by Dr Pandula Siribaddana

Created on: December 25, 2011   Last Updated: December 26, 2011

Hormone Replacement Therapy (HRT) makes use of synthetic estrogen and progesterone to supplement the same naturally occurring hormones in the body. It helps lower or avoid the postmenopausal symptoms and the disease condition known as osteoporosis in women.

Both these conditions take place due to the lowering of naturally occurring estrogen and progesterone in the body after menopause. However, although HRT is useful to avoid these unwanted symptoms, studies have revealed that HRT can give rise to many other disease conditions among susceptible individuals. Therefore, doctors advocate more cautious use of HRT than during the early days of its use and one important aspect in this regard is to know how to switch hormone replacement therapy when necessary.

Although some of the recent studies do not see the necessity to wean-off HRT as there have not been a demonstrable difference between weaning off and abrupt stoppage, many clinicians advocate weaning off as the best method of switching from HRT back to natural hormones. Although there are many ways of doing the same, the rule of thumb is to lessen the hormonal dose gradually without allowing the withdrawal symptoms to manifest during the process.

Thus, the first phase of switching hormone replacement is to lessen the dose either by taking a lower dose pill, taking the hormonal pill every other day or placing half of the hormonal patch instead of the full patch. During the switching process, the person should not feel the withdrawal symptoms at any point. However, if such symptoms manifest, they should revert to their usual dose without a delay. If there are no such symptoms, further reduction of the dose is possible after about one month.

In the second phase, the HRT dose is further reduced using similar methods to that used in stage one. After continuing in this new dose for about a month without any withdrawal symptoms, it is time to stop the hormone replacement completely.

When a person is taking both estrogen and progesterone together, doctors will advocate continuing the progesterone for few more weeks even after stopping the estrogen dose.

Another aspect that needs consideration is the necessity to use alternative medications during the switch between HRT and natural hormone. This is useful to avert the withdrawal symptoms as well as to prevent the bone thinning which may take place after withdrawing the HRT.

In any event, the switching of HRT is not an easy task although careful assessment of the person’s needs and proper weaning off should largely lower the unwanted effects.

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