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[Morwenna]

Correct me if I'm wrong but I'm given to understand that menopause symptoms are caused by the gradual shutting down of the ovaries, which in turn creates increasing depletion of the hormones oestrogen and progesterone? (Simple definition). If this is the case then why do so many ladies who are on HRT actually (voluntarily) reduce their dosage as they get older? (I'm not referring to those who are encouraged to stop taking it by the age of 60 against their will by their GP's).

I'm mid fifties and currently on a regime of medium strength HRT (Femoston 2/10) and vaginal oestrogen therapy (Gynest cream). I once reduced the dosage of my vaginal oestrogen to 'see what would happen' basically, and paid for it dearly!

My GP is happy to prescribe HRT 'for as long as I need it'. But how do you know how long it's needed for? Surely if it's replacing something that's gone forever then it will be needed forever? I personally can't ever see myself coming off it. I'm aware that a lot of ladies don't take HRT at all and seem to sail through menopause with no obvious effect (what's the difference between them and me for example, and do they actually still have or indeed want satisfactory sex lives?) but equally there are many who succumb to degenerating ailments and horribly debilitating 'symptoms' that in my opinion could be avoided through HRT. (I can remember my Grandma suffering terribly from cystitis symptoms in her eighties which were not bacterial infections so clearly she would probably have benefited from vaginal oestrogen?) And before you think I'm very 'pro' HRT, I was originally one of those who was determined to take the 'natural' route - this was before I was unlucky enough to have all 38 symptoms of menopause kick in at the age of 51!

Could someone please explain why when oestrogen levels in the body have dropped to their absolute minimum from the mid fifties and beyond, that a lot of ladies on HRT seem to advocate opting to reduce to a very low dose (or none at all)? Is it simply anxiety in respect of the risks or do our bodies gradually become able to function satisfactorily on less oestrogen?  I'm confused. 

Thank you x

[Witches Cat]

Hi Morwenna, I'm one of those who don't like taking anything, even headache pills if I can get by without. In my family there are folks who have and have had  "addiction" problems. I am aware that people in families who have this problem can become addicted to almost anything, (even collecting stuff, and I'm like that myself) so once I felt I was human again with the HRT, I thought it had done its job and I didn't need it any more.   The doc said if I wanted to come off the pills to cut them down gradually,  I have tried this 3 times now and each time after a month or two I am back in a dreadful state. I now realise my body needs then and probably always will, so I'm sticking with them, they are one of the higher dose pills, but they are working for me most of the time until I get into a state over something, and then until I can talk myself down nothing is going to help. I think though, if I wanted to go lower, I'd ask for a lower dose pill instead of mucking about with the dose myself.  (coming up 59 now)

[Taz2]

I believe it's because it has been shown that the risk of some cancers is caused by the amount of time that the body is exposed to oestrogen. This is why women who begin their periods early and start menopause late have been found to be at a greater risk (albeit not that much greater risk) of breast and uterine cancer. It's the overall years of exposure which put your risk up. Apparently.

Taz x

[honeybun]

I don't like taking any medication at all. I have been on HRT since 49, now 54. My GP has said the cut off is 60, she did say they would carry on prescribing afterwards if symptoms returned. She also said the less you are on the less the shock to the system. I am now down to half a patch and have reasonable symptom control.

I would increase again if I needed to but things are ok for the moment. It's very much a personal choice and what suits one won't suit another.


Honeyb
x

[Morwenna]

I'm with you ladies who say you don't like taking any medication at all. Don't get me wrong I would give up HRT in a heartbeat if I thought I could function normally without (and remain reasonably healthy) - but I'm not sure I would be able to? 

[honeybun]

That's what some of us do though. Reduce down but still have symptom control.

HRT has never been a magic bullet for me. It does help with flushes but that's about it. I still have anxiety,aches and pains...the list goes on.

Some lucky ones maybe get to feel the way they did before meno but I'm not one of them.
I have not reduced my HRT so much that it does not work but obviously if a reduced dose does the trick my body does not need any more. We are all given much the same amount and we all have different needs so it makes sense to me to be on the smallest amount I can.


Honeyb
x

[Dana]

I'd have no issues at all about staying on estrogen for the rest of my life, if it wasn't for the whole progesterone crappola. That is the only reason I will try to reduce my medium dose down to a low dose, or stop it altogether. However, it might work out that I can't do either.

