How to Come Off HRT

Since the Women’s Health Initiative study ending in 2002, there has been an increasing number of studies confirming that bio-identical hormones are safer than, and superior to, their synthetic counterparts.  I have found that women respond better to them, with far fewer side effects.  Many women have no difficulty in deciding against synthetic hormones, either because of their experience of the contraceptive pill, or because of side effects (very common in women with a degree of ‘estrogen dominance’).  Others have had no such problems, but are uneasy about the accumulating evidence.However, for those women already on HRT for menopausal symptoms or bone density problems, there is often a dilemma. They may be uncertain of the effectiveness of the alternatives, and unsure of how to change from one to the other. Their GP may be have limited knowledge of these, or even be actively against them. What to do?

Types of HRT

Because there are so many different forms of synthetic HRT, it can be somewhat discouraging to women wanting to make the switch.  Just to clarify, the main types of HRT are:

1. Continuous combined HRT; where either a patch or tablet containing both estrogen and a progestogen (progestin) is used straight through a repeated 28 day cycle.

2. Sequential combined HRT; where an estrogen patch or tablet is used to cover the 28 days of a cycle, and a progestogen tablet added for the second half of it. A slight variation on this is with the former used only for the first 14 days, then a combined tablet or patch for the second 14 days.

3. Estrogen alone HRT; as either patch or tablet continuously, or an implant, prescribed for women who have had a hysterectomy. Many experts now believe, however, that these women should be given the same protection as those with an intact uterus, as ‘unopposed’ estrogen also has an unwanted effect on sensitive breast and ovarian tissues.

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