Quitting Hormone Replacement Therapy
Should You Quit? If So, When?
There is no set time a woman should be on HRT. "We ask a woman to go off hormones at 5 years," says Anne W. Chang, MD. "We talk about the reasons why she should go off. But it's a shared decision."
"Being on hormones longer doesn't raise your risk for blood clots, but age does," Chang says.
Isaac Schiff, MD, goes over the pros and cons of quitting of hormone therapy with his patients every year. He says he puts the cons, like breast cancer risk, in perspective.
"If you aren't on hormones, your risk of breast cancer is 3 out of 1,200 per year," Schiff says. "If you're on hormones, it's 4 out of 1,200." Some women are comfortable staying on hormones with that risk. "It's a very individual decision," he says.
Women who have had their uterus removed are often given estrogen only. They aren't more likely to get breast cancer, so many decide to stay on hormones longer.
You should stop hormones if you get certain medical conditions, like breast cancer or liver disease, while taking them.
Other Options to Relieve Most Common Symptoms of Menopause
When deciding whether to quit, think about why you started taking hormones. Maybe hot flashes drove you to it. Hot flashes can pass after a few years. If they don't, they usually get less intense over time. The following may be enough to bring relief:
- A low dose of an antidepressant such as Celexa, Effexor, or Prozac
- Gabapentin, an anti-seizure medicine
- Dressing in layers, drinking cool drinks, avoiding spicy food and alcohol, and exercising daily
There are three options for vaginal dryness, pain, itching, and burning:
- Low-dose, prescription vaginal estrogen works best. You apply it as a cream, tablet, or ring into the vagina. Only a tiny bit is absorbed into the bloodstream, so the chance of health problems is much lower than with estrogen pills.
- Water- or silicone-based vaginal lubricants are put in the vagina or on the penis just before sex to reduce discomfort. You can buy them over the counter.
- Vaginal moisturizers, also available over the counter, keep tissues moist. You apply them three times a week, but not before sex.
For mood swings and depression:
- Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), can help mood.
- Daily exercise, plenty of sleep, and stress control techniques like yoga, deep breathing, or relaxation exercises can also help.