Suggested guidelines when coming off estrogen replacement therapy

We’d like to warn women who have been on estrogen therapy for a long time, that it’s not wise to go “cold turkey” and stop their estrogen as their body is conditioned to a high threshold of estrogen. A sudden drop in estrogen can actually cause hot flushes and can contribute to rapid bone loss as the body tries to adjust.

We suggest you begin by cutting your estrogen dose in half, and then again by half in a few months time, until you find the lowest possible dose that keeps you free of symptoms.

If you are using natural progesterone in conjunction with an estrogen reduction program, remember to take your break from estrogen at the same time as you break from progesterone.

Just be aware that progesterone will amplify estrogen receptors, that’s why we suggest you initially halve your dose of estrogen when introducing progesterone back into your body. In effect, the body still interpreting estrogen at high levels. As progesterone becomes more effective and your body adjusts so, in turn, will the body synchronise with the gradual reduction of estrogen.

Some women do go “cold turkey” and feel great for 2-3 months, and then fall into a hole. The reason being, they are initially over-riding estrogen dominance symptoms with progesterone and also they have reserves of estrogen in their body fat. The sudden slump comes about because when they have used up all their body’s reserve of estrogen. Symptoms such as hot flushes, teariness, anxiety, palpitations, insomnia, bladder infections, cystitis, may surface.

If this occurs it is perhaps advisable to re-introduce a small amount of estrogen to restore equilibrium to the body and to abate symptoms. Then, if inclined, a gentle reduction program using your symptoms as a guide.

Some women can come off estrogen altogether, whereas some cannot. They may require a small amount along with their progesterone. Many women prefer to try phytoestrogenic formulations and high intake of plant foods containing phytosterols and find this sufficient without the need to take estrogen replacement therapy.

If progesterone alone does not abate symptoms of hot flushes and vaginal dryness after four to seven months (incorporating phytoestrogens), it’s usually an indication that some form of estrogen is required. Best you get your hormone profile checked out.

A small number of women find the patch form of estrogen delivers too high a dose, dumping in body fat. These women prefer to take transdermal estrogen where they can control dosage at low levels. And, of course, there are those women who successfully take low oral doses of estradiol (0.25 - 0.5mg per day three out of four weeks) or 2-4mg of oral estriol along with their progesterone cream as opposed to Premarin that is reported to be less kind in side-effects for a lot of women.

A more popular form of natural estrogen therapy emerging is the Triest combination incorporating the three estrogens in proportion, compounded by a select few pharmacists (all forms of estrogen require a script in Australia).

I have been on estrogen for hot flushes but would like to use progesterone. Will I need to stay on my estrogen?

As a rule of thumb, estrogen levels should be halved upon beginning progesterone supplementation. This is to allow for heightened estrogen sensitivity in your body that generally follows once progesterone has been introduced. As you progress over a number of months, you may find that your body needs less and less estrogen. In fact, some women wean off estrogen replacement therapy altogether.

Women without ovaries continue to make estrogen from their body fat and, because natural progesterone makes the estrogen receptors more sensitive, they may find that they can stop estrogen replacement therapy completely after 5-6 months.

With the reduction of estrogens and the introduction of phytoestrogens via diet or vitamin supplements, women usually find that estrogen supplementation is no longer required to control hot flushes beyond a very small amount of estrogen cream to maintain vaginal tissue health, and to protect the vagina from atrophy.

If a woman genuinely requires estrogen therapy, then she is advised to use the minimal amount to maintain hormonal health. Particularly thinner women who are at greater risk of osteoporosis and hot flushes. We recommend patches or cream rather than tablet form so the body does not have to break it down via the liver.

Natural estrogens are estrone, estradiol and estriol. Premarin which most women are familiar with is not a natural estrogen. Actually the drug ‘Premarin’ comes from PREgnant MARes urINe. Think about that next time your doctor suggests synthetic estrogen therapy.

I qualify for some estrogen because I am still having hot flushes and vaginal dryness but I?m not sure when I am meant to be taking it.

Use estrogen on the same days that you use progesterone cream, leaving 5-7 days without either hormone. It is advisable to find the lowest dose that controls symptoms. Estriol is the least harmful of estrogens available, and is usually prescribed to treat vaginal dryness.