All You Need To Know If Quitting HRT
With the increasing data available on the health hazards of HRT, particularly long-term, many more women are considering coming off it but can be unsure of what is involved. I am an experienced practitioner in the use of bio-identical natural hormone and this question comes up frequently from womening wanting to come off HRT, but unsure how to do so. I hope this timely advice and simple suggestions will show you the best and least stressful way to do it.
Research has confirmed that bio-identical hormones are safer than and superior to their synthetic counterparts. In my own practice it has been my experience that women respond positively. 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 'estrogen dominance').Others have had no such problems, but are uneasy about the accumulating evidence.
Women who have previously been put on HRT for either osteoporosis or menopausal symptoms can be faced with a difficult decision. They may be uncertain of the effectiveness of the alternatives, and unsure of how to change from one to the other. Their GP may be have limited knowledge of these, or even be actively against them. What to do?
Types of HRT:
Because there are so many different forms of synthetic HRT, it can be somewhat discouraging to women wanting to make the switch. Just to clarify, the main type of HRT are:
1. Continuous combined HRT; where either a tablet or patch containing both estrogen and progestogen (progestin) is used straight through a repeated 28 day cycle.
2. Sequential combined HRT where an estrogen patch or tablet is used to cover the 28 days of a cycle, and a progestogen (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.
3. Estrogen alone HRT as either patch or tablet continuously, or an implant prescribed for women who have had a hysterectomy. Many experts now believe, however, that these women should be given the same protection as those with an intact uterus, as 'unopposed' estrogen has an unwanted effect also on sensitive breast and ovarian tissues.
Practical considerations:
It is really not as difficult as it may seem , no matter what type of HRT you are taking. The key element here is to ensure you start using bio-identical progesterone straight away, if the HRT is estrogen only, but if it is a combination type then you need to stop the synthetic progestogen element and replace it with progesterone. This can usually be done over a single cycle of 28 days, and significantly reduces both the cancer risk and that of cardiovascular events such as heart disease, stroke and blood clots. As a bonus, you may also find that your sense of well-being, mood and energy levels all improve. It is entirely possible to use spare estrogen patches or tablets from the following month's supply to cover the full 28 days, if you need to replace the combined form in the second 14.
Many women can 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, and either cutting down the patches or taping under the gel type to reduce their surface area in contact with the skin.
Once the situation is stable, attention can then be given to reducing or replacing the estrogen component. As bio-identical progesterone can be converted into estrogen in the body, this may be an added source, and women who have been deficient in progesterone may also not need additional estrogen 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 estrogen cream, or a bio-identical combination cream containing both progesterone and estrogen. You could also consider phytoestrogens, supported by Vitamin E, omega fatty acids and a regime of bone support, which has received a positive boost in the addition of progesterone itself.
Whatever you decide, I hope your journey through menopause is as healthy and straightforward as possible.
About the Author
Dr Tony Coope left general practice after over twenty years experience, before which he spent four years as a hospital doctor. He has an Integrated Medical approach including the use of nutritional supplements, bio-identical hormones, botanicals and homeopathy. He is a regular contributor on all aspects of hormonal health on the information website http://www.bio-hormone-health.com
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