There comes a point in every woman’s life, as she gets older, where she will experience many profound changes within herself. This process, called the menopause, is not something that is desired, but it occurs nonetheless – call it an inevitable rite of passage, if you will, preparing you for a new stage in life.
The symptoms associated with menopause include hot flashes, night sweats, fatigue, irritability, vaginal dryness, and low libido. Let’s face it, they’re a nuisance at the best of times and can leave you feeling totally down in the dumps at their worst.
On the bright side, advancements in the fields of science and medicine have allowed for innovative therapies that can help alleviate some of Mother Nature’s inescapable effects. One such innovation, hormone replacement therapy (HRT), is designed to replenish sex hormones – such as estrogen and progesterone – that begin to naturally decline in a during menopause. This in turn helps relieve those pesky symptoms mentioned above.
While HRT can work wonders for women who may be struggling with readjusting to this new phase of life, it does not cure the root cause of the issue and is certainly not intended as a quick-fix or permanent solution. Eventually, there will come a time when you will have to stop your HRT for several reasons that are discussed below, and so you must consider how to best do so in a way that works in unison with your body and minimizes any undue stress.
With that said, read on to learn exactly how you should be planning your exit strategy from HRT so that you can emerge from it feeling your best.
When it comes to HRT, you have to take the good with the bad; despite the array of associated benefits, including effective relief from hot flushes and depression, it also comes with a several risks.
Much of the research conducted over the last couple of decades suggests that HRT doubles the risk of developing ovarian cancer and increases the risk of breast cancer, even when taken for a relatively short period of 5 years or less This is especially true for women aged 60 or above. While it has also been proven that this risk can reduce over time, it is still higher in women after 10 years of taking the treatment, as compared to those who have never taken HRT. It is important to note that these risks have only been identified in the combined HRT treatment (containing estrogen and progesterone), not the estrogen-only type.
Evidence indicates that HRT reduces the risk of cardiovascular issues, such as heart disease and stroke, in women under 60 who begin treatment within 10 years of starting menopause. Conversely, the risk is likely to increase in women aged 60 or over.
For the above reasons, it is important that you take the medication at the lowest possible dose for the shortest period of time, especially if you fall within the higher end of the age spectrum. Talk with your doctor if you have any questions or concerns; they will go through all of the benefits and risks with you to choose the best course of treatment and put your mind at ease.
There’s no set time for when a woman should come off HRT; it all depends on individual factors based on the various pros and cons. As a rule of thumb, for healthy women – that is, those who do not have a weakened immune system or any underlying health issues – HRT is safe to use in small doses for short-term relief of menopausal symptoms. However, because the accompanying risks appear to increase with age and the duration you take HRT, women aged 59 or above who have taken the treatment for 5 or more years should think about stopping.
In females whose menopause is induced by a hysterectomy (removal of the uterus), who are prescribed estrogen-only treatment after surgery, their likelihood of developing any type of cancer is not increased, so they may decide to stay on the treatment for a longer period.
If you’re feeling confused, apprehensive, or unsure about the best time to quit HRT, a conversation with your doctor will help to demystify the topic and make it less of a daunting prospect.
Perimenopausal symptoms can last 2 to 5 years on average. As your hormone levels gradually decline, your body, accordingly, learns to acclimate to this ‘new normal’.
There’s a common myth among women that HRT is a magical solution to your menopausal nightmare by banishing all of those unwanted symptoms once and for all. In reality, however, this certainly is not the case. All HRT really does is deliver a large dose of sex hormones that naturally continue to decline in your body; as a result, the medication is effectively able to mask the symptoms by tricking the body into thinking that menopause is not taking place.
Because HRT causes your body’s receptors to only recognize concentrated, synthetic forms of estrogen and progesterone, it can be difficult to adapt to significantly lower levels of hormones that are naturally produced by the body once you stop your treatment. While this process does gradually correct itself over time, it is ideal to gradually wean yourself off HRT to lessen the shock to the system.
When you’re taking HRT and suddenly decide to stop, your hormone levels drop drastically, so you can imagine (although some of you may not have to) how this sudden change can wreak havoc on your body. The sudden withdrawal can cause your system to struggle with adapting to the change, thereby bringing about a whole host of menopausal symptoms at an excessive level – think of it like menopause on steroids.
Of course, milder preparations of HRT aren’t likely to take the same toll on your body as the stronger ones, particularly if you haven’t been taking them for that long and if your symptoms weren’t all that severe to begin with. If you fall under this category, it may be possible to stop your treatment immediately without sufffering any unpleasant effects.
In the same way, there is no fixed time to quit HRT, neither are there any hard or fast rules on how you decide to come off it – it all depends on you as an individual: more specifically, the type and dose of HRT you’ve taken, how long you’ve been taking it, and the severity of your symptoms before the treatment.
While some women opt to go ‘cold turkey’, others may feel more comfortable gradually weaning themselves off the medication to ease any adverse withdrawal effects. Like always, the best advice lies with your doctor, but the latter option may be worth considering if you have been treating for a longer time period at a higher dose.
Slowly decreasing your dose over a period of 4 to 6 months, and sometimes up to a year, is generally advised to minimize recurrrence of perimenopausal symptoms. This can be done by asking your doctor to reduce the strength of your dose and taking a pill every other day, eventually followed by every 3 days and so on, rather than on a daily basis.
A worthwhile exit plan is key to ensuring that your body gets the support that it needs as you prepare for the HRT withdrawal process. While it is amazing how powerful and resilient your body is when it comes to creating stability within all of its complex systems, there’s only so much it can do on its own. Without an adequate care plan, there is a high that symptoms will recur.
A rich, nutritious diet is the first step to achieving a healthy hormonal balance. Getting essential vitamins and minerals is vital if you want to look and feel your best during and after menopause. This includes eating a wide range of colorful fruits and vegetables, eggs and dairy products, oily fish such as salmon, and lean protein from chicken or beef. Also, think about how you can naturally boost your estrogen levels by eating foods that are hormone-rich, such as flax seeds, soy, dry fruits, and nuts.
A well-functioning digestive system is also important in achieving a good quality of life during menopause. After all, your gut is where all the essential nutrients are absorbed into the body, so it needs to be working at its optimum rate to minimize menopausal symptoms. Follow a balanced diet that includes sufficient fluids and fiber, as well as maintaining a healthy weight by getting enough exercise every day. To give your gut that extra boost, it may be worth eating probiotic-rich foods or taking a daily supplement with your meals to replenish the levels of good bacteria.
A weakened immune system is directly linked to more severe menopause symptoms. During menopause, in addition to a reduction in your sex hormones, the stress hormone, cortisol, can also increase, which in turn, weakens your immune response. It is therefore, important that you keep your stress levels as low as possible by getting enough sleep, which helps to regulate cortisol; exercising, which boosts chemicals known as endorphins that elevate your mood; and also trying stress-reduction techniques, such as yoga or meditation.
Ideally, you should start incorporating the above habits and lifestyle changes around 4 to 6 months before you begin to wean off HRT. As always, be sure to speak with your doctor first to make sure that your strategy is working for you rather than against you. Ultimately, taking the necessary time and effort to care for your body during menopause will have you on the right track to living your best life.
Reviewed by Dr Roy Kedem, MD
Information last reviewed 07/12/21