a week and replaced it for maca root powder..
Should i take both of them or just maca?

AnnA Rushton | 5:26 pm, June 14th, 2016

Gill please read Dr Coope’s article as this gives you the information you need. Kilovance is a form of HRT with both estradiol and a synthetic progestin so that usually means using Serenity first as per his advice.

Gill Bateman | 10:56 am, June 14th, 2016

I am taking kliovance (4months so far) hate being on it as I have put on weight. I want to wean off it, I will take advice from my gp, but as he knows nothing about (or says he doesn’t) bio identical cream, serenity or 20-1 cream. I need advice as to how to add it and which one. From the response from well Spring I am guessing I should be using the 20-1 cream? But how do I start and how do I start to wean myself off the Kliovance 1mg. I would appreciate your comments urgently.
Gill Bateman

AnnA Rushton | 9:42 pm, January 23rd, 2016

Wendy we cannot answer questions on medication, you need to speak to your doctor, but certainly increased weight around the stomach is associated with excess oestrogen so you may find it helpful to read this article.

Wendy Curry | 9:22 pm, January 22nd, 2016

I am 53 and have recently had the mirena coil removed. At the same time I was given Kliovance to replace the Climagest I have been taking for over a decade. Despite having maintained a healthy weight on a balanced diet, and taking lots of regular exercise, I have noticed a stark increase in fat around my stomach hips and tops of my legs. I have already gained about 5 pounds in weight and have only been taking the Kliovance for 5 weeks. I am inclined to stop it immediately and revert to the Climagest, as I am going on holiday in 3 weeks and will look horrible in a bikini. Will this cause any harm?

Jenny | 3:05 pm, January 17th, 2016

Dear Dr Coope

I am currently taking tibolone hrt following having my ovaries removed in 2014 due to severe PMS month after month.

I am still getting hot sweats and
As this hrt doesn’t contain oestrogen and it
Mimics the actions of the hormones produced by the ovaries can I use the 20-1 cream with the hrt ?

I am concerned about coming off the hrt completely as it has helped my mood after suffering for many years with hormones
(Although I would prefer the natural approach)

I look forward to hearing from you.

Thank you


AnnA Rushton | 10:36 am, January 17th, 2016

Dr Coope is unable to reply to individual questions on this site. If you wish to consult him please do so via this link:

Jenny | 1:06 pm, January 16th, 2016

Dear Dr Coope

I have been taking livial hrt for 9 months following removal of ovaries due to severe PMS for 12 years. I also had endometreosis on one ovary and under my belly button and a fibtoid.I have since gained a stone in weight.I also take vit d & calcium and menopace.

I have been really exhausted lately and started feeling emotional and low again. Also dizzy and nauseous.

I ordered the 20-1 cream a couple of months ago but haven’t started using it due to my mood being good. Which it hasn’t been for around 12 years.

I am unsure and really on how to come off the hrt. Will this cream help my severe symptoms. I would rather take something natural and get back to my normal weight if it can help my mood and emotions.

Many thanks

Jenny Snee

AnnA Rushton | 8:52 am, October 15th, 2015

After a hysterectomy we suggest a combined cream such as 20-1 is best to help with the plunging hormone levels Nicola. See this article by Dr Dach of the USA

Nicola | 10:10 pm, October 14th, 2015

Great article. I am 50 yr old woman who had a total hysterectomy this year and removal of ovaries. I am reluctant to go on HRT but the hot flushes and other menopause systems are starting to seriously affect my life. Is it possible to use the progesterone cream, would this help with menopause ? or should I also be taking some form of oestogen as well, I would prefer to be using as natural products as possible. Thanks any advise appreciated.

AnnA Rushton | 12:40 pm, August 23rd, 2015

For severe flushes a combination cream such as 20-1 can be more effective Kay but you need to speak again with your doctor as vaginal dryness should have responded to the oestrogen in the patch. At 47 you are probably in perimenopause when periods do become more erratic but if your body is able to produce them then it is healthy to do as you will be shedding old, retained endometrial lining.

kay | 1:27 pm, August 20th, 2015

hi I am 47 and i suffered from severe hot flushes(at least 1 per hour around the clock accompanied by sweating from places that shouldn’t sweat like ankles fingers and under the eyes) and night sweats for more than a year before resorting to hrt. I tried many natural remedies. Chinese herbs ect. Harmony tablets worked for a couple of months then my body seemed to become used to them and the symptoms returned. I tried a progesterone cream from the compound pharmacy this never worked and the measuring and applying different size doses was way to complicated. when starting hrt they put me on the lowest dose continuous patch estalis 50/140 this worked really quickly to eliminate the hot flushes and night sweats however did nothing for the vaginal dryness, dry eyes or weight gain I still got a period ever 6-8 weeks. . After 4 months the hot flushes started to return nowhere near as severe however it was disappointing as I am aware of the physical and emotional stress on my body during these states. The doctor then put on estalis sequi 50/140 this stopped the hot flushes again but also the period. and has not resolved the weight gain or the vaginal dryness. I actually feel much better when I get a regular cycle so am not too sure what i should be aiming for with all this as the doctors goal seems to be to stop the period all together. I guess that it is assumed that women don’t like getting a period! Which cream would you recommend for me to normalise my hormones and weight and what protocol would I follow with that?

AnnA Rushton | 11:42 am, August 3rd, 2015

Jennifer we cannot comment on whether you would benefit from going back to HRT but Dr Jeffrey DAch of the USA recommends that a combination cream such as 20-1 is helpful for anxiety and depression – his article may be of interest: Jeffrey Dach

Jennifer | 9:24 am, August 3rd, 2015

Hi i was put on HRT at age 34 years old after mass abscesses that actually almost killed me was very lucky indeed. was in hospital a month until got my temp down then operated (drained abscesses) and antibiotics ect. then well enough for a total hysterectomy. Now i am 46 years old. Been On everol 100 but not always everol same HRT just different names ect. twice a week.
i stopped taking them obviously not advice doctor sometimes i actual forgot to take them.
anyway Now i feel all symptoms coming back and my mood has lowered really bad and ive noticed total change in me.
I still have HRT and in date as wwas just couple mths ago stopped.
I can also get repeat prescription here Scotland.
Will starting again help my symptoms and help stop the depression cane along with it?
any information will help.
new doctors so not helpful at all to be honest. Hence came on here.

