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[panthers]

Well I recently reached my 60th Birthday and I am still reducing my HRT.  Originally on 14 mg a week and now down to 3 mg (take one tablet Mon/Wed/Thu.  I had an HRT checkup at the docs last week who quite happily provided me with another prescription for 6 months which at the rate I take them will last me over a year.  The dilemma is do I reduce the dosage again in January to 2 tablets a week or stay on the 3.  Alot of my meno symptoms have gone thankfully but I have very sore joints and dry skin (only come on since reducing my HRT).  I should have discussed with my doctor at the time.   Has anyone had any experience of taking a maintenance dose or do I wean myself off it completely?  Apart from sore joints which occasionally wake me up I feel fine in myself.   

[Dancinggirl]

Hi.  I presume you have had a hysterectomy as you don't mention progesterone?
I think there are some ladies who continue with a very low maintenance dose - hopefully they will be along with advice.
I'm taking a break from HRT at the moment and can relate to your comment about dry skin - I'm spending a fortune of body lotion and feeling very itchy. I have sore joints with or without HRT but I worry about osteoporosis as I know I have borderline density - I will get this checked again soon.
I think a very slow reduction of oestrogen over months or even years could be a good way to go for your bones.
Good luck  DG x

[bramble]

I reduced from a low dose HRT to 0 over the course of 6 months. Once I got down to a pill every 3 days, I then did that for 4 weeks and stopped with no noticeable increase in adverse effects. I think it would be worthwhile to stop at some point and see how things go.

Bramble

[Hurdity]

Hi panthers

I was 60 last May and have not started on reducing to a maintenance dose yet nor intend to.

I use 50 mcg patches with a 6 weekly cycle of Utrogestan which gives a bleed. I tried reducing to 37.5 mcg following a supposed thickened lining (but probably due to the point in the cycle that I had the scan) but within weeks started to get flushes and sweats waking me up and disturbing my sleep. As I still work part-time in an occupation where I have to be on the ball totally, and be in front of large groups of people, I decided to go back up to the dose I've been on for 6 years and all symptoms have disappeared.

I know the current view is that symptoms may return for many women even if you stop gradually, but if you really want to or have to stop HRT completely you are supposed to ride them out for a while to see if they disappear. As always it depends on your circumstances and general health - and should be your decision not your doctor's!

Although the amount of oestrogen required to protect bones from osteoporosis is a 50 mcg patch and I think 1 mg estradiol in tablet form (this is the licensed amount), the effect is dose dependent and some protection will be conferred by small amounts of oestrogen - but just not as much as larger doses!

I presume you are still using vaginal oestrogen or have started this to keep VA at bay?

Hurdity x

[panthers]

I am on a non bleed HRT tablet and I have never used vaginal oestrogen.  VA has never been mentioned at any of my checks.  I have no problems with bladder, penetration etc although it takes a little longer and sometimes I need some extra lubrication! Is it something I need to discuss before it kicks in?   
Still not sure what to do about reducing again - have recently read that there are more risks to increasing or starting HRT after 60. My mum is borderline with osteoporosis but she refused to take HRT (I have now taken it for 12 years).  I was told that the HRT I am on protects the bones but is not a reason for taking it.  Like many over 60's now we are really busy, run our own business, look after grandchildren half of the week and have elderly parents.  Not easy.

[andius]

If your life is still that active, you might want to stay on the 3mg awhile (course this is just my thought).  I think it is a lot easier to deal with all kinds of menopausal symptoms if you don't have to work or have other responsibilities outside the home. Why rock the boat?....your dosing schedule right now is pretty low in total dose. The longer you drag the "weaning off" out, the greater your chances of having less symptoms.  Did you have a lot of symptoms before you started HRT?, is that why you started?

That said, it can only be your decision.  Why are you reducing the dose if your doctor is willing to keep giving you prescriptions  OR are you reducing via doctors advice and the RX is just to get more pills in order to wean off? You should definitely discuss vaginal estrogen at some point and get some vagifem just in case to be ready.  If it starts and you aren't prepared, you can have quite a bit of suffering.

Andius

[panthers]

I did have a lot of symptoms before starting HRT.  Worse was the nightsweats and palpitations, took place about every hour during the night.  Stuck it for 6 months and couldn't cope any longer.

Trying to wean off only because it is not generally recommended for over 60's.  My doctor is happy to prescribe HRT.  My blood pressure is normal, I don't smoke and my BMI is in the normal range which according to her lowers my risk of problems. 

This VA thing bothers me - is it something that just happens?  I reduced from 4 tablets to 3 a week in July and have had no side effects so far.

[andius]

Well, it was my first symptom even before the hot flashes or other symptoms really kicked in.   I thought I had a UTI and went to the urologist.  The urethra burned and when I urinated my vulva burned like a yeast infection.

It only happened when I missed periods for 2 mo or more.  When the periods came back, it went away. Then when they left for good, I had it continuously. I have been checked for infections, had my bladder looked at(inside), etc and they never find anything except minimal blood cells in urine.  I was treated with all kinds of antibiotics over many months and nothing helped.  I started local estrogens, and eventually vagifem  helped a little but the burning never really has gone completely away for good. Started HRT 7 months ago after 3 years of putting up with this burning. Still burning some but better than originally.

To answer your question....I think it comes on slowly, first dryness, some irritation, etc that gets worse.
It is hard to separate the urethral and vaginal symptoms, they sort of overlap.  You will know something is up down there though.  If it stays untreated for a while, it gets worse and can take weeks/months to reverse.

Andius

[panthers]

Sounds awful - I have never had those symptoms.  Mine were generally nightsweats, palpitations and anxiety.  I remember spending a night in hospital on a heart monitor as my heart was racing for hours - that was really scary but stopped after being on HRT for 3 weeks!

I have decided to stay on the 3 a week after reading some of your replies and thank you Andius for your help with the VA thing.  I am now more aware and can something about it if it occurs.