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[Tempest]

I have been doing a bit of research on this as I know so many people report having extreme difficulty coming off HRT.

My own experience has been that I have extreme problems now when I stop anything, in so much as my symptoms are much worse than they were before when I took nothing at all. I suspected that this was the same as the 'rebound effect' that appears after stopping many prescription drugs - it makes perfect sense. It also makes perfect sense that over time, things can and do settle down but for many it's too tough to 'sit it out' - most probably because women are not prepared that things will be worse before they get better.

I found this excerpt that explains this in a bit more depth in an endocrinology journal:

https://academic.oup.com/edrv/article-lookup/doi/10.1210/er.2001-0014

Ongoing and recent research supports this view - there are plenty of scholarly articles available on this subject online.

It's interesting that antidepressants and stress reduction are cited as being good supportive 'tools' in reducing the effects of withdrawal, so I think it's important to not dismiss the use of antidepressants if they can be useful - some women choose to or need to stop their HRT for various reasons. And we all know that stress reduction is key at this time of life anyway, but not always easy!

I hope you find this interesting!

[cubagirl]

I know I've tried to come off on several occasions.  Can't do it.  The flushes & sweats come back with a vengeance.  So I now use half of a 25mg evorel patch.  GP says he's fine with it so long as my BP behaves.  If that starts going haywire, then he will need to rethink it.  You wouldn't think that being on such a small dose would make so much difference, but it does for me.

[Tempest]

I can completely see how it would following my research, Cubagirl! The factors involved in withdrawal syndromes are very complex indeed. It's a whole raft of physiological and psychological aspects.

As a fellow oopherectomy lady, I say if it's working for you right now then that's the main thing. I'm on Tibolone just now which is weakly estrogenic and I do hope to step off HRT completely again following discussion with my Consultant at my last appointment. I'm focusing on  as many supportive measures as I can muster to hopefully ready myself in a place where that can happen! Mentally, I definitely felt better off HRT - much more 'level'. It also depends on the result of my DEXA scan. xxxx

[Hurdity]

I haven't read the paper yet Tempest - but in relation to oestrogen withdrawal there has been some limited research done on stopping HRT and whether it should be done slowly or quickly. As far as I can recall, although it was a small study - the research showed that the outcome of stopping HRT was the same irrespective of whether it was done slowly or quickly - in other words if the sweats are going to come back they will do even if you taper over 9 months. If they are not - they won't. However those who tapered quickly found the symptoms (obviously) came back quicker than if you tapered if you see what I mean. This is just from my head and don't have time to look it up - so apologies if it's not quite accurate - but the gist will be the same. I think the NICE Guidelines recognised that this was an area where future research is needed since it is of obvious importance to many women wanting to stop HRT - (and perhaps especially in their 60's for various reasons!). I haven't looked into the mechanism of withdrawal though!

I think it is well known that for example progesterone withdrawal gives similar symptoms to withdrawal of some ADs - possibly something to do with GABA receptors (again something I've not looked into - Elisabeth Vliet talks about this in her book).

Personally I would never replace HRT with ADs when I decide to come off. After all I am taking a bio-identical hormones transdermally and ADs are a type of medication to eliminate symptoms. When I decide to stop I will just do it (by tapering so that the return of sweats is gradual) and hope that they dissipate after a year or so.....

I sympathise with those who perhaps have to stop earlier than they would choose eg for medical reasons and eg have to work full-time - which may necessitate considering medication.

Tempest I thought Tibolone was not weakly oestrogenic? The main metabolites are the oestrogen-like compounds and I understood these to be more powerful since Tibolone does have bone-protective effects - but the third metabolite has progestogenic effects and weak androgenic effects - but I am sure this is just semantics and probably not the subject of this thread!

Hurdity x

[Dancinggirl]

Speaking from my own personal experience: it is very important to come off HRT for the right reasons and at the right time.   I see HRT as a nutritional supplement - it replaces the hormones that our bodies crave and it brings some benefits and some negative side effects. Using HRT will always be a balance of benefits versus side effects until they find a good alternative.
When women are told to stop HRT by their GPs, simply because of supposed risk factors, then the psychological effect of this will inevitably make you dread the withdrawal of this ‘life enhancing' supplement - thereby making withdrawal far worse.
Lifestyle is crucial - you really need to be in a more relaxed time in life and be able to concentrate on maintaining a good diet and exercise regime, have as little stress as possible and be prepared to take life at a steadier pace.
I have come off HRT 3 times over 25 years and my first 2 attempts were awful for various reasons.  Now, at 60, I feel ready to move forward without the full systemic ( now over 6 months since I stopped ) and actually feel relieved not to be coping with the side effects that HRT brings. DG x

[Tempest]

Hi Hurdity!