AnnA Rushton | 8:52 am, April 27th, 2015

Given that the medical advice is not to be on HRT longer than 5 years due to the increased risks for cancer and heart disease Lydia your doctor may not be willing to prescribe it any longer, many will not, but it is of course up to you. The article indicates how to come off it and the advice is to do so very slowly or you will get withdrawal symptoms. For bone protection you need progesterone and oestrogen and we recommend you use a combined bioidentical natural HRT replacement such as 20-1.

Lydia Duttet | 11:13 pm, April 26th, 2015

I have been taking elleste duet 1mg HRT for 6 years and was prescribed it at age 45 primarily for bone protection. I am now 51 and have been advised to come off it as the risks increase, but what is the best way to come off it, and is it necessary? Advice much appreciated!

Emah | 7:21 pm, March 28th, 2015

Had total hysterectomy with ovaries removed almost 4yrs ago. Placed on livial but still had hot flashes, insomnia, malaise, weight gain, hair loss, pains,forgetfulness,etc Since November 2013 I have been on premarin, estrogel and estraderm and my condition is not improving. I am having severe heat and sweating and the weather is very hot in my country. The doctors say I don’t need progesterone since I have no ovary. I now have biest transdermal cream 0.5/1 mg and progesterone cream 200mg. i have started both 2 days now and no relief . Should I continue with progesterone cream and stop biest for some weeks? Pls advise

AnnA Rushton | 11:38 am, March 22nd, 2015

Maddy we are not doctors and can’t this question here fully but in general given what you have told us then yes a combination cream such as 20-1 may be helpful, and the progesterone content will support thyroid function. However, progesterone will interfere with the contraceptive properties of your Pill so you would need additional protection to prevent pregnancy. If you wish further advice please email

Maddy | 3:48 pm, March 21st, 2015

I would really appreciate some advice. Having been suffering from ongoing upper abdominal burning pain (for 8 months now), which was originally put down to sludge in my gallbladder, I stopped taking Cerazette as I discovered it stops the gallbladder from functioning correctly and there is family history. Given that I am 47 I then asked for my hormones to be tested (on advice of a nutritionist) to determine whether I was peri or post menopausal.The blood tests done 2 months later indicate that I am,(non existent oestrogen and FSH of 66 then 98 6 weeks later), however I had no periods/bleeding on this pill and in the past it took 2 years for my periods to resume after 10 years on a combined pill. My GP is adamant because of my age that I am menopausal however and my symptoms are in line with low oestrogen and progesterone from what I have read. My Dr has prescribed Ovestin for 2-3 months and I was then intending to try Maca for a month and then 20:1 natural progesterone cream. Is this a sensible course of action? The GP wouldn’t test my progesterone but I have read that this normally crashes more than oestrogen so no doubt it is low / non existent too. In the last couple of weeks a normal vaginal discharge has returned, so now I’m wondering whether I should bother with the Ovestin (which I gather is the least potent oestrogen) or whether I should give myself the boost first? Do you think my periods might resume and if not, how long do I need to use contraception for? Many thanks for your assistance, it is much appreciated. In case it helps, symptoms range from dry eyes, skin and vagina (latter better recently), feeling the cold even more than usual, non existent libido for as long as I can remember, blood sugar dizziness, fatigue, disturbed sleep (could be abdominal pain), joint/muscle pain, memory loss, hot hands and feet when I wake early. I don’t know if the gastric issues (still undiagnosed) are caused by the hormonal imbalance but no doubt it can’t be helping. My nutritionist thinks my thyroid isn’t functioning properly but I know it’s all connected and have had a stressful 18months, so it’s hard to know what came first

Cathy Carter | 11:44 am, February 13th, 2015

Very useful information many thanks

jr | 11:26 pm, May 1st, 2014

Nice to see an article advocating progesterone to help blunt estrogen withdrawal. Moreover, this is one of the few recommendations I’ve read where it questions (indirectly) the physiological “wisdom” of ever giving a woman estrogen-alone, even even she’s had a hysterectomy. High estrogen almost always precipitates a hysterectomy in the first place; I would think the LAST thing such a patient would need is MORE ESTROGEN!

Although this is a side note, it is becoming increasingly clear (though not reported by news outlets or even medical journals) that unopposed estrogen poses some unique risks that are not seen with estrogen/progesterone – atrial fibrillation, prolonged QT interval (a risk for stroke and sudden cardiac death), peripheral arterial disease, ovarian cancer, and possibly colorectal cancer in older women.

I think Dr. Jerilynn Prior makes a great, similar recommendation – start progesterone if you’ve been on only estrogen or estrogen/progestin; taper the estrogen, and then stay on progesterone for as long as needed. It does not cause stroke, blood clots or breast cancer.

Dr Tony Coope | 9:29 pm, April 30th, 2014

Jeanne: if you are comfortable with that, it would be a good place to start, and it is possible that it might be enough to give you relief. If not, remember that it would not be a bad thing to use a higher dose of estrogen for a while, as your previous problems were influenced by an excess of estrogen without adequate ‘opposition’ of progesterone. A normal level of oestrogen with progesterone cover is an entirely different proposition. Also your ‘withdrawal phase’ tendency to severe symptoms such as hot flashes would lessen with time as you gradually decrease the dosage of estrogen.

Jeanne P | 5:40 pm, April 30th, 2014

Thank you for your reply. Have spent a little time researching this and am horrified to read HRT may have triggered my asthma which began at 37, three years after I began HRT. I also have had gallstones and dry eyes. That being so I am reluctant to return to oestrogen gel use albeit in conjunction with progesterone cream even though current hot sweats are very difficult. Would 20:1 cream plus vagifem pessaries offer enough relief? Many thanks for your help.

Dr Tony Coope | 4:00 pm, April 28th, 2014

Jeanne: your story (threatened and actual miscarriages, growth of ovarian cysts), suggests that you had been progesterone-depleted for many years. Then after your hysterectomy at 34 you were on estrogen-only HRT in one form or another for 20 years+. Now as your estrogen levels decline the ‘withdrawal effect’ is that your menopausal symptoms, both physical and emotional, are more severe than they would otherwise be. Going onto bioidentical progesterone is definitely a good idea, but it may not be enough to resolve your ‘estrogen deficiency’ symptoms. Your doctor will have suggested coming off your HRT because of the long-term risks of ‘unopposed’ estrogen, but the addition of progesterone fulfils this opposing action, enabling you to continue with minimal risk on an estrogen patch or gel at the lowest effective dose. The same applies to an estrogen cream that you may need to use to improve your vaginal symptoms.