If that is the case I might consider a hyster at some point, so I can eliminate the whole prog merry-go-round, but I am also well aware that that could also come with its own set of problems too.

Oh to be able to find a time machine that would send me back about 10 years, and keep me there. Life was so much simpler then. I didn't realise how good I had it. 

[Joyce]

I'm a bit like HB, I've halved my HRT patch. I reduced my patch to lowest dose last year. Beginning of this year, I cut it in half. It's taken a while, but now flushes are only about 3/4 a day. None of the drenching sweats I got when off HRT a few years back. At recent review I told GP I'm not prepared to stop completely at this time, which he was OK with.

If it was possible to do without it, I would. I know the risks, discussed with hubby & both of us agreed that quality of life outweighed the risks.

[Taz2]

It's one of those unanswerable questions isn't it. I have two friends who have gone through the meno at the same time as me and I was the only one to take HRT. They have had a tough time but, now, both of them are free of hot sweats, have regained their energy levels and no longer forget phone numbers or where they are supposed to be. One of them is 62 and the other is 60 like me. They do both use Vagifem though.  We were all feeling the same until I stopped HRT and now I am lagging behind them big time! One started flushes at 52 and the other at 54 and for both of them they lasted seven years. Of course that was seven years of me feeling great and urging them to try HRT as I watched them floundering. Now the boot is on the other foot. It's all about choices I suppose.  If seven years is right I should be feeling better by 67 then!!

I look at it that nobody knows what's around the corner and something could have killed me off during the last seven years and I was at least enjoying much of my life.

Taz x 

[Joyce]

I've been on it for a long time. Meno consultant said that as I'd started very young my arteries etc would have been preserved in whatever state they were in at that time. Good way to describe Oestrogen - a preservative. 

[Taz2]

I wouldn't recommend a hysterectomy to do away with the progesterone problem Dana! You might find you have the hyster and then get denied HRT for another reason anyway plus it is a major operation and often leads to prolapse at a future date. I certainly didn't have it lightly - although now, as long as I can persuade my GP, it's good to think that I can at least have oestrogen only HRT.

I agree that the phrase is very apt!! 

Taz x

[Dana]

Agreed. A hyster is certainly something I really don't want to do unless I absolutely have to.

I'm now in a quandry where I'm not sure if some side effects I'm getting could be because my estro dose is too high. I'm using a 50mcg estradot patch, but just lately my insomnia has ramped up and I'm gettig headaches. Is this too much or not enough? Could be either according to what I'm reading on Dr Google.

So I figure I've got start my experiment somewhere, so last night I put on 3/4 of a patch. So far no headaches, but it's too soon to tell. If it does mean that I need to reduce then that's great, but I'm scared it might mean I have to increase. I've been post-meno now for around 3 years so I would have thought I wouldn't be needing to increase surely.

[Taz2]

How long have you been on patches for Dana?

Taz x

[Morwenna]

My GP advised that oestrogen has a 'half life' which means it stays in the body for quite some time after stopping or reducing the dose. So the effects of withdrawal may not be seen for several weeks Dana...

[Dana]

How long have you been on patches for Dana?

Taz x

Well that's another thing. I was on patches (50mcg) for quite a while with no problems. Then a few months ago I started having sleeping issues again, so I switched to estradiol tablets (2mg) and everything settled nicely. So I just assumed I wasn't absorbing the patches properly for some reason.

However, the sleep issues have started up again so now I'm not sure what to do. I decided to switch back to the patches because it's easier to tinker with the dose than it is with tablets. Yesterday I put on 3/4 of a 50mcg patch, and I still had a horrible night again, although I know it's too soon to know if that new dose is right.

However, I did an experiment last weekend by taking 2 x 2mg E tablets, and I actually slept really well that night. So this morning I decided to increase my patches to 75mcg and see what happens. If things improve I will stay at the dose for a while, but then I'll try slowly cutting them again to see what dose I can settle on.

I'm really hoping that all this is just a blip in the system, because going up in dose is really not what I want to be doing after being post-meno for a few years. I was hoping I could start going down in dose, but I can't cope with the horrible insomnia, so if extra E is the answer then so be it. Of course the extra E might make the problem worse.. sigh..