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Hormone Replacement Therapy

What is the best way to come off HRT?

Question

I've been taking HRT- Prempak-C –for ten years. In view of the recent research, I've decided to come off it. I tried just stopping taking it bur have felt dreadful, with hot flushes after only a few weeks. Have you any advice to help me come off HRT?

Answer

Firstly, it's vital that - unless you have a severe complication, which it doesn't sound as if you do - you come off HRT slowly, over several months. I do advise you to talk to your doctor about this.

Now a little about hormone replacement therapy in general... As women come to the end of their reproductive life, the activity in their ovaries declines because the eggs they are born with run our As this happens, the levels of the female hormone oestrogen drop. (There is always some oestrogen in the body because the ovaries go on producing a little; even if the ovaries are removed, the adrenal gland produces a hormone called androstenedione, which is converted to a form of oestrogen).

HRT was developed in the 1940s as a method of replacing the lost oestrogen. In the mid-1970s, research confirmed that using oestrogen alone significantly increased the risk of cancer of the uterus (womb), so progestogen, a synthetic version of the other main reproductive hormone progesterone, was added to protect the womb. HRT was then relaunched as a "wonder drug". However, there was still very little hard scientific evidence to show either that HRT was safe or that it had the multiple benefits that were claimed. Since then many studies have confirmed that the risks outweigh the benefits in most cases.

A consensus statement put out by the Royal College of Physicians now says that the use of HRT in menopausal or postmenopausal women is controversial. They recommend that it should only be used for menopausal symptoms, such as hot flushes, in the lowest possible effective dose for the shortest possible time. This is because of the significantly increased risks of breast cancer, heart disease, strokes and blood clots in the leg or lung. In November last year, the European Expert Working Group, which consists of experts from 28 countries, agreed that doctors should not recommend it as the first line of treatment for osteoporosis.

The lack of oestrogen has a range of effects, including irregular periods, aches and pains, low blood pressure, poor circulation, dry skin and mouth insomnia, fatigue and low mood. lf the ovaries release even a small amount of oestrogen, urgent messages are sent to the entire body that the missing hormone is on its way and all hell breaks loose: the woman's heart rate goes up, she starts to sweat, her face gets flushed, her body warms up and she feels agitated. Then, as soon as the body realises that it's only a tiny amount the symptoms subside.

Remember, menopause is a natural transition. It will come no matter what if you did not go through it naturally because you were taking HRT, you will go through it now. A good number of women don't, in fact, experience uncomfortable symptoms, but you want to be sure to avoid them if you can. The key is to keep your stress levels down. The less anxious you are and the more harmonious your life, physically, mentally and emotionally, the better your threshold of tolerance to symptoms. In many countries, women go through menopause without bother. If they do get symptoms, they accept them as part of this change.

Here are some simple tips:

  • Take regular exercise in the fresh air.
  • Practise Yoga, particularly the cobra and semi-bridge poses.
  • If you have hot flushes, do retention breathing the second you feel the tide rising. Breathe in through your nose to a slow count of three, hold the breath for three, then exhale slowly through your mouth to a count of six. Practise this twice a day for five minutes, so you can do it easily when the need arises.
  • Eat fresh, wholesome food, preferably organic; avoid coffee, excess salt, spicy food and alcohol.
  • Drink two litres of fresh, still water daily between meals.
  • Take vitamin B complex, : one daily for two months.
  • Take Shatavari : one twice daily for three months. This Ayurvedic supplement helps to balance hormones.
  • Take Dong Quai: one daily for three months. This Chinese supplement helps alleviate hot flushes.
  • Massage the neck and shoulders twice a week to improve blood flow to the brain; this will help sleep and improve hormonal balance. Also have professional massages twice a month, if you can.
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