Jeanne Powell | 12:46 pm, April 28th, 2014

Some advice please. Menstruation began at 14 yrs. On pill aged 20 yrs for 4 yrs. I have 3 children and experienced threatened miscarriage with each of them as well as 2 actual miscarriages. At 34 I was diagnosed with ovarian cysts and underwent a total hysterectomy followed by oestrogen patches, then Premarin tablets and finally Sandrena gel over a continual period of 23 yrs. I have always struggled with hypoglycaemia and breast pain which I controlled with sunflower and pumpkin seeds. In 2013 aged 56 I began to experience severe day and night hot sweats with my hair becoming wet and awoken at night and GP suggested cessation of HRT in early 2014. Now some 3 months later I struggle with increasing hot sweats, vaginal dryness, breast and joint pain, weight gain and am taking antidepressants. I have ordered some serenity cream but would appreciate some advice.
Regards Jeanne P

Dr Tony Coope | 9:37 am, April 11th, 2014

Margaret: If the 20:1 combined cream is not enough to suppress your flushes, you can always combine Serenity (progesterone only) with an oestrogen gel or patch. This gives you the option of reducing the dose of oestrogen to the lowest effective dose, while still having the protective cover and benefits of the progesterone,(if you have the cooperation of your doctor, which of course does not always happen).

Margaret | 9:56 pm, April 10th, 2014

I am 76 been on HRT everol patches for twenty years not always everol .Came of HRT last two years , been having a bad time since hot flushes bad sleep mood swings you name it , no one tells you what happens when you stop using it . Tried serenity last year was ok , just gone back on it not working to well yet .

Dr Tony Coope | 11:57 am, February 24th, 2014

Ester: it seems likely that you were suffering from a classic oestrogen/progesterone imbalance with low progesterone, giving rise to the symptoms which eventually resulted in a hysterectomy. Your menopausal symptoms were made more severe by this previous state of affairs; although they were eased by the HRT, in my view it is not a good thing to be on estrogen-only replacement, (even though you have had your womb removed) as many other tissues have oestrogen receptors and are at some increased risk without the ‘oppositional ‘ balancing effects of progesterone. Neither are synthetic progestins the best option. You may find that a 20:1 combined progesterone/estrogen cream will be sufficient to control your symptoms as you come off your present HRT, but if not, a good alternative is to continue your estrogel in your present dose, add progesterone cream, and then gradually reduce your dose of estrogel (if you can) to the lowest dose that keeps your symptoms at bay. If this is not possible, then you will still be on a regime that should be more effective and safe, without the risks of oestrogen alone. Once you are on the progesterone, then you can safely use an estrogen cream for vaginal use if you should need it. Also, it would be helpful, but not essential, to have a 1-day progesterone/estradiol saliva test to confirm your hormone levels as a starting point.

Ester Cashmore | 11:07 am, February 24th, 2014

Hi, I had a hysterectomy at age 36 yrs leaving my ovaries in place; This was done because of heavy bleeding. Previously I had suffered very heavy periods which at times could last for up to 10/12 days with heaviness, pain and headaches and also suffered bad PMS. Everything seemed fine until I reached 45 yrs and then I started to get signs of menopause; at age 50 yrs I suddenly started having severe hot flushes and night sweats, palpitations, headaches, depression, anxiety, fatigue and really bad vaginal dryness. I was put on oestrogel HRT which is estradiol @ 2 metered doses per day one on each thigh, though I was not really happy with the idea of going down this route (as my body does not respond well to medications) this seemed to work well and I was on this for three years until my daughter had a dvt and my mother also had a dvt in that year I was taken off the HRT reducing it slowly. Within a short period I was suffering all previous symptoms again, I was prescibed vagifem pessaries for dryness, they worked but it didn’t last, 12 months after coming off HRT I was put back on it but this time I have managed to reduce the does to 2 metered doses every other day. I’m now 56 yrs and I still get mild symptoms. I would like to try a more natural product but am unsure about what would be best for me, can you help please. Regards Ester

AnnA Rushton | 11:06 am, January 24th, 2014

It is never advisable to stop HRT suddenly Nina as you can get a severe onset of menopausal symptoms. This article by Dr Coope will give you more information:

Nina Sharp | 5:57 pm, January 23rd, 2014

Can you pls advise me. I have been on Premique 0.625 for 14 years. Firstly I had the Premique cycle but then went onto the above (no bleed). I have been advised by a new GP that I can just stop these… no weaning… but a friend of mine thinks this is wrong and I should seek advice. I never really had any hot flushes etc associated with menopause. I went on anti depressants (citalopram 20mg) at the same time. I am still taking these. Had a bone density test in 2006 which stated I had Osteopenia – slight thinning. I would welcome any advice. Thank you very much. Nina

AnnA Rushton | 11:31 pm, May 15th, 2013

Dr Coope’s article explains that you need to stop the progestogen part. HRT needs to be stopped gradually or you can get more severe symptoms and using Serenity alongside will help with the symptoms. If your symptoms are severe or you have vaginal dryness you may be better to use 20-1 so you have some additional oestrogen once you have stopped your HRT.

j gillespie | 11:00 pm, May 15th, 2013

I am taking HRT but its not working for me , so I am going to come off it, I am on Elleste duet 2mg tablets. please can you tell me the best cream I need to take and The best way to come off the HRT, THANK YOU J GILLESPIE

Una Halligan | 2:34 pm, April 9th, 2013

Dear Dr. Coope,
I have been taking ‘Femeston 2/10’ for the past 5 years. I am now aged 60. I am anxious to come off HRT-however, when I asked my doctor for his advise he was reluctant & told me I would ‘loose my oomph’ (!). However, I really want to try to come off the HRT as I have accumulated fat around my abdomen & back….despite a well balanced low-calorie diet & plenty of exercise (gym & long walks with my large dog….who needs 2-3 hours of exercise per day). I would be very grateful for your advise. Thank you. I live in Ireland.

