Hormone replacement therapy
What to expect when you’re stopping HRT
by Marcy Holmes, NP, Certified Menopause Clinician
Almost overnight, the government HRT study published in July of 2002 created national recognition of hormone replacement therapy side effects and health risks. Since then, women by the millions have stopped their HRT — sometimes just as suddenly. Ironically, it’s often the doctor who prescribed the hormone replacement therapy in the first place who is urging his or her patient to stop HRT.
Unfortunately, not many of these doctors have much advice for patients who are dropping their hormone therapy. And the flurry of more recent, misleading headlines about the safety of HRT for younger women only confuses matters further. A woman came to me recently for help when her menopause symptoms returned after she stopped her estrogen replacement therapy. She said her doctor had flatly told her he didn’t know how to help her, and that if she wanted relief she needed to go back on her HRT or get help from someone else.
This may seem surprising, but remember that until recently doctors have been taught to consider HRT a near-perfect solution for symptoms of perimenopause and menopause. The American College of Gynecology has been developing guidance for gynecologists concerning HRT withdrawal. But a great reserve of knowledge exists among complementary and functional medicine practitioners that can help you make better health choices for yourself. Here’s an overview of HRT alternatives and what to expect when you transition off HRT.
Expect HRT withdrawal problems if you quit “cold turkey”
Many women stop HRT suddenly, which is very stressful for your body. That’s because it has grown dependent on this external supply. Your body could make its own hormones — right through perimenopause and menopause — but it cut back production when you began HRT. Your body can resume its estrogen, testosterone and progesterone production, even developing secondary hormone production sites to compensate for the decline in hormones from your ovaries. In fact, that is the natural order of things. But your body needs time and support to develop those sites.
In addition, we believe the stronger estrogen replacement therapy drugs, such as Premarin and Prempro, actually modify the estrogen receptors in your cells so they only recognize the synthetic hormones. It takes time for those receptors to resume their original form and accept natural HRT, whether that’s your body’s own hormones, bioidentical HRT supplements, or plant-based hormonal support in the form of phytotherapy.
As a result, the type of synthetic hormones you’ve taken and how long you’ve been on them are important factors in your response to stopping HRT. A third factor is how severe your symptoms were before you started hormone replacement therapy. In sum, the more severe your original symptoms, the stronger your HRT, and the longer you used it, the more likely it is that you will have symptoms of HRT withdrawal when you quit.
Tips for Personal Program Success
Practice being still. As little as ten minutes a day spent in quiet meditation can give you numerous physical, mental, and emotional benefits. Focus on deep breathing, which allows oxygen to reach the tissues and quiet the mind, allowing space for your inner voice to emerge and guide you in your life.
Many women are surprised that their symptoms are worse when they stop HRT than they were before they started. This is often due to the “rebound effect” that is common to prescription drugs. The second major reason is that women may be taking less care of themselves now than they were before.
Of course, each woman is unique. Some stop HRT abruptly and have no symptoms of hormone imbalance whatsoever. We call them the lucky few. Our waiting room is full because the majority of women experience anew all the symptoms of menopause when they stop their HRT, and they have nowhere else to turn.
Expect a soft landing if you take care of yourself
The underlying cause of hormonal imbalance is what we call the “Inverted Ratio.” That’s when the demands you place on your body far outweigh the support you give it. If you have symptoms of hormonal imbalance, you have the Inverted Ratio. The truth about hormone replacement therapy is that it can fix the symptoms but it never eliminates their underlying cause.
Your body has the power to make and balance its hormones at every stage of your life. But to do so, it needs adequate support. That means rich nutrition, a well-functioning digestive system so your nutrition is really absorbed, a robust metabolism, and a program of exercise and stress reduction. If your symptoms are moderate to severe, you can layer phytotherapy overtop this foundation to normalize your levels naturally and more quickly. (Sounds impossible? Then you just need a little help to make it happen. Click here to learn more >>.)
Understand that your body will need extra support during your HRT withdrawal. The more severe your hormonal imbalance, the more support you’ll need. After you’ve weaned off HRT completely, the maintenance phase requires less support.
Ideally, you will have the opportunity to put this program of support in place before you begin to wean off HRT. We advise everyone to allow 2–4 months for the weaning process overall, if possible (some require a little less, some more). If you do it with care, you may well feel better than you ever have in your life.
Expect to be successful even if you failed the first time
We see many women in the Personal Program who stopped HRT “cold turkey,” couldn’t deal with the eruption of symptoms, and went back on HRT. They’re not happy, but at least they’re functional.
We counsel these women to learn from the setback and make another attempt. They need to put their support program in place first, and then wean off HRT gradually.
Expect success if you’re willing to work at it
Over 80% of the women who enroll in the Personal Program have problems that are obstacles to restoring their health after getting off HRT. Most common are digestive problems (floral imbalance, leaky gut syndrome, etc.) and endocrine problems (insulin resistance, adrenal exhaustion, hypothyroidism, etc.). Not surprisingly, these problems all interfere with hormonal balance.
Problems like these have taken years to develop and can’t be resolved overnight. Their effect can be discouraging to women seeking an alternative to HRT. After making exciting progress in the first few weeks of weaning off HRT, women often stop improving, finding themselves with too many symptoms remaining. They may blame the lack of hormone and estrogen replacement and say, “This isn’t working.” But in fact, the natural alternative to HRT is working — it’s gradually healing the years of damaging health habits that created the conditions in the first place.
For many women, stress appears to be unresolvable. Stress can trigger hot flashes, insomnia, weight gain and other menopause symptoms. For many women the sources of stress in their lives seem beyond their control. But we’ve seen over and over again that women can make their lives less stressful. Once you begin to take care of yourself you’ll get your strength and energy back. Then making additional changes seems easier. And it will be.
Don’t be surprised if you need help, especially in the beginning
Most women know there are natural alternatives to HRT, and lots of them spend months self-prescribing soy, dong quai, black cohosh, and so on. Each of these can have positive effects, but they are a solution only if your symptoms are few and mild. We count those women among the lucky few, too. Most women who self-prescribe get discouraged and then don’t know where to turn.
We designed our Personal Program to provide women with an at-home version of the methods developed at our medical clinic over the last 21 years. Besides getting the same medical-grade, doctor-formulated nutritional supplements and gentle phytocrine support to to balance your estrogen, progesterone and testosterone levels naturally, we offer you personalized attention, including access to our Nurse–Educators.
To get started, take our hormonal profile. If you have questions about whether the Program will work for you, call us toll-free at 1-800-798-7902. The Support Desk is open 8:30 AM–8:30 PM ET, Monday–Friday.
You’re also welcome to become a patient of the clinic. Clinic hours are 8:00 AM–12 noon and 1:00–4:00 PM ET, Monday–Friday.
Expect to feel great!
We view the whole of menopause as a great awakening. Nature intends for you to begin to take better care of yourself now. Time and again we’ve seen a woman find her voice, learn more about her miraculous body, and begin making choices that work for her. We believe you lay the foundation here for decades of health and happiness ahead.
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse–Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic.
We’re always happy to welcome new patients to our medical clinic in Yarmouth, Maine, for those who can make the trip. Click here for information about making an appointment.
Original Publication Date: 12/05/2003
Last Modified: 03/27/2008
Principal Author: Marcy Holmes, NP, Certified Menopause Clinician