Coming off Hormone Replacement Therapy

 

Coming off Hormone Replacement Therapy

If you have decided you want to stop taking HRT, you need to do it gradually, otherwise you may have a return of your symptoms, especially hot flushes.

Taking HRT does not delay menopause. If you have been on HRT for some time you have probably passed through menopause without noticing. However, if you suddenly stop taking the HRT, your body might react to the sudden loss of oestrogen. Hot flushes may then occur.

If you have been taking HRT for another indication, you may want to discuss other approaches with your doctor. For established osteoporosis or very low bone density, there are other medications, as well as the lifestyle strategies of exercise, smoking cessation and a calcium-rich diet. You can write to us for more information about these.

How to reduce your HRT dose gradually

There are a number of different strategies for achieving this:

  • Use a lower dose HRT
You can ask your doctor to prescribe a lower dose of the HRT. Many brands are available in very low strengths. For example, many women use 0.625 mg Premarin which is also available as 0.3 mg. You can use this lower dose pill for 2-3 weeks, then alternate the pills, one day on, one day off, then one pill followed by two pill-free days and so on until you are off them.
  • Cut HRT pills in half

Some pills, eg Trisequens can be cut in half, and the same regimen followed.

  • Increase the interval between pills
  1. For two weeks, take a pill every second day, instead of every day.
  2. For the next two weeks, take a pill every third day.
  3. For about the next two weeks, take a pill every fourth day.
  4. Then take a pill every fifth day for about two weeks.
  5. Finally, you can stop.

Whichever strategy you use, the whole process should take 6-8 weeks.

If your hot flushes return, it means your menopause is not over. if this happens, you will have to chose whether to go back onto HRT until your menopause is finished, or complete your menopause without medication. You can write for our leaflet Help for Hot Flushes: How to Keep Your Cool at the Menopause.

Types of pills

If you have had a hysterectomy, you are probably taking only oestrogen. Examples of oestrogen-only pills are Premarin (conjugated equine oestrogen), Progynova (oestradiol valerate), and Estrofem (oestradiol).

If you have not had a hysterectomy, you will be taking a therapy which combines oestrogen and a synthetic form of progesterone, called progestogen or progestin. Some combined therapies have separate oestrogen and progestin tablets. If this is the case for the tablets you are taking, you do not need to take the progestin tablets when you are coming off the therapy, but remember, if you decide to continue HRT for any reason, you will need to restart taking the progestin.

In some therapies, the oestrogen and progestin is contained in one tablet, for all or part of the cycle. In this case, just follow the five steps given above.

These are the combined therapies (oestrogen-progestin):

Kliogest (oestradiol-norethisterone) - oestrogen and progestin combined in one tablet. Follow the steps above.

Menoprem (conjugated equine oestrogen-medroxyprogesterone) - 28 oestrogen tablets and 14 progestine tablets - you do not need to take the 14 progestin tablets.

Nuvelle (oestradiol-levonorgestrel) - 16 white tablets containing oestrogen, 12 pink tablets containing oestrogen and progestine. Follow the steps above.

Prempak-C (conjugated equine oestrogen-norgestrel) - 28 oestrogen tablets and 12 progestin tablets - you can leave out the progestin tablets.

Proveffe (conjugated equine oestrogen-medroxyprogesterone) - 28 oestrogen tablets and 14 progestine tablets. You can miss out the progestin tablets.

Trisequens (oestradiol-norethisterone) - the blue and red tablets contain oestradiol; the white tablets combine oestrogen and progestin, so follow the steps above.

Patches

If you are using an oestrogen patch, you may be able to get a lower dose patch from your doctor. The most commonly used brand is Estraderm 50. You can get your doctor to change you to Estraderm 25 and use that for two weeks, then use it alternate days and gradually spread out the time you wear it. This is not perfect as the dose is fluctuating, but it is the only way to come off it. If you are using Femtran, the patch can be cut in half with scissors as the oestrogen is all over the patch, not just in the middle as with Estraderm. You can use half a patch for two weeks, then a quarter for two weeks etc. You do not need to take the progesterone pills.