Updated 05/20/2023
Have you been trying to figure out whether or not you should stop HRT? And what to even expect from the whole process?
The information out there on hormone replacement therapy (HRT) withdrawal can be confusing. And while I don’t want to make this seem too complicated, I know that for women, the decision to start or stop HRT is almost never simple.
As with so much in medicine, what should largely be a personal decision made with the help of a trusted healthcare provider can become clouded by loud voices on both sides of the debate about the safety and benefits of HRT.
But if you are considering, or have decided to discontinue, HRT– for any reason– I want to help you understand what the whole experience might look and feel like, how to do it as safely as possible, and what to do to support your hormones through the process.
Let’s take a closer look.
What’s the truth about HRT, anyways?
In 2002, a government study about HRT called the Women’s Health Initiative (WHI), made women acutely aware of HRT side effects and health risks.
Although more than two decades have passed, that study remains incredibly influential, both because of its own findings and for the seemingly endless debate that followed it in the medical field.
Since the original study was published, millions of women have stopped taking HRT—sometimes suddenly.
And 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. Saying that it’s risky is one thing, but then where are women supposed to go next?
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 exactly 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.
Thankfully, although it isn’t always pointed to by doctors, there’s actually an abundance of research on this topic 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.
Questions to Ask Yourself Before Stopping HRT
While many women certainly have similar experiences with HRT, this remains a fundamentally individual journey. These are some of the questions I recommend asking yourself and talking about with your practitioner as you make your decision and move forward with it.
- Is stopping HRT the right decision for you? If you’re reading this article, you may have already made a clear decision to discontinue your hormone replacement therapy. And I want to help support you through this! But, if you’re still on the fence, this is the first question you need to ask yourself. Remember that nothing is black and white– for some women, HRT really is helpful, and stopping may not be the right choice.
- What type of synthetic hormones have you been taking, and for how long? 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. The longer you’ve taken them, the more gentle you may want to be when coming off. It’s also worth researching the prescription you’ve been taking to see if there is any specific information out there, or even documented experiences from other women about how they felt during the process.
- How severe were your symptoms before you started HRT? It’s 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.
- What’s your plan for supporting your hormones during and after the transition? The good news is that there are many natural strategies you can take to support hormonal balance as you transition away from HRT. But it’s so important to think about and get ready for those changes before you get started. In fact, when it comes to healthy lifestyle modifications, I would definitely recommend starting to make them before you even begin reducing your dose.
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.
How to support your hormones when stopping HRT
Here are some of my top tips for reducing HRT withdrawal symptoms and supporting hormonal balance during the process.
- Focus on nutrition. Your body needs rich, healthy nutrition to achieve and maintain hormonal balance. Learn more about the best (and worst) foods for your hormones here.
- Support your digestive system. A well-functioning digestive system that will optimally absorb the food and help detoxify the hormones is key for hormone health.
- Exercise & reduce stress. A manageable routine of exercise and stress reduction will help you get through the withdrawal period and beyond.
- Try phyotherapy. If your hormonal imbalance symptoms are moderate to severe, adding phytotherapy to this foundation will help stabilize your levels naturally and faster. My Menopause Support formula includes black cohosh, red clover, chaste tree, and some of the other most effective plant medicines to help balance your hormones.
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.
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.
