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. Isn’t it interesting how time can change things, even with science?
Unfortunately, many of these doctors have no real advice for patients who want to stop their HRT. And misleading headlines about HRT safety for younger women only creates more confusion. Recently, a woman came to see me, asking for help because her menopause symptoms had returned after she discontinued her estrogen replacement therapy. Her regular healthcare practitioner had simply said he didn’t know what to suggest. His best guess was that if she wanted relief from her symptoms, then she would either need to start back on the HRT or try an 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. It’s a surprise sometimes, when we seek (and follow) advice from a healthcare practitioner to realize that they really might not know what the best options are.
Such is the case with HRT. Remember, most practitioners were taught that HRT was a near perfect answer to alleviating symptoms of perimenopause and menopause. It’s encouraging that the American College of Gynecology has been developing guidance for gynecologists about HRT withdrawal, but a wealth of information already exists. There are copious amounts of well documented research among complementary and functional medicine practitioners that can help you make better health choices for yourself. Let’s look at an overview of HRT alternatives and what you can expect when and if you want to transition away from HRT.
Can You Expect HRT Withdrawal Problems If You Quit “Overnight”?
Many women who decide HRT isn’t for them will just suddenly stop taking it, and this is very stressful for your body. When the study first came out, I heard of many women who dumped their hormones down the drain several days, or even weeks, after the report was made public. But when you take HRT, your body’s internal system grows dependent on the additional supply. While originally your body could have made its own hormones right through perimenopause and menopause, it cut back production when you began HRT. The good news is that your body is an amazing creation, and it can resume estrogen, testosterone, and progesterone production; it can even develop secondary hormone production sites to compensate for the decrease in hormones from your ovaries. This is the normal and natural order of things, but your body will need time, and your continued support, to develop those sites.
There’s more to consider; I 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 these synthetic hormones. It takes time for those receptors to return to their original form and accept natural HRT, wherever it comes from. Natural HRT can be your body’s own hormone production, bioidentical HRT, or phytotherapy, which uses plant-based hormonal support. Although it’s possible that your body will not be able to recognize natural HRT again, for most it is easily accomplished.
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. It’s also important to consider how severe your symptoms were before you started HRT. The more severe your original symptoms were, the stronger your HRT would have been; the longer you used HRT, the more likely it is that you will have symptoms of HRT withdrawal when you quit. A gradual reduction may be more appropriate for you.
Some women are surprised at how much worse their symptoms get when they stop HRT – and how much worse these symptoms are than originally, before they ever started HRT. Prescription drugs often have a “rebound effect,” women may not be taking as good care of themselves as they were before, and once the estrogen receptors have been primed they need to be supported in other ways. All of these factors may impact why the symptoms suddenly seem so bad.
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 often full because most women who stop HRT experience all the symptoms of menopause again, sometimes with more aggression, and they don’t know where to go for relief and support.
Expect A Soft Landing When You Take Care Of Yourself
Hormonal imbalance is a result of what we call the “inverted ratio.” That’s when the burden that you place on your body greatly outweighs the support you give it; in other words, the basket is too full of demands. Hormonal imbalance symptoms indicate that you have the inverted ratio. And while HRT will relieve those symptoms, it won’t do anything to eliminate the underlying causes.
Your body is a marvelous machine that 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, adding phytotherapy to this foundation will help stabilize your levels naturally and faster.
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. The severity of your hormonal imbalance will determine how much support you need. Typically, the maintenance phase will require less support.
Ideally, you should have your support plan in place before you begin to wean off HRT. I advise patients to allow 2–4 months, if possible, for the weaning process. This gives your body time 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.