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Women gardening

Coming off HRT: What really happens?

Is it a good idea to suddenly stop taking HRT, or should you wean yourself off gradually? Many women who come off HRT are unaware that if they suddenly stop taking it, they could re-develop menopausal symptoms, which are sometimes even stronger than they were before.

HRT is designed to replace the female sex hormones that naturally decline over a period of months or years during menopause. However, HRT was never designed to be a permanent medication. Once you've made the decision to stop taking it with your GP or gynaecologist, thought needs to be put into the best way to come off it: why you may be considering stopping HRT, how to manage coming off the various types of medication, and how it could affect you.

For more advice and information about the menopause, please visit our Menopause Advice Centre.

When's the right time to stop taking HRT?

For many women, HRT can be incredibly supportive during menopause, with research trials showing a significant reduction in hot flushes, vaginal dryness, and depression. HRT is also commonly prescribed to women who have experienced early menopause or a hysterectomy, as oestrogen is required to help support bone density and therefore reduce the risk of osteoporosis.

Yet there are risks associated with taking HRT, which have been reported in research trials over the past 15 years. Most recently a review in The Lancet in February 2015 showed that HRT nearly doubles the risk of ovarian cancer, even if taken for only 5 years. Previous studies had indicated an increased risk of breast and ovarian cancers after longer term use, yet this is one of the first studies to confirm an increased risk after just a few years of taking the medication. Although this risk reduces over time, it is still elevated after 10 years compared to women who have never taken HRT.

There is also conflicting evidence as to whether HRT helps to support heart health. Some studies seem to show a protective effect, yet this seems to be more prevalent in women under 60 who take HRT within 10 years of starting menopause. For those over 60 who start HRT, the risk of cardiovascular problems such as heart disease and stroke appear to increase.

These are significant risks, yet they do need to be weighed up against the potential benefits of HRT: in women who are unable to sleep due to continual hot flushes, as an example. Nonetheless, HRT is not a permanent medication and the overriding recommendation is that it should be taken at the lowest dose possible for the shortest period of time.

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What's the best way to come off HRT?

Whatever form or dose of HRT you are using, it's advisable to come off your medication gradually, weaning the dose down over a period of time. Your body may have become dependent on the additional supply of hormones provided by the HRT, and if you stop taking them suddenly you may go into an 'overnight menopause.'

The menopause naturally occurs gradually ' over a period of around two years as your sex hormone levels steadily decline. This gives your body time to get used to the lower levels, and adapt accordingly. This is in stark contrast to a sudden drop in hormone levels caused by stopping HRT immediately.

There are many different forms of HRT in varying strengths, so it's important to discuss with your GP the best way to come off your medication. The type of HRT, the length you've been taking it, and how severe your symptoms were before you took your HRT are all factors to consider. If you're on a stronger dose of HRT, have been taking it for a long time, and experienced severe menopausal symptoms beforehand, the more likely you are to experience withdrawal symptoms.

In fact, stronger preparations may modify oestrogen receptors in your body: they may recognise only the high levels of oestrogen in your medication, rather than the lower levels your body is able to produce. However, in most women, this does correct itself over time ' which is why gradually weaning off your HRT is advised.

Some milder preparations of HRT may be able to be stopped immediately, such as a topical cream for vaginal dryness. Yet, for the majority of HRT medication, it is advised that you gradually wean yourself off over a two-four month period. This could mean taking a HRT tablet every other day rather than every day, or reducing the size of your HRT patch.

Natural ways to support your body as you stop taking HRT

As your sex hormone levels decline, your adrenal glands and fat cells help to take over and produce oestrogen and progesterone. Therefore, a key strategy when coming off any HRT preparation is to give your adrenal glands as much support as possible ' preferably around 3 months before you start coming off HRT. Your adrenal glands are also responsible for your stress hormones, so focus on giving yourself plenty of rest and stress-relieving activities such as gentle exercise, yoga, and massage.

Phytoestrogens, derived from naturally occurring compounds that have oestrogenic activity, can also start to gently support your oestrogen receptors by binding to them, and so acting as hormone regulators. These are found in food sources such as tofu, nuts, seeds, cress, beans, and pulses. You might also want to consider a phytoestrogen supplement that contains soya isoflavones, as well as herbs, such as sage, black cohosh, and red clover, as these also may help relieve hot flushes and other menopausal symptoms.

For more advice and information about the menopause, select Menopause from the Your health menu above.

Catherine Jeans DipION mBANT CNHC is a nutritional therapist and founder of The Family Nutrition Expert. She has a special interest in women’s health, supporting hormonal balance and optimal wellbeing in women of all ages, through the use of food, nutrition and functional health.

Find out more about Catherine Jeans.

Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn’t possible, supplements can help. This article isn’t intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.