AnnA Rushton | 1:02 pm, February 24th, 2013

Pauline please follow Dr Coope’s guidelines in the article. The key is to reduce the patches slowly while supplementing with bioidentical hormones.

Pauline | 8:37 am, February 24th, 2013

I am 60years old and have been on Everol 25 for the last 8years. Could you please give me some guidance on how best to stop these patches. My doctor has said it is now time to come off HRT.

kathleen Kelly | 7:25 pm, January 26th, 2013

Dear Dr Coope, I have known about bio identical hormones for years but never knew where I could get the. I am now 52 years of age and had sudden onset menopause at 44. This year has been the most difficult with weight loss, muscle loss despite regular exercise, night sweats , flushes, poor memory and more. I suddenly feel like I have to push push
push to do anything. This would not be in my make up. My blood readings show no oestegen and an elevated prolactin of 625, this is concerning. I started three weeks ago 2mg of Kilogest oestergen only and I feel terrible on it. I am suffering from anxiety, to sleeping alot and not wanting to go anywhere. Can you please help me. I did try herbal remedies for years and they were much more supportive of allieviating the symptoms. I would love to hear back from you. I am living in Ireland. Kathleen

Jules | 9:44 pm, January 14th, 2013

Hi…I’ve been on femseven parches for about a year. ..but I give in….! I have taken the patch off and I’m not putting it back on! I’ve put on loads of weight and I just don’t feel well 🙁 I’m just approaching 50 ..I know the night sweats are going to be horrible but it can’t be any worse can it?? Is the right thing to do???

Denise | 6:05 am, November 10th, 2012

I am 62 years old.Had a complete hysterectomy at 39 yrs I had a history of D&C’s, ovarian cysts and fybroids also heavy bleeding .I have been using Ostradiol patches since the hysterectomy, started off with Estraderm 100 , it was reduced to 50mg and when it was discontinued I was put on Evorel 50.I have experienced breast pain, redness and itching at patch application site also on other body parts.What scared me most was when we travelled by airplane to Cape Town, I wore compression stockings as a precaution, but on our return both my legs were terrible sore and the surface veins very enlarged, two smaller ones had burst. My legs are still very painful and feel heavy I immediately stopped using the patch, but dont know where to go from here.In the meantime I am applying Venevine Intensive (Leg vein Health )Cream and I’m taking 1 capsule of the same product containing Butcher’s Broom & Horse Chestnut & red vine leaf extract , daily.My Dad suffered a fatal Cerebrovascular accident at the age of 49 and my moher had vascular thrombosis and died of a Pulmonary embolism at age 71Please advise

Susan Garnett | 12:47 am, August 30th, 2012

I am 61 years of age and my GP has recently taken me off Cyclogest pessaries which helped with the menopause. I also use Gynest cream 2-3 times per week. All the usual menopause symptoms have come back much to my surprise! Would Serenity or 20-1 help me please? Do I need a hormone check. Do I need to let the Cyclogest get out of my system. Your help would be very much appreciated.

wellsprings | 9:35 am, June 25th, 2012

You can certainly balance with Serenity bioidentical progesterone cream or switch to 20-1 which combines progesterone with two natural oestrogens. You may find the following article by Dr Dach to be helpful:

debbie | 1:02 pm, June 24th, 2012

Hi, I had a hysterectomy 8 years ago leaving one ovary intact but now at age 53 following the onset of hot flushes, night sweats and other classic symptoms have been diagnosed as well into menopause and started taking 0.625mg of premain 6 months ago which has helped with these symptoms. I am however, worried about the continued or long term issues of taking oestregen and am seeking advise on either scaling this down/cutting out or “balancing” with something else?

kiara | 4:20 pm, June 4th, 2012

Thankyou so much for all your help.

AnnA Rushton | 7:05 pm, June 3rd, 2012

You may also want to get your testosterone levels checked Kiara as that may account for the increase in facial hair

kiara | 3:07 am, June 3rd, 2012

Thankyou for your reply and I will have a saliva test done….why also am I growing a mow and have facial fluff…grrr!!!

Dr Tony Coope | 5:29 pm, June 1st, 2012

Kiara: your symptoms suggest you have progressed from a low-progesterone picture, probably with normal estrogen levels, to a mixed one in which both hormones are low.
You would be very unlikely to ‘overdose’ on the 20:1 cream, and you may need some extra vaginal estrogen, but as this is somewhat complicated I would recommend you to have a salivary hormone profile done to clarify the present situation before starting the cream. This will make getting the balance right much easier in the future. I can arrange this for you if that is helpful; if it is, you can send your contact details to

kiara kumeroa | 12:18 pm, May 31st, 2012

I want to add that I kept my ovaries

kiara kumeroa | 11:51 am, May 31st, 2012

I had a hysterectomy when I was 41 yrs…I am now 57…I had a fybroid tumor. I have had hot flashes, night sweats, emotional challenges and now dry vagina and absolutely no libido..this has caused me to talk to my doctor who minimises my symtoms as nothing to be concerned about…..grrr…so I found Serinity…I did try it about a year ago and found i still had hot flashes and night sweats and also got tender breasts and they swelled….I have recently ordered the 20-1 serenity and am yet to try it out…Should I be getting a saliva test before I use any of this?? is there a possibility of me overdosing on eostrogen???

So want my libido to rock again…Desperate…
Cheers Kiara

Dr Tony Coope | 12:06 am, May 2nd, 2012

Margaret: I’m having to make a few assumptions here, but I’m very happy to go through this with you in more detail if that would be helpful (e-mail:
I agree with your sister, for the following reasons. if you had the Mirena coil fitted to reduce premenopausal heavy bleeding (fibroids?), this would suggest that your progesterone levels had been low for many years, which would increase your risk of depression or emotional fragility. If it was for contraception, then you do not need it now. The problem is that you have been put on Premarin (conjugated estrogens only) and need a progestogen to oppose/balance any risks associated with that. The synthetic progestin in the coil is designed to act locally and is not a good choice to fulfill that function; it is also known in some women to worsen pre-existing depression or emotional problems, and interfere with regular sleep patterns; – is it possible that this is what has happened to you?
Lastly, as you have a family history of breast cancer, ineffectively balanced estrogens are definitely not a good idea.
The good news is that the solution is relatively simple. I would have the coil taken out asap, which could have surprisingly beneficial effects on sleep and mood. I would stay on the Premarin for the moment as cover for the hot flushes and night sweats, and start on a double dose of progesterone cream (1/4 of a teaspoon twice daily) until you stabilise. Then when you feel ready, weeks or even several months later, you can cut to half that dose and start to reduce the estrogen tablets to see what dose you actually need, if at all.
You may well need some guidance and support in all this, so do let me know if you do not have access to that.

