Stopping HRT

[YorkieTheRabbit]

I’ve been on HRT for18 months, and I’ve decided to try without. I started on elleste duet 1mg and took those for over six months but my migraines got worse so swapped to femoston. After a few months the gp upped it to 2mg, this was due to migraines, mood and low libido.
Six weeks in, I ended up seeing a different doctor, I was a wreck, crying shaking, felt distraught, had self harmed and had terrible thoughts. She put me straight back to1mg and told me to go straight back if things didn’t improve. I felt better but not as good as I should, I have a good life, no worries etc
I know from what the second doctor told me that her first line of treatment for menopause, is anti depressants, which I’m not prepared to take, I’m fine for most of the month but four days or so my mood low, I’m impatient, fly off the handle and am generally unpleasant plus the migraines haven’t got any better. The thing with the migraines is the the year leading up to taking hrt, they’d really improved and I was hoping I’d finally grow out of them!
I’m sorry for the long rambling post, my pint is, what should I expect from stopping hrt?
I’m nearly 52 had been on the mini pill and didn’t have a bleed for several years while taking it, not even in the four months between stopping the pill and starting the hrt. I suffered night sweats and anxiety at night for two years before getting hrt. I’ve no idea if these will come back but I’m really hoping for some advice on how to deal with them if they do, so I can prepare in advance. Thanks for reading

I know from what the second doctor told me that her first line of treatment for menopause, is anti depressants,

You do realise this is completely against the medical guidelines of NICE? If this is her stance, you might want to tell her and print off the guidelines.

I get migraine (usually only pre-menstrually) and have used HRT for 11 years. It's not got worse and in fact is better.

The advice for women with migraine is to use transdermal HRT- so you ought to use a patch or estrogen gel. (Some GPs are unaware of this, and also lack confidence to prescribe gel because you need 2 separate products- gel and a progestogen- they don't come in a 'pack' together.)

Presumably you are using a sequi sort giving you a bleed each month?

If so, that's why you are finding the low mood when you take the progestogens in the 2nd half of the cycle.

If your periods have stopped for good, you could use continuous HRT- estrogen AND progestogen daily. This is no-bleed and you won't get the fluctuations of a cycle.

I personally think you need to carry on finding the right HRT rather than give up after trying one type (pills.)

You could use an estrogen patch and the Mirena coil.
Or estrogen gel and the Mirena.
Or a patch / gel and daily Utrogestan.

Maybe if you can't get any sense out of your GP you could see a private consultant or there may be an NHS menopause clinic in your area?

Thanks for your reply Jingling
I did ask the first gp about gel but she dismissed it as unsuitable for me, said it was for women who “ had trouble downstairs” odd term for a thirty something gp to use
My migraines have got worse over the 18 months which is part of the reason for stopping
I took my last tablet yesterday, I’ve not been back to the doctor since I sat there in tears, which was November, I thought I’d give it a try with out

Have you the option of another GP? Sorry but yours is useless. I'd go as far as writing a letter about her to the practice manager for mismanagement/ lack of education on HRT.

She clearly does not know the difference between Oestrogel and Ovestin Cream. Ovestin is a cream used in the vagina for vaginal atrophy.

This is appalling.

PLEASE find another GP- is there someone else in the practice?

This is just so awful and you are not getting the right treatment.

My very lovely regular gp retired just before I started on hrt the two I’ve seen since are fine but obviously don’t know much about the menopause, the first actually told me she knew next to nothing about it
There is one other who I’ve only seen once, a few years ago, about migraines, he point blank lied about treatment available, I compared about him and refused to see him since.
There isn’t a menopause clinic in my area but from looking on the internet, there is a private consultant not too far away.
I forgot to add, yes I do have a monthly bleed

I am thinking of giving up HRT too. I've been taking it for nearly 6 months. My main symptoms are low mood and anxiety. The HRT hasn't changed this at all. The other symptoms I get (mind fog and night sweats are nothing compared to feeling terrible every day). I have a Mirena and Estrogel. I am going to up my dose to 3 pumps as recommended by the excellent Jingling but if that doesn't work I may try to come off it and see what happens.

I woke up in a terrible anxious state today and thought I wasn't going to get through it. I dragged myself to yoga and had a brew with my friend and I suddenly feel loads better and the anxiety has worn off. Not suggesting that is a cure but maybe I need to address my anxiety in other ways.

It’s horrible felling like that Liver
I generally feel fine but by day three or four of the progesterone I star with migraines which last up to four days. My mood starts to drop my anger soars then I start to bleed after around seven days of progesterone. I bleed for seven to nine days.

