By Carol Scurfield, MD
New information about the risks and benefits of hormone therapy (also called Hormone Replacement Therapy or HRT) has many women asking how to safely stop taking the hormones they have been prescribed for their menopausal symptoms.
Most women who are on hormones therapy are taking two hormones: a form of estrogen and a form of progesterone. Women who no longer have a uterus are usually only on estrogen.
It is generally better to gradually wean off hormones rather than stopping abruptly, especially if you have been taking them for more than a few months. Stopping suddenly is not dangerous, but you may be uncomfortable while your body adjusts to new lower natural hormone levels. It is best to work with the doctor who prescribed your medication to create a plan that is best for your situation.
Some common scenarios are:
Situation 1: I'm on estrogen and progesterone pills every day
Get lower strength pills and begin alternating your regular dose one day with the lower dose the next day for about a month. Then take only the lower dose pills daily for the next month. The last step is to start taking only the lower dose pill, every second day only for a month or so. Then stop taking the pills completely or take one pill every three days if you feel you still need some hormones.
How quickly you get through the steps depends on how your body reacts to the changing hormone levels. You can expect some hot flashes as you go through the steps. They should be tolerable if you don't come off the hormones too quickly.
You may need to go slower if you are having a lot of hot flashes when you move down a step. If this happens, go back up to the higher dose and try reducing the dose again in another week or so.
Some women taking pills switch to an estrogen gel because it is easier to control changing the dose. See situation 3.
Situation 2: I take estrogen pills every day and progesterone for part of the month
Gradually start reducing your dose of estrogen as described above. Once you have finished the estrogen, take two weeks of progesterone and you should be done.
You may have some bleeding as you are finishing the progesterone or shortly after you stop. The bleeding should be like a normal period.
Situation 3: I use the estrogen patch and progesterone pills
To begin weaning, patch users can simply stop wearing the patch every day. When you would normally put on a new patch, delay putting it on for one or two days so your body has some time without the hormones. Eventually you will not be wearing a patch at all.
Some women cut their patches in half to wean themselves off hormones. This will not work with all patches so talk to your doctor if you want to try this. Using a lower dose patch may be a better way to do it.
You could also get a prescription for estrogen gel and slowly reduce the amount you apply each day. The estrogen gel offers an advantage - if you are having a lot of hot flashes in a day, you can apply a little more gel that day. Gradually lowering your dose can help minimize your discomfort.
Once you have finished the estrogen, you should take a course of progesterone to ensure your uterus is empty.
Weaning yourself off hormones comfortably is possible. It may take a little time and effort as you explore other ways to deal with the changes menopause brings. It may be helpful to remember that menopause is not an illness but a natural life transition that is different for each of us.
Good luck!
Dr. Carol Scurfield is a member of the advisory board for AFI, and is a family physician working at the Women's Health Clinic, Winnipeg, Manitoba.
This article first appeared in A
Friend Indeed (Mar/Apr 2003), the newsletter for women in menopause
and midlife.
Reviewed June 2006.