Dr Tony Coope | 10:50 pm, May 1st, 2012

Kate: because bioidentical progesterone is safe, has many potential benefits, and is protective against estrogen-dependent cancers (breast, womb and ovaries), it would be best to use it in the standard dose of 1/8th of a teaspoon twice daily, three weeks on, one week off. There is no need to be concerned about keeping the dosage down to the minimum while you are also on the Evorel patches.

Margaret | 12:43 pm, May 1st, 2012

Sorry that comment should have read should not instead of should

Margaret | 12:41 pm, May 1st, 2012

I wonder if you could offer some advice please. I am 53 and have been on Premarin 0.3mg for the last four years and have a marina coil in place almost seven years. The reason I went on hrt was the extreme mood swings, hot flushes and night sweats. I woul like to come off the tablets and have the coil removed but don’t know what to do. My older sister has breast cancer and says I should be on them. My health mentally is not great and I take sleeping tablets also. Any advise would be appreciated.

Kate | 12:28 pm, May 1st, 2012

Thankyou for your reply concerning everol patches. I would like to take your advice and use a 25mcg Evorel (estradiol only patch) along with bioidentical progesterone. I have been on Kliovance conti in the recent past and only a bit nauseated. However at the end of second packet and during the third packet I started to bleed on three occasions. Would you recommend a really low dosage of bioidentical progesterone (Lower than 25mg patch).

Dr Tony Coope | 10:10 pm, April 30th, 2012

Kate: it appears that Evorel Conti patches only come in the 50 microgram strength. There is no reason why you should not cut the patches in half, – this would give you a dosage of 50 mcg estradiol and 85 mcg of norethisterone (synthetic progestogen) per 24 hours.
However, I would be happier if you used an Evorel (estradiol only) patch, which IS available in a 25mcg strength, and replaced the synthetic progestin with bioidentical progesterone. This would give you the same or greater benefit with a much lower risk of side effects.

Kate | 5:12 pm, April 30th, 2012

Can you get everol conti in a 25mcg patches. If not is it okay to half everol conti 50mcg patches.

wellsprings | 3:22 pm, April 29th, 2012

Anita – there is no need to wait at all you can start with Serenity immediately. You will find information on application and dosage plus other questions here:

Anita | 3:02 pm, April 29th, 2012

Hello Dr. : after 5 horrifying months of HRT (combination estradiol and levonorgestrel) I weaned myself off in one month and dispensed of it completely 3 days ago. it caused extreme fatigue, joint pains stiffness and messed up my thyroid and adrenals so badly I suffered constant hair shedding , droopy eyelids double bags under eyes,and low body temperature. within days of cutting the patch in half I started to improve yet the doctors insisted nothing was wrong and the blood tests showed “normal” tsh levels…anyway, I am on the mend now, and I can feel the hot flashes creeping up on me already, although they are not yet “full blown” . how long (days/weeks) must I wait before trying Serenity progesterone cream?

Dr Tony Coope | 12:42 pm, April 6th, 2012

Pauline: this is a slightly tricky one, as Premique consists of both conjugated estrogens and a synthetic progestogen in the one tablet. Ideally you would replace the progestogen with the progesterone cream (Serenity) at the start, leaving you to gradually reduce the estrogen component over time according to the degree of withdrawal symptoms you may experience. This is not possible here, but a neat solution would be to stop the Premique and immediately replace it with the Serenity cream, with the addition of Premarin 0.625mg tablets, which contain only conjugated estrogens at the same dose. You can then take as long as you need to reduce the estrogen, while continuing with the progesterone.
If you find difficulty in obtaining a prescription for Premarin, you could start the Serenity and then gradually reduce the Premique as you describe. The only potential downside to this is that the synthetic progestogen and the progesterone in Serenity will be competing for the same receptor sites, possibly interfering with the full effect of the progesterone. This will lessen, however, as you increasingly wean yourself off the Premique.

Pauline | 11:18 pm, April 5th, 2012


I am taking Premique 0.625mg/5mg 28 day continuously and have been on HRT for approx 20 years and am61 years of age. I would like to come off it and if I were to take one tablet every other day to wean myself off, when should I start taking the serenity cream. Should I wait for a month or two or can I start it almost straight away to replace slowly what I will be missing when I stop HRT completely. If possible I dont want to be without the progesterone and so could start taking the serenity cream to replace or top up what I will be losing with the reduced HRT.
Thank you for your help


Thank you for your help and advice

Dr Tony Coope | 4:14 pm, March 23rd, 2012

Chris B: Usually progesterone tends towards the opposite, as it supports thyroid function, and also acts as a diuretic, encouraging the excretion of excess fluid from the body. In the USA Dr CW Randolf has written a whole book, (‘From Belly Fat to Belly Flat’), about the ways this hormone can contribute to weight loss. So, as from your history it seems likely that you have in the past had a prolonged depletion of progesterone, I wouldn’t follow the impulse to discontinue it.
The only theoretical way that it could in certain circumstances cause weight gain is if it sensitizes estrogen receptors, which then respond more actively to estrogen already present, increasing fluid retention and interfering with optimum thyroid function, the opposite effect of progesterone itself.
A more fruitful approach might be to look at the possibility of lowered thyroid function, and also whether you have a degree of insulin resistance, either of which can make taking off the pounds extremely difficult. A mild degree of each of these, plus a history of stress leading to adrenal fatigue and some hormone disruption (the stress hormone cortisol is made from progesterone) is difficult to diagnose using compartmented mainstream thinking, but exists in the population in seriously large numbers.
Let me know if you need further information on this.

Chris B. | 1:27 pm, March 20th, 2012

Hi, i had a partial hysterectomy when i was 36 and now i am 44. I am currently on 50mg on bio-identical progesterone cream. I feel better but i have been dieting and exercising non stop and cannot lose a pound. I was thinking of weaning myself off the cream but dont know how. Doctor is not very helpful. Do you think the cream is causing me not to lose any weight. Just would like to have a different opinion..Thanks

wellsprings | 9:08 am, March 8th, 2012

Jeanne – we believe that cenestin is a combination of 9 synthetic oestrogens and oestrogen use is linked to an increased risk for cancer and strokes.