Yorkie- you need a different HRT. There is no way you ought to be bleeding my day 7 of the progestogens especially when it's Femoston.

It sounds as if you are not absorbing the progestogen ( hence the headaches and the early bleed.) Women with migraine sometimes find the Mirena coil works well because a) it's contained in the uterus and b) you won't get the fluctuations of pills as they pass through the digestive system.

Pill form of HRT is becoming a bit passe now; new advice is to use transdermal as it has better absorption and is less risky re clotting.

You should try a patch, or gel and Utrogestan, or gel and the Mirena.

A good dr would work through all of these options with you.

Honestly, if this was a man's issue would GPs be allowed to be so untrained on something that affects all women and 50% of their Patients? No.

I didn’t think bleeding so early was right. It didn’t happen when I first started on elleste, the first three months I bled around day three of the oestrogen pills. As time went by it got earlier. I did tell both gps, both of whom are women, but they didn’t seem to think it was a problem
I’m really grateful for your help Jingling you have far more knowledge than either doctors I’ve seen. I’m not sure what to do though as I took my last hrt yesterday and wouldn’t be able to get an appointment until next week Thursday at the earliest. I’m so fed up of the hrt malarkey I really feel like trying to go without for good

What symptoms did you have that made you want to use HRT?

Not getting monthly migraines is a blessing of my menopause
Could you come off HRT for a trial period? That way, you can decide for yourself whether or not it is for you. Every woman is different and whilst HRT is brilliant for many women, it isn't for everyone.

That had been my initial plan miss come off it and see how I go. It was night sweats, several a night, lack of sleep, down to waking up hot drenched in sweat then night time anxiety. I put up with it for two years, tried herbal stuff like menopace but nothing helped and being so tired made me irritable so I went to the doctor for hrt. I’m hoping that the night sweats etc might have subsided after three and a half years.

Yorkie -the bleeding you had may be nothing to do with the HRT- have you thought of that?

If your own periods ha d not stopped, then they can return and be very irregular. Being on the mini pill, you didn't know if they had stopped or not.

This bleeding could be a natural period.

If you don't use HRT, you might have some bleeding which would be a period.

However, in peri you could go for many months with none then one comes out of the blue.

In the meantime, it's my guess that you will find the flushes and sweats come back as you are only 51- and many women find once their periods stop, these symptoms kick in even more (sorry).

One idea - could you stay off HRT for a month or two, find another dr, and then try another sort?

Or the other plan is see your GP and ask for a change in type of HRT- tell her you want an estrogen patch or gel and Utrogestan.

Thanks again Jingling I
I had wondered about my natural periods. I had some spotting for a couple of months after I started the mini pill then nothing at all for three years. After that I would bleed for a few days but not on a regular cycle. They stopped again after probably four years, i I think I went another three years without anything before I started on the hrt. So unfortunately I don’t know where I am with it all. I’m going to give it a go without anything and see how it goes. If the symptoms return and I can’t cope then I’m going back to the doctors but this time, thanks to your help and some more research, I’ll be better informed and more equipped to ask for different types of hrt. I’d like to think I won’t need it but I won’t hold my breath

Hrt doesn't suit everyone. I kept a log of all my symptoms, sleep quality etc... For 5 months, 3 of which was being on hrt Las year. I was looking at it again last week and it was very clear that although hrt helped with night sweats, I felt worse overall whilst on it getting worse as the weeks went by and the time I felt the best was the 4 weeks after I stopped it.

I still struggle with some aspects of it, but all in all, I am definitely better without it. Saying that, it is worth giving another regime a try, but sometimes, drugs dont do the miracles it do to others.

That’s a good idea swing I’ll start keeping a record of how I am since stopping and I’ll also write about the problems I’ve had whilst on hrt.
If I end up deciding I need to try hrt again I’ll at least be able to tell the doctor what’s happened and when. Thanks again

In general, migraine can get worse in peri menopause because of the huge rise and fall of hormones and the lack of complete cycles. As I mentioned before, pill form of HRT is the worst of all for anyone with migraines, partly due to possible added risk, but also because pill form HRT is not absorbed so well and produces metabolites during digestion which can cause side effects (including loss of libido.)
If you have any type of digestive issues- IBS for instance- it could be you are not absorbing the estrogen or the progestogen in a pill form.

If you are having a regular bleed only 3 weeks into the HRT cycle (day 7) either you are not absorbing the pill very well, or it's your own cycle breaking through.

Having a break for 2-4 months might help you see what's going on.