Quitting Hormone Replacement Therapy?

Provided by: DrWeil.com

Q: I'm currently on hormone replacement therapy (HRT) and have been for 10 years. I would like to get off. How do I do this? Do I just quit, or do I need to back it down? -- Terri M.

A: Conventional medical wisdom holds that since you've been on HRT for so long, it would be best to wean yourself off slowly. However, the few studies on this subject suggest that it really doesn't matter whether you go cold turkey or withdraw from the hormones gradually: there seems to be no difference in the incidence of menopausal symptoms that develop as a result.

One study, published in the December 2003 issue of Obstetrics and Gynecology, found that about one-quarter of the women participating were unable to discontinue hormone therapy because of the withdrawal symptoms they experienced.

The women who had the most trouble quitting had begun taking estrogen after a hysterectomy, and had been on it for 10 years or more. Of the women in the study who succeeded in withdrawing from HRT, 71 percent quit abruptly and 29 percent tapered off HRT.

There was no difference in the incidence of menopausal symptoms between the two groups. Another study, published in the May, 2004 issue of the Journal of Women's Health, also found no difference in symptoms between women who quit abruptly and those who tapered off. If you decide to wean yourself off HRT, discuss your plan with your doctor. I suggest cutting back on HRT over the course of two months.

You can do this by taking decreasingly lower doses of estrogens. You're probably taking 0.625 mg of estrogen daily. You want to bring this down to 0.4, then 0.3 mgs daily. Either ask your physician to prescribe lower-dose estrogen or start taking your pills every other day, instead of daily. Continue taking your full dose of progestin whenever you take estrogen. If your HRT prescription is for a pill that combines both hormones, ask your physician for separate prescriptions so that you can slowly lower your estrogen dose.

Once you're off the hormones, you may experience hot flashes, night sweats or mood swings, and within two or three months you're likely to notice vaginal dryness and loss of fullness of your breasts. Hormonal changes can also lead to some temporary hair loss. If vaginal dryness becomes problematical, try Replens, a non-hormonal gel, which should be applied three times a week, or use the lubricant Astroglide at the time of intercourse. Both are available over-the-counter. Alternatively, speak to your physician about prescription estrogen creams that can be applied vaginally or the vaginal ring (Estring) that time-releases estradiol (a natural form of estrogen) daily; the ring has to be replaced every 90 days.

If you were taking HRT to protect against osteoporosis, make sure that you're getting 1,500 mg of calcium daily from your diet and, if necessary, from supplements. Weight-bearing exercise, such as brisk walking, along with strength training can protect your bones. If a bone density test shows that you're at high risk of osteoporosis, you may want to consider taking Fosamax (alendronate sodium), Actonel (risedronate sodium) or Evista (raloxifene), prescription medications that can help strengthen bone.

Many women find relief from hot flashes, night sweats and vaginal dryness by taking black cohosh (Cimifiuga racemosa) plus 800 IUs of vitamin E daily. Alternatives include the supplements dong quai and evening primrose oil, which work for some women. Two to three daily servings of whole soy foods (tofu, tempeh, edamame, and soy milk) will give you some safe plant estrogen (phytoestrogens) that may help relieve symptoms. If these natural approaches don't help, talk to your physician about Effexor (venlafaxine) or other drugs that can relieve hot flashes.
Andrew Weil, MD