Current medical advice is that oestrogen is not suitable for women with any history of breast cancer and that if it is prescribed it should be used at the lowest effective dose and for the shortest amount of time.

Women after a hysterectomy do need progesterone to balance their hormones, protect from strokes and strengthen their bones so we suggest you discuss this again with your doctor and ask for what specifically you are still taking this medication.

You will find a number of articles here that will give you more information and in particular this one may be relevant for you:

Jeanne G | 9:46 pm, March 7th, 2012

Have been taking cenestin for approx. 15 years (.3) Had a total hysterectomy 25 years ago, had breast cancer, Stage 1 with radiation and lumpectomy in1990. My doctor says I should continue with the cenestin, even though everything I read points to discontinuing it. I am 79 years old – look and feel years younger. What to do???

wellsprings | 8:59 am, March 5th, 2012

Fatima – based on the symptoms you describe – which are those of oestrogen dominance – then Serenity would be the best place to start rebalancing your hormones. Generally most women find that progesterone alone is sufficient to control their symptoms and only switch to 20-1 with its added natural oestrogens if they have a specific need for oestrogen related symptoms or their flushes are not sufficiently controlled by Serenity alone.

You will find articles by experts in natural hormone usage and prescribing on the site, and these two might be most helpful to you:

You can also visit our Facebook page for comments and support from other users of Serenity:

Fatima Sindhi | 9:30 pm, March 4th, 2012

Hi, I am 52 years old and I have just entered menopause and stopped menstruating just over a year ago. I had a ligation 17 years ago when my last child was born. I decided to visit my doctor since i am now getting hot flushes and mood swings. My ovaries are still intact and so my doctor prescribed Evorel Conti patches. I have just used it for a month and gained 4kgs. I have now stopped and would like start natural treatment. Please help coz the night sweats become unbearable sometimes.

wellsprings | 3:23 pm, February 5th, 2012

Linda – as you will have from the article it is best to reduce gradually as you have been doing and you do also need to rebalance your hormones with bioidentical natural progesterone. Progesterone provides protection for your bones and to prevent heart disease and balances oestrogen dominance. You might find it interesting to also read these articles by Dame Dr Shirley Bond and Dr David Zava: and and finally this one too

Linda | 2:50 pm, February 5th, 2012

I had a complete hysterectomy for endometriosis and pelvic congestion among other things 33 years ago when I was 27. I originally started on HRT of Ogen and then went to patch, then back to generic Ogen. I am on the lowest dose available and have for the last 3 weeks been cutting the tablets in half. I want to get off of the HRT but have noticed that I have a low grade headache almost constantly with occasional stronger ones. I assume this is because of the reduction in HRT. I haven’t noticed any other “temperature” issues, maybe a bit more waking up in the middle of the night. Are there natural herbs or remedies that can help with the side effects that will be coming?

Dr Tony Coope | 5:55 pm, January 23rd, 2012

Ronda: you may well be suffering from symptoms that have a more complex cause than is often the case. If your hysterectomy was for heavy bleeding and/or fibroids, it is likely you have had longstanding ‘estrogen dominance’, – a relative deficiency of progesterone in relation to estrogen, even if your estrogen levels were in the normal range. In this latter case your post-hysterectomy symptoms would not be too severe.
Then you are put on a high-dose estrogen patch; when you try to reduce your dose of Evorel, you experience the estrogen withdrawal symptoms of night sweats etc. This acute phase may subside, but I believe these symptoms in the longer term are not just about estrogen, but about hormone balance as well as other factors such as stress and unresolved emotional issues.
Given your history, you will need progesterone as part of the solution, and of course many doctors, as yours has, follow the mainstream guidelines that women having had a hysterectomy only need estrogen. If they do prescribe a progestogen, it will be a synthetic version that only addresses a part of what you need, and also has some risks attached, unlike bioidentical progesterone.
it is possible that the Wellsprings 20:1 combined cream might help, although it only has a small percentage of estrogen. The most likely successful combination for you, in my mind, could be a combination of a lower-strength estrogen patch with progesterone cream.

Ronda | 10:18 am, January 23rd, 2012

Hi I had a full hysterectomy 8years ago and commenced Evorel 100 patches 6weeks after my operation. Three months ago I requested for them to be cut down due the the side effects of taking HRT long term. The first few weeks I felt ok but now I am develoding symptoms headaches night sweats and a bit PMT like symptoms. Is there something I can add in to reduce these symptoms? I was hoping to cut down to Evorel 25 but I dont think I am ready due to the symptoms I am having now .

pamela | 9:38 pm, September 21st, 2011

I do that already…I workout five days a week and with a great personal trainer. It is a tough weight…it is holding on for dear life. I think the only answer it to stop HRT and deal with the symptoms

Dr Tony Coope | 9:37 pm, September 21st, 2011

Pamela: if it was on standard HRT (with a synthetic progestin) that you put on weight, then switching to your present regime (especially without the estrogen) should increase your likelihood of reversing this trend.
If you have been gaining weight on this second regime, omitting the estrogen may help, but it is worth considering other factors:
1. How much stress have you been under, and for how long, and how much carbohydrate does your diet contain? Stress always releases glucose into the bloodstream as part of the ‘fight or flight’ response. If this is not quickly used up, the pancreas has to secrete insulin to remove it. In chronic stress this can lead over time to ‘insulin resistance’ with persistently high levels of insulin in the blood, which means that a high proportion of carbohydrate is immediately converted into fat, making it very difficult to lose weight. A diet high in carbohydrates (especially those with a high glycaemic index which are absorbed rapidly into the bloodstream) will exacerbate this. Chronic stress also causes more progesterone to be converted into the stress hormone cortisol, denying the body some of the the former’s benefits , and increasing the deposition of fat in the abdominal area.
2. Have you had your thyroid function checked? An underactive gland, even moderately, can have a significant effect on your weight.
3. Have you a past history of symptoms of estrogen dominance? An extended period on the contraceptive pill or standard HRT can also lead to a progesterone/estrogen imbalance, which tends to encourage fat deposition on the
hips and thighs.
Dr Tony Coope

wellsprings | 4:29 pm, September 21st, 2011

It is common to put weight on in those areas at menopause and the best advice is a good diet and exercise targeted to those specific areas – wish we had an easier answer for you.

