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[Bluebirdie]

Hello,

I’m seeing GP tomorrow as they want to review my HRT. I’m 57 and been happily managing insomnia, flushes, mood swings etc for about 5 years on HRT. I’ve had a Mirena coil for 4 years for progesterone, use 4 pumps of gel and twice weekly vagifem/ovestin.

I’m actually stopping work soon and happy to consider stopping HRT.

Whenever I accidentally forget the gel I get a “dirty” brown light bleed but I’m worried, despite my age that I might be thrust back to the waterfall periods I was having pre Mirena (& hysteroscopy which told me all was ok at that point). My mum didn’t stop having heavy periods until a hysterectomy at 55, same with some aunts so am anxious I may haave the same freaky genetics.

And, although I’ll cope better not at work, I don’t relish the idea of rapid ageing of skin, bones, sex life etc. and returning to night sweats and no sleep…

But it seems a good time to consider it, no? Anyone else who stopped either abruptly or gently who can be encouraging and reassuring? Did you find symptoms returned and if so how did you manage them without hrt? Thanks.

[Hurdity]

Hi Bluebirdie

It's entirely up to you if you would like a trial of stopping HRT. Although it is most likely that you are post-menopausal at 57, if your mother had a late menopause then you may do too, and a few women do not reach menopause until late 50's though unusual.

If you are post-menopausal then it's not advisable to have the Mirena in on its own though yours will now be running lower on progestogen. This is because it can cause overthinning of the endometrium ( womb lining) which can cause spotting and ulceration in extreme cases

The ony time I stopped HRT was several years ago - for 3 months, something like 2011 as I recall - had been on HRT several years then - and I stopped abruptly. Symptoms all returned within 3 months.

The advice is that the eventual outcome will be the same whether you stop abruptly or taper but that it is more tolerable to taper off. Perhpas consider gradually tapering to a lower dose eg 2 pumps and see who you feel - and then that could be your dose for the next few years? At some point you will need a new Mirena to protect your womb.

Hope this helps

Hurdity x

[joziel]

It's not very clear from your post exactly why you want to stop HRT? It seems to be helping you and has fixed a lot of symptoms which will likely return if you stop it.

Why do you want to stop HRT? Don't you want to enjoy your retirement and live a long and healthy life with as few chronic health conditions as possible?

There is no need to ever stop HRT. You can take it until you die. Three of my grandparents lived to be 95 and I have every intention of taking it until then....

[Mary G]

To be honest, I wouldn't touch it with a barge pole.  Unless you have an underlying health problem or serious issues with HRT, it's just not worth coming off it.  The only time I have stopped everything was to get genuine baseline hormone blood tests but I'm not going to do it again.

It takes a long time to get HRT right and if you stop now, you will undo all that hard work and put yourself at risk of getting nasty menopause symptoms and longer term health problems when you want to enjoy retirement. 

I think it would be a pointless exercise.

[Bluebirdie]

Thank you for your thoughtful replies.

I am aware that taking HRT carries some additional health risks. I do understand that these are minimal and there are some benefits too but nevertheless, these are still additional risks and I don’t generally think I should take medications I don’t need. So wondering what counts as “need” if I’m effectively post menopausal now.

And at some point I will need to stop so I am wondering about whether - after I’ve adjusted to early retirement - now may be as good a time as any.

But I take the point - it may be harder (impossible?) to restart and get things right.

Fortunately the GP was very open to what I wanted and was not pressurising me to make any particular decision or rush etc..

[sheila99]

Both options carry a risk so it depends which you think is the greater risk. I feel the same way as you about medication but perhaps think of the 'replacement' in hrt as it's replacing what we should be producing ourselves (meno is a major design flaw). I was 57 before my periods became irregular so it's quite possible you're still peri. Two other things to consider before you make your decision, some gps are reluctant to restart hrt once you're older and osteoporosis isn't much fun. There is no age limit for stopping now so you can take it for life if you want to. Or you could try cutting down and see how you feel.

[joziel]

Bluebirdie, those thoughts are outdated approaches to HRT and I hope you've done your research into the latest thinking on it. You might like to check out the book called Estrogen Matters by Bluming, available on Amazon.

There are actually almost zero risks IMO to continuing HRT. The only definite risk is that of endometrial cancer if you don't take enough progesterone, but seeing you will typically get unscheduled bleeding a very long time before that happens, you will have sufficient warning. There are not really any other risks to it. The risk of breast cancer is negligible and estrogen was actually found to be protective against breast cancer in several studies. I'm not sure what other risks there are you can be talking about?

On the other hand, stopping HRT will increase your risk of heart disease (which is the number one killer of all women), dementia (number 2 killer), osteoporosis (which leads to fractures and ends quality of life and independence), bowel cancer, arthritis and joint disease, insulin resistance and metabolic disorders, high cholesterol - and much more besides. It's a no-brainer.

As for the "at some point I will need to stop it...". Er, why? Why exactly do you think you will need to ever stop HRT? The current thinking is women should be allowed to remain on it until they die. There is no reason to stop, although dosages may need to be adjusted as we age. I plan to remain on it all my life and I also plan to live to at least 95.... 

HRT isn't a "medication", meaning an artificial drug - it is the provision of your natural hormones. Just as if you were deficient in thyroid hormones, you would take T4 and maybe T3 as well - all your life. With no expectation you would stop it. Because you're not going to suddenly start making thyroid hormone again. Same goes for sex hormones.

There is nothing more natural than death and disease.

[Mary G]

The bowel cancer point is very interesting. I wonder if it's the oestrogen receptors in the intestines that are protective and speed up transit?