Photo By: Jana Leön
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Knowing When and How to Quit HRT
By Melissa Hendricks
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How do I know if it's time to stop using hormones?
In general, doctors are steering patients away from using HRT for more than five years. If you've been using hormones for menopausal symptoms, you may want to try getting off after two to three years. "I suggest women try to wean themselves off therapy slowly and see how they feel," says Jan Shifren, M.D., director of the Menopause Program at Massachusetts General Hospital in Boston. "If they feel miserable," they probably should go back on and try again in another six months to a year.
If I decide to quit, should I go "cold turkey"?
Many doctors advise tapering off gradually, although there is no scientific evidence it works better than going cold turkey. One method is reducing the dosage, for example, shifting down from 0.625 mg of estrogen per day to 0.4, 0.3, and then to zero, over a period of weeks or months. Another is gradually decreasing the number of days per week you take the pills. If you are on combination therapy, continue taking an appropriate dose of progestin along with the estrogen. And discuss your plan with your doctor before you proceed.
Will I go through menopause all over again?
If you are still in menopause, your symptoms may resume. If you are past menopause, you may experience hot flashes, night sweats, or mood changes. If they occur, do not taper your regimen any further until they subside.
Vaginal dryness will return within two to three months. Breasts will lose any extra fullness they acquired.
If your skin became smoother or your hair thicker, those benefits may reverse themselves. Note that abrupt shifts in reproductive hormones can trigger hair loss, as many new mothers learn. The loss is temporary.
How long will my symptoms last?
That depends. If you are still going through menopause, you may experience a return of the symptoms. If you are past menopause, the night sweats and hot flashes that occur as you withdraw from HRT may last several weeks or months. Some women, whether or not they have used HRT, continue to have hot flashes for many years or even a decade after menopause begins.
What if my hot flashes don't go away?
Some postmenopausal women will have persistent and debilitating hot flashes even after they have given tapering a valiant try. Doctors believe only a small minority will have this trouble. If you are one of these unlucky few, you may want to try a more gradual tapering regimen or try a lower dose of HRT. Ask your doctor about drugs such as Effexor (venlafaxine) that curb hot flashes. But you may decide that the benefits you reap from HRT outweigh its risks.
Who has the most trouble quitting?
Doctors say they have no way to predict which women will have more trouble than others. "Some women who never had hot flashes while going through menopause have significant hot flashes when weaning off HRT," and vice versa, says Shifren.
In theory, thin women may have more trouble than obese women, who tend to have higher levels of their own estrogen. Likewise, smokers, who generally have more hot flashes at menopause than nonsmokers, may have more trouble when quitting HRT.
Is it bad for my body to go off and on HRT?
Getting off hormones may take several attempts. Doctors have found no evidence that stopping and starting HRT will harm your body. Only make changes under the supervision of your health care provider.
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