Pamela | 3:29 pm, September 21st, 2011

Just was wondering what I can do to lose the belly, thigh and hip fat that has been gained while on hormone replacement. I am on Progesterone, Testosterone and was on Estrogen for a very short time, but no longer take Estrogen. Any help will be appreciated.

Dr Tony Coope | 10:22 am, July 8th, 2011

Barbara: this isn’t quite comparing like with like, as Vagifem (estradiol) vaginal tablets are used specifically for the treatment of vaginal atrophy, having a mainly local action, while estradiol patches have a more general application, the hormone being absorbed and distributed throughout the body via the circulation. It is never quite so clear-cut, however, as the patches often help the VA, the cell receptors there taking up some estrogen from the bloodstream, and a small proportion of the estrogen used vaginally will also find its way into the general circulation, occasionally having some effect on hot flushes, etc.
For practical purposes, Vagifem can be considered very safe, although I prefer to use Gynest (estriol cream or pessaries), which is a much weaker estrogen and is therefore used in greater volume, helpful in reaching the entire surface area of the vagina.
Bioidentical progesterone can be used with either local or general estrogen therapy, and adds another dimension of safety.
Which combination you should use depends on whether your menopausal symptoms are general or local, or both, and what your progesterone/estrogen levels are (it would be helpful to have a 1-day saliva test to establish this).
Lastly, one has to consider hormonal deficiencies or imbalances in the context of other illnesses present. I find that many women with chronic fatigue and related syndromes have depleted adrenal and thyroid function. This often has to be addressed before the hormone problem can be fully resolved; (if you would like further info on this, e-mail me at

Barbara | 5:45 pm, July 7th, 2011

Hi: Is Vagifem safer to use vs. the combination of estradiol patches (Vivelle .025, changing 2x week) + progesterone cream (1 ml. every night)? I am 64 yrs. old and have CFS (chronic fatigue syndrome), fibromyalgia, and IBS. Thanks.

Dr Tony Coope | 11:32 pm, June 11th, 2011

Carol: this situation may be more complicated than it needs to be. I am not clear as to whether you are still using the FemSeven Conti (in reducing doses) at the same time as the Evorel 25 patches and the progesterone cream, or whether you have replaced them with the Evorel.
If it is the first option, and you are using both patches with the progesterone cream, then there are two potential problems:
Firstly, that of again increasing your exposure to estrogen, and secondly, that the synthetic progestogen (levonorgestrel) in the FemSeven will compete for your cell receptor sites with the bioidentical progesterone, reducing the latter’s beneficial effects.
If it is the second option, this is logical and efficient, as the Evorel patch releases 25mcg per 24 hrs, half the dose of the FemSeven, and no progestogen, which is replaced by the progesterone cream, thereby ensuring a smooth transition.
I would suggest continuing with the progesterone, in a cycle of 3 weeks on/1 week off; using the Evorel patches continuously but cutting these down as you are able according to the level of symptoms; and dispensing with the FemSeven patches altogether.

At some point it could be helpful to have a saliva test for estrogen and progesterone to establish your balance of these hormones.

Carol | 7:07 pm, June 7th, 2011

I’m 60years old and for the past nine years have been onFemSeven Conti.I suffered vey much with vaginal dryness and cystitis,but have been advised to come off hrt now due to increased risk of breast cancer.I have cut my patch down now to a quarter after 4 months and have had a few problems back again.My doctor has prescribed vagifem which have helped and i have ordered a jar of natural progesterone.My doctor has also prescribed 2months of Evorel25 to use with the progesterone while I wean myself off my FemSeven.Am I to use the patches and progesterone continuously or to have a break of 7days a month,many thanks Carol

Dr Tony Coope | 8:54 pm, May 29th, 2011

Paulette: this is a very unfortunate story; your original symptoms, infertility and subsequent events strongly suggest that you were suffering from low progesterone levels . Then later, although the CES damped down the potential estrogen-deficiency symptoms resulting from the removal of your ovaries, these are now emerging as you come off the HRT and can continue for a distressingly long time.
Although it is a good idea to come off the CES in due course, you shouldn’t have to go ‘cold turkey’, and I think it’s important to establish accurately your present progesterone and estrogen levels. You may in fact need both, and it is helpful to know where you are starting from!
Also, unless you have been remarkably calm about all you have experienced, the accumulated stress may have over time depleted your adrenal, and perhaps thyroid functions, increasing your hormonal problems.
If you are unable to find a doctor in your area who understands the biochemical basis of your problems, (not all endocrinologists and gynaecologists seem to think in these terms), it should not be difficult to sort this out via a telephone consultation (and a test or two if necessary) and have you return to a state of well-being you have probably forgotten is possible. I would be happy to go through this with you if you would like.

Paulette | 7:47 pm, May 22nd, 2011

I had a total (ovaries gone) hysterectomy at 35, I’m now 51. I had menstrual problems (heavy bleeding requiring 8 D&C’s over the years, long periods without a period, fertility problems – requiring a specialist’s help of laser surgery on my ovaries combined with Clomid to successfully conceive) my entire life. I was put on CES (conjugated estrogens) at the time of my hysterectomy and my Dr is now suggesting that I slowly taper off it. Only several days into a routine of taking the CES every second day, I’m already feeling ‘off’. Nauseous, dizzy at times. I’m worried this is going to be a nightmare! My GP is clearly not tuned in to the effects of hormones in the body as he passed this off as being no big deal. I’m beginning to realize it very well might be. We live in a small town however, with my options for treatment being limited. I know my hormones have been out of whack forever, so I’m wondering if I should be getting more specialized care, or just continue with this taper off plan and deal with its effects as best I can on my own.
Thank you for any suggestions you may have!

Dr Tony Coope | 3:20 pm, March 31st, 2011

Marilyn: your regime of supplements and the slow weaning-off your HRT should certainly reduce the likelihood of symptoms, which are often associated with too-rapid changes in hormone levels.
However, there are other factors involved. There seems to be a correlation between the appearance of symptoms at and after menopause and the experiencing of problems at the menarche (the original onset of menstruation), premenstrually, or after birth (the baby blues). I have written about this and its connection with trauma in childhood and adolescence in an earlier article on this site (‘The Menopause: Golden Opportunity or Last Chance Saloon?’). Having a previous history at one of these times makes it more likely, but not inevitable, that a woman will have symptoms later at menopause.

