A Twitter friend recently asked me about stopping hormone replacement therapy (HRT). It was a question that I hadn’t explored on this blog. Although the foundation of Flashfree is to provide information about alternatives to HRT, I’ve never really considered the “what now” of the issue, as in, what if you decide to go off hormones or try alternatives after you’ve been on HRT? So this post is dedicated to her, and to those of you who want to know if there is a safe and effective way that HRT should be stopped.
Interestingly, when I looked into the issue, the answer seemed to be even less clearcut than the therapy. In fact, there are no guidelines for stopping HRT. To be honest, this disturbs me quite a bit; don’t you believe that if a physician is going to recommend that you take hormones, that he or she should have some clear guidelines as to how to take you off of them? Granted, until the Women’s Health Initiative started to reveal the dangers and risks of HRT, there was no real reason to stop therapy, (although, I’m of the mindset that there’s really no good reason to start HRT).
Fortunately, researchers are finally starting to look into this issue although study findings (which are published in the online edition of Menopause) highlight that the practice of stopping HRT is intuitive and not evidence-based.
So, what did they learn?
Among 438 group practice physicians surveyed, an overwhelming majority believed that women should taper HRT, with most believing that the best strategy was not only to slowly decrease the dose, but also to reduce the number of days HRT was taken per week. However, they had no suggestions with regards to how to taper use of HRT patches, even though the patch is increasingly being recommended and touted as a safe solution to oral hormone therapy. (Notably, like the evidence from this particular study I am talking about, the evidence that shows the safety aspect of the HRT patch is mostly observational, meaning that it is subject to personal bias.)
More interesting, however, was the finding that the majority of the physicians who participated in the study were more strongly influenced by their personal beliefs than by colleagues’ actions or most importantly, by a woman’s preference. In other words, physicians are not asking their patients about what they would like or if they have any thoughts about stopping therapy. More shocking was the fact that only 2% of physicians surveyed relied on actual evidence to stop hormone therapy. Physicians who indicated that they believed that some action should be taken if symptoms returned after stopping hormones overwhelmingly turned to behavioral changes or exercise, not to alternative therapies such as herbs.
In an era of evidence-based medicine and strategies that integrate eastern and western philosophies, why are our physicians relying on their own personal belief systems rather than real facts? Why aren’t they asking their patients how they feel about stopping therapy or if they have fears about symptoms returning and then thoroughly exploring alternatives with them. Are these findings in a vacuum or will they be found on a broader basis? Does the problem lie in fact that there are no standards? What’s more, why hasn’t the American Medical Association or American College of Obstetrics & Gynecology devised guidelines for stopping HRT therapy? Why hasn’t the Food & Drug Administration demanded this guidance in labeling?
Finally, why do we continue to play Russian Roulette when it comes to women’s health? Isn’t it time for a change?
Let’s start with HRT. There are a lot of folks out there who continue to espouse the benefits, deny the risks and ignore the facts. Clearly, this story continues to unfold. Unsafe medical practices are even more unsafe when they are not backed by evidence, right? Is HRT the exception? What do you think?
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- Wednesday Bubble: HRT – wait a moment! « Flashfree - [...] in early May, I wrote a post about the difficulties in stopping hormone replacement therapy (HRT) and the disturbing…
- HRT and breast cancer – more red flags « Flashfree - [...] more, be aware that once you start taking hormones, your practitioner might not be able to provide evidenced-based information…
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I’ve been pondering this question for over a year. During my last annual visit w/my doc, she never seemed to answer the question of HOW I can come off HRT only asked why I’d want to. Here I am a year later still on them. Perhaps she doesn’t know how to help me stop these drugs.
I’m ready and have contacted my acupuncturist to see if she has any thoughts on
helping me off these. I’m ready to find natural treatment, my symptoms are long gone. If you are brave enough to google for answers, don’t. The symptom, side effect lists are scary.
Thanks to Liz for this post; I’m so grateful!
Susan – thanks for your comment and candor. I think that this issue is critical and I hope that by bringing attention to it, we can spark some interest among the ‘powers that be’ to take action.