Thank you for replying so thoughtfully.

I think the idea of using AD's is to 'bridge' withdrawal to minimise disruption to neurotransmitters - there is some debate as to whether this disruption plays a part in contributing to vasomotor symptoms (as well as low mood when estrogen drops). Therefore, part of a 'tapering strategy' to minimise discomfort. I think this can be very helpful - and the treatment with AD's need not continue indefinitely (I discussed this with my Consultant. She holds a clinic and counsel's ladies about treatment options with BRCA mutation prior to oopherectomy, some of whom prefer not to or cannot use HRT).

In various research papers regarding Tibolone, is states that it's metabolites exhibit weak estrogenic, progestogenic and androgenic actions - I'm not sure if there is something unique about Tibolone that is bone protective over say, low dose estrogen replacement but I hazard a guess that it's possibly due to its combined estrogenic and androgenic effects. xxxx

[Tempest]

I absolutely agree wholeheartedly, Dancinggirl! Choosing the right time for you can mean the difference between success and failure - too many GP's are traumatising women when it comes to forcing them off HRT.

I have always admired your example when it comes to sensible lifestyle changes and self care - this is something that I'm addressing moving forward. This is so important, and HRT is but a part of the 'wellness package' as we transition into our later years.

I really am so very glad that you've now made the transition as comfortably as possible to no HRT, and at the right time for you. This is absolutely as it should be! xxxx

[Hurdity]

Speaking from my own personal experience: it is very important to come off HRT for the right reasons and at the right time.   I see HRT as a nutritional supplement - it replaces the hormones that our bodies crave and it brings some benefits and some negative side effects. Using HRT will always be a balance of benefits versus side effects until they find a good alternative.
When women are told to stop HRT by their GPs, simply because of supposed risk factors, then the psychological effect of this will inevitably make you dread the withdrawal of this ‘life enhancing' supplement - thereby making withdrawal far worse.
Lifestyle is crucial - you really need to be in a more relaxed time in life and be able to concentrate on maintaining a good diet and exercise regime, have as little stress as possible and be prepared to take life at a steadier pace.
I have come off HRT 3 times over 25 years and my first 2 attempts were awful for various reasons.  Now, at 60, I feel ready to move forward without the full systemic ( now over 6 months since I stopped ) and actually feel relieved not to be coping with the side effects that HRT brings. DG x

Great post Dancinggirl - as you know I am also a strong exponent of lifestyle and holistic approach along with HRT rather than a medication based approach - I think one becomes more conscious of this as one gets older!

This is also recognised and promoted strongly by the medical profession and also in the paper for World Menopause Day 2014 ( maybe then?) - which recognised that HRT was only one of many strategies women needed to adopt for optimal health in the second part of their life.

Prevention of Diseases After Menopause was the title: http://www.imsociety.org/downloads/world_menopause_day_2014/white_paper/wmd_white_paper_english.pdf

There was a thread on the forum here: http://www.menopausematters.co.uk/forum/index.php/topic,25545.0.html
s quite detailed but interesting for anyone that wants to look at the scientific data on this!

Tempest - thanks yes - I thought with Tibolone it's just that it's a low dose and why it is given to post-menopausal women who are deemed only to need a low/medium dose - hence I can see why it would not be suffcient for those with TAH/BSO who tend to need higher doses of oestrogen - from what I gather. I did read something somewhere recently about the relative bone-protective effect but can't remember where    - I expect I have it bookmarked....

It's all very interesting anyway!

Hurdity x

[Tempest]

Without wanting to blind anyone with science, I thought I'd just add this interesting study:

https://www.ncbi.nlm.nih.gov/pubmed/8746883

It' specifically relates to women with endometriosis post bilateral oopherectomy, and talks about Tibolone's bone preserving properties - what's really interesting is the conclusion at the end of the text which states 'Tibolone seems to cover the whole spectrum of post oopherectomy consequences',  and so despite its individual weak actions it seems like a very good treatment option following BSO.

I'm sure women who have received this surgery will be encouraged that Tibolone might be something that they can try if they have failed to find relief with other types of HRT, and that it will address their needs adequately.