Also, a total hysterectomy is often the consequence of problems related to long-term hormone imbalance, (frequently the syndrome known as ‘estrogen dominance’). If your progesterone has been persistently low, the effects may emerge when you tail off HRT, even though they may have been masked (paradoxically) by the conjugated estrogens of the Cenestin.

Hopefully, all will be well. If you do develop symptoms, however, it would be worth checking your estrogen/progesterone balance via a saliva test.

marilyn rosado | 4:59 pm, March 27th, 2011

Dear Drs.,
I had a total abdominal hysterectomy 10 years ago and have been on cenestin 0.3% since. So far, all is okay. However, I want to wean off the medicine entirely and just recently have begun a tapering regimen of 1/2 tablet daily for a month, then every 2 days for a month and so on. For years I have been taking calcium plus D, Omega 3, Flaxseed oil, B-complex, Magnesium and a Multivitamin daily. I also take 12.5mg for HBP (everyone in my family has it). I also do 30 minutes cardio daily with weight lifting 5-6 days a week. Do you think that with these supplements I will be okay without the HRT. I do not want any form of HRT once I have tapered off over the next 5 months.

I appreciate any response.

Dr Tony Coope | 8:59 pm, January 20th, 2011

Cheryl: whatever the reasons for your hysterectomy, it is odds-on that you have had an imbalance in your estrogen/progesterone ratio for many years prior to this. Leslie is right in saying that the condition of ‘estrogen dominance’ is still not well recognised by the medical mainstream. I wouldn’t go so far as to say ‘most’ women (or men) are estrogen dominant, but it is certainly very common, and should be suspected wherever there are persistent heavy periods, PMS, fibroids, difficulties in conception, recurrent miscarriages, breast and ovarian cysts, to mention but a few.
In this context she is also right in saying that adding more estrogen is not a good thing without the balance of bio-identical progesterone, which may be all you need in any case.

I think it would be best for you to find a doctor who can establish the truth of your situation rather than self-medicate here, – it could save you difficulties later on. I would be happy to go through this with you if you would like, – just e-mail me at

Leslie | 4:45 am, January 19th, 2011

Cheryl if you research Premarin on the Internet you will find it is very controversial – and has many adverse side effects. I am sure Dr. Coope can address this with bioidentical hormones.

In 2002, the Women’s Health Initiative reported on the results of the first independent study of HRT and they realized the risks to women’s health outweighed the benefits. This was after HRT was on the market for 30 years.

Unfortunately, too many health professionals are not aware of this. Most women and men are estrogen dominant and adding more estrogen through Premarin may cause cellular overgrowth which is not a good thing. Also research ‘estrogen dominance.’ You have come this far…keep doing the research. You will find your answers. I have many articles about HRT on my blog at

Cheryl Jackson | 3:00 am, January 19th, 2011

I am 44 and just had a total hysterectomy 2 weeks ago. My doctor put me on premarin. We did not discuss hormone options before the surgery so I am taking them. I would like to be on something natural. What would you suggest I do? I any help is greatly appreciated. Thanks, Cheryl

Dr Tony Coope | 11:44 am, January 13th, 2011

Sally: Even if you were to go onto a combined HRT, with the added synthetic progestin giving you a protection factor by ‘opposing’ the estrogen, it also brings its own potential problems (increased risk of cancer, cardiovascular disease and blood clots) as well as a tendency to depression in vulnerable women. This would be one step forward, at least three back.
Bio-identical progesterone would be a much safer option with its own positive benefits, even if you were to stay on the estradiol. However, a good option for you might be to replace this with the safer estrogen in a combined 20:1 ratio progesterone/estrogen cream that is now available.
I am happy to provide this for you, but would first need to talk through your history with you to assess whether this is the best course of action. If you would like to do this, just e-mail me a telephone number to and I will contact you.

Sally | 12:07 pm, January 11th, 2011

Very interesting article! I had a full hysterectomy when i was 32 and am now 50. I dont want to stop taking HRT (i use Fematrix 40 patches or Sandrena Gel depending on what im doing – they both contain estradiol). I really like the idea of changing to bio-identical HRT but where do i go to get it? I am also wondering if i should be going back to my doctor and discussting whether i would be better off using a combined HRT. If you think this may be the case could you suggest how i should explain to my doctor why and the benefit to myself (if any). Many thanks, your articles are always informative and helpful.

Dr Tony Coope | 5:23 pm, January 10th, 2011

Leslie: thank you for your kind comment, and for your question, which is an important one.
The simple answer is yes, as the word ‘natural’ is often used as an easier alternative to ‘bio-identical’. However, the former has a much less specific meaning. It can (rightly in this case) be thought of as meaning natural to the body, and therefore bio-identical. Or as meaning ‘of nature’, with the implication of being good for you; however hawthorn berries and certain exotic species of mushrooms are natural in this way, but I hope you wouldn’t try adding them to your diet!
Closer to our subject, the commonly used HRT Premarin (prepared from pregnant mare’s urine, and containing a mixture of estrogens) can be said to be natural, but the constituents used are natural to horses and not necessarily to humans, which gives rise to the potential for side effects.

The word ‘bio-identical’ in this context is very specific, meaning ‘of an identical molecular structure to the hormones found in the human body’. For reasons which I will go into in my next article on this site, concerning confusion in the use of the words ‘progesterone’, ‘progestogen’ and ‘progestin’, this greatly reduces the risk of unwanted side effects. This holds whether the hormone is ‘natural’, synthetic, or a mixture of the two. An example of this last is the hormone we know as natural progesterone, which is in fact derived from natural plant-based sources such as soy or wild yam, but is altered in the laboratory to conform identically with the human molecule. Therefore, although it can be said to be both ‘natural’ and ‘synthetic’, the important thing is that it is definitely bio-identical.

Leslie | 11:35 pm, January 6th, 2011

Thank you for this great article. Question: when you are referring to bio-identical progesterone – do you mean natural progesterone?

About Us
Contact Us
The Team
Terms of Use  © 
Learn more about Serenity Natural Progesterone Cream Learn more about Serenity Natural Progesterone Cream