Friday, 9 May 2014

Quitting Hormone Replacement Therapy for Menopause


By Camille Peri
WebMD Feature

Is there a right time to stop using hormone replacement therapy (HRT) to relieve menopause symptoms? Are there risks to staying on hormones or to quitting them? What can you expect if you quit?

If you are healthy, most experts agree that HRT is safe to use at the lowest dose that helps for the shortest time needed. If you're 59 or older, or have been on hormones for 10 years, you should talk to your doctor about whether it's time to quit. Here are some things to consider when you decide. 

Risks of Hormone Replacement Therapy

A large study called the Women's Health Initiative showed that women who took estrogen and progestin were more likely to have illnesses such as heart disease, breast cancer, stroke, and blood clots than women who didn't.

Some women in the study took estrogen only because they had had hysterectomies to remove their uterus. They had a slightly higher chance of stroke and blood clots, but not breast cancer or heart disease.

The risks depend on your age when you started hormones and how long you've taken them.

  • Your chances of heart attack only go up if you are age 60 or older when you start them or if you became menopausal more than 10 years ago.
  • Your chances of getting breast cancer go up when you've take estrogen and progestin for 5 or 6 years.
  • Your chances of blood clots and stroke are still low if you are under age 59.

How Long You've Used Hormone Replacement Therapy

There is no set time a woman should be on HRT. "We ask a woman to go off hormones at 5 years," says Anne W. Chang, MD, of the University of California at San Francisco. "We talk about the reasons why she should go off. But it's a shared decision."

"Being on hormones longer doesn't raise your risk for blood clots, but age does," Chang says.

Isaac Schiff, MD, of Massachusetts General Hospital in Boston, goes over the pros and cons of quitting of hormone therapy with his patients every year. He says he puts the cons, like breast cancer risk, in perspective. 

"If you aren't on hormones, your risk of breast cancer is 3 out of 1,200 per year," Schiff says. "If you're on hormones, it's 4 out of 1,200." Some women are comfortable staying on hormones with that risk.  "It's a very individual decision," he says. 

For women who take estrogen only, the choice is somewhat different, Schiff says. They aren't more likely to get breast cancer, so many decide to stay on hormones longer.

Quitting may take some trial and error. "Sometimes a woman tries to go off hormones at 3 years, but her symptoms persist, so she goes back on," Chang says. "Then she tries again at 5 years. That usually works."

You should stop hormones if you get certain medical conditions, like breast cancer or liver disease, while taking them.

source : Quitting Hormone Replacement Therapy for Menopause

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