by Marcelle Pick, OB/GYN NP
In 2002, a government study about hormone replacement therapy (HRT) called the Women’s Health Initiative (WHI), made women acutely aware of HRT side effects and health risks. Since then, millions of women have stopped taking HRT—sometimes suddenly. In a strange twist, it’s usually the same doctor who suggested HRT who is now encouraging his or her patient to stop HRT. Interesting how time can do that even with science.
These doctors, unfortunately, don’t have much advice for the patients who want to stop HRT. In addition, there are often misleading headlines about HRT safety for younger women, and this only creates more confusion. Recently, a woman came to see and asked for my help because her menopause symptoms had returned after she discontinued her estrogen replacement therapy. She said her health-care practitioner just informed her that he didn’t know what to suggest to help her. His best guess was that if she wanted relief from her symptoms, then she would need to start back on the HRT or try antidepressant. That’s not encouraging for women who are trying to create a better quality of life and take care of their bodies in a natural way. It’s difficult for women to not feel a bit deceived. For those of us who seek and follow a health-care practitioner’s advice, because we trust that they know better than we do what the best options are, it is a surprise to find out that they don’t.
It also might be surprising that a practitioner would not know how to help with this situation, but remember that most practitioners were taught that HRT was a near perfect answer to alleviate symptoms of perimenopause and menopause. As a positive response to this issue, the American College of Gynecology has been developing guidance for gynecologists about HRT withdrawal. However, there is a copious amount of well documented research that exists among complementary and functional medicine practitioners that can help you make better health choices for yourself. So let’s look at an overview of HRT alternatives and what you can expect when and if you want to transition and stop taking HRT.
Can you expect HRT withdrawal problems if you quit “overnight”?
Many women who decide to transition off HRT will just suddenly stop taking it, and this is very stressful for your body. We saw this happen when the study came out, as many women flushed the hormones down the drain several days or weeks after the report was made public. Your body’s internal system has grown dependent on this additional supply. Originally your body could have made its own hormones—right through perimenopause and menopause—but it cut back production when you began HRT. The good news is that your body (the wonderful creation that it is) can resume its estrogen, testosterone, and progesterone production, and it can even develop secondary hormone production sites to compensate for the decrease in hormones from your ovaries. In reality, that is the normal and natural order. However, your body will need time and your continued support to develop those sites.
Another factor to consider is that we believe that the stronger estrogen replacement therapy drugs, such as Premarin and Prempro, actually modify the estrogen receptors in your cells, so they only recognize this strong type of hormones. It takes time for those receptors to get back to their original form and accept natural HRT. For some this may not every happen, but for most it is easily accomplished. The natural HRT can be from your body’s own hormones, bioidentical HRT, or plant-based hormonal support in the form of phytotherapy.
Consequently, the type of synthetic hormones that you have taken and the length of time that you have been on them are both very important factors to consider when you stop HRT. An additional factor to think about is how severe your symptoms were before you started HRT. The more severe your original symptoms were, the stronger your HRT would have been, and the longer you used HRT, the more likely it is that you will have symptoms of HRT withdrawal when you quit. The gradual reduction may be more appropriate for you.
Some women are surprised that their symptoms get worse when they stop HRT. And that the symptoms are worse than they were before they started HRT. One major reason is usually because of the “rebound effect” that is a common response to prescription drugs. The second major reason is that women may be taking less care of themselves now than they were before. The third reason is that once the estrogen receptors have been primed they need to be supported in other ways.
Of course, each woman is different. Some women stop HRT suddenly and have absolutely no symptoms of hormone imbalance. They are however, the lucky few. Our clinic’s waiting room is full because most women who stop HRT will experience all over again all the symptoms of menopause, sometimes with more aggression, and they don’t know where to go for relief and support.
Expect a soft landing if you take care of yourself
The essential cause of hormonal imbalance is what we call the “inverted ratio.” That’s when the body burden that you place on your body greatly outweigh the support you give it. The basket is too full with demands. If you have symptoms of hormonal imbalance, you have the inverted ratio. The facts about HRT are that it relieves the symptoms, but it will not eliminate the underlying causes. I describe this as what is going on upstream that then created the symptoms.
Your body is a marvelous machine and it has the power to create and balance its hormones at every life stage. However, to do this, it needs adequate support from you. This means rich, healthy nutrition; a well-functioning, digestive system that will optimally absorb the food, and help detoxify the hormones; a robust metabolism; and a manageable routine of exercise and stress reduction. If your hormonal imbalance symptoms are moderate to severe, you can add phytotherapy to this foundation to help stabilize your levels naturally and faster.
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If you understand that your body needs the extra support while you’re going through the HRT withdrawal process, you will be better able to deal with any symptoms that might occur. If your hormonal imbalance is severe, then you’ll need more support, in fact much more support. After you’ve completely stopped taking HRT, then the maintenance phase will require less support.
Ideally, you should put this plan of support in place before you begin to wean off HRT. We advise the women we see to allow 2–4 months, if possible, for the weaning process. This will allow for the body to adjust to the changes. However, some women require a little less time, some a little more time. If you proceed with care, there is a great possibility that you will feel better than you ever have in your life.