Hi Liz
I’m surprised you don’t bring up bio-identical HRT, which is basically a drug-free alternative to bringing your hormones into balance. I swear by it. It’s becoming quite mainstream, as well. I strongly recommend you read Suzanne Somers books, in particular, The Sexy Years. When you use bio-identical HRTs, and you get the dosage right, there are virtually no side effects.
Jesse (SeptemberMay on Twitter)
But I have! See: http://flashfree.wordpress.com/?s=bioidentical+hormones
I was on HRT for twenty plus years (low dose estrogen), when my Neurologist recommended I discontinue use to see if my headaches would improve. I checked with my GYN who said no problem (via the nurse), so off came the patch. It has been a month and while my headaches are much better, there are other symptoms that have increased. Heart papitations galore, hot flashes galore, some insomia, weakness, and I’m so very tired, even when I do get a good night sleep. Is this normal? I have tried to find information about what to expect coming off HRT cold turkey, but there is very little information to be found. Any advise would be appreciated.
Kathy, I am not a healthcare practitioner so I am not in a position to give advice. However, I will do further research and see what I can find. I’m sorry about the extreme resurgence in symptoms. Have you considered trying anything alternative, such as acupuncture or Chinese herbs?
Ihad my hysterectomy(full)20 years ago and have been on a low dose H.R.T.until 2 months ago when my Dr. suggested that I wean myself off them,at once hot flushes returned, extreme tiredness even after a nights sleep plus headaches etc.So now feel I would rather take any risks involved that put up with the daily awful symptoms not knowing how long it will go on. I was taking one pill a day and am now on one every 9 days. Any advice please?
Hello – I have been on low dose HRT since 1990 (23 years) after a hysterectomy, never had any problems since, very fit, look younger for my years (70 this year). Then registered with new doctor in different area and no way will she prescribe them for me, surely it is my choice if I know the risks. No breast cancer in family history, regular mammograms. Then I stopped taking HRT 3 months ago, have had hot flushes but that doesn’t bother me, think other effects will take time to show. All in all I feel fine,not as get up and go as before.I have osteo arthritis in my hip and am finding I am having more pain with this. Have not put on any weight, I think being on HRT kept me slim. If I want to go back on HRT I think the choice should be mine so would like to know if it is possible to buy HRT if I go privately to a doctor. Any comments welcome. Thanks
Patricia, I cannot offer medical advice. But I would think that a licensed medical professional will not continue to prescribe HRT so that you can remain at your goal weight.
Can you go back on your hormones if you have been off them for a month or so?
Hi Elaine. I am not a medical professional but a medical/health writer. Consequently, I can’t provide medical advice nor replace the advice of a health practitioner. From what I’ve read, there are no guidelines for stopping or restarting HRT. I would recommend that you speak to the person in charge of your care. Thanks so much for your comment and for reading Flashfree.
Best to you.
I had a hysterectomy that left both healthy ovaries intact at age 38. The first 2 years of symptoms beginning age 49 were fairly well controlled by OTC Estroven. Black Cohosh was not enough by itself. I had every symptom possible…sometimes hotflashes that sent sensations of electricity through me and dripping wet then freezing cold when they were done and I had several per hour on some days. After that, nothing was helping.
I tried the bioidentical Progesterone cream you can order online. It worked a few months then it all resumed again. So I went to a friend who is a Pharmacist and she does Custom Compounding. I did the saliva tests and she compounded the estrogen/progesterone cream for me. My hormones were lower than could be measured at that time. It worked almost 4 months before all the symptoms came back. She increased the dose and added Testosterone and DHEA. That worked only a couple more months before the symptoms began to creep back and they are full force again. I requested another saliva test and sent it off this morning. I’m very interested in seeing what the levels are now but concerned about what to do about it when I do have the results. I’m very involved in the decisions as an RN myself. Any ideas are appreciated. Cat
Cat – I am not a physician so I can’t comment specifically on your experience. Nevertheless, it sounds as though your RN offered some sound advice. Until researchers provide more information, we are stuck with trial and error.
I have been on 20mg estradial and 25mg testosterone since I was 35 when I had to have a full hysterectomy. I am now 59 and I can no longer get the implants as they have been discontinued. So I wanted to know if it is okay to just leave it now and not do anything and can I expect any symptoms or anything. Thanks
A
ny advice on weaning off H.R.T.after 20 years will be welcome.