By Rachel Lankester, Founder, Magnificent Midlife
I came off HRT when most women are going on it, at the ‘average’ menopause age of 51. Coming off HRT at that age was always something I’d planned to do. Here I explain why and how I did that.
At 41 I found out I’d gone through early menopause. But I hadn’t experienced any signs of menopause! The doctor who told me was as shocked as me. At the time it was a devastating diagnosis because I was trying for another child. It was also very confusing as I thought everything was normal.
I suspect nowadays the diagnosis would be different. Or perhaps with a different doctor, the diagnosis might have been different. I think I was probably in perimenopause. Since it happened, I’ve learned the knowledge of doctors (GPs) in the UK, of menopause, is woefully inadequate. This is crazy considering menopause affects 50% of the population!
I was advised to take HRT at least until the average menopause age of 51. This was to protect my bones and heart from 10 fewer years of estrogen than ‘normal’. I wasn’t very keen on this particularly when all I was initially offered was Premarin which is made from pregnant mare’s urine (and yes mares are kept pregnant so they can produce this). But discovering I had borderline osteopenia in my hip after a bone scan 3 years later finally persuaded me to suck it up and take the HRT.
Knowing what I know now would I have made the same decision? I’m not sure. Then I followed the advice to go on hormone therapy, but only until average menopause age if I was feeling okay, and I took this advice to heart.
I decided to take the version that was as ‘natural’ as possible, coming from plants rather than horse’s urine. So I started taking Estradiol gel, and Utrogestan as my progesterone, as I needed that still having my womb. I also took vaginal estrogen pessaries in the form of Vagifem to combat issues with vaginal dryness.
Coming off HRT
I weaned myself off HRT at 51 as advised. I have an inherent dislike of taking medication unless I absolutely have to. High blood pressure didn’t go away after pregnancy, and I was advised to take medication because of family history. I took my BP meds at first, but subsequently tried lifestyle changes to keep my BP normal. I take a similar approach to menopause.
I don’t want to medicalize a natural transition in a woman’s life unless absolutely necessary. We don’t automatically medicate puberty, and I don’t believe hormone therapy should be the default option when it comes to menopause.
I was very confident of being able to wean myself off HRT without any adverse effects. I know a lot of women are worried. Why wasn’t I?
When I first got the early menopause diagnosis I consulted Dr Marilyn Glenville, a nutritionist who specializes in women’s health and particularly hormonal balance. Dr Glenville put me on a restricted diet, gave me a special tincture to take and within a month my periods had returned! This was quite miraculous for me and in retrospect shows how wrong the initial diagnosis was because of the hormonal fluctuation in the perimenopausal years.
What did I do in terms of changing my diet? I was told to cut out all caffeine, sugar, alcohol, processed food and have regular meals and snacks so my blood sugar level remained constant. I think I was also advised to cut out dairy but that’s a fuzzy (brain fog) memory! The herbal tincture I was given had some agnus castus in it.
The reversal didn’t last and within nine months I was back to my postmenopausal state. Maybe I didn’t keep up with the restricted diet, I can’t really remember. But this experience showed me that my lifestyle could have a direct impact on my hormonal balance (and that hormones can fluctuate wildly during perimenopause). I’ve continued with many of these ideas and learnt lots of new ones.
This is what I put in place before stopping the HRT. I tried to stop gradually, but it wasn’t really possible. I did reduce the estrogen gel, but as the progesterone was one pill nightly, and it couldn’t be cut in half, there wasn’t much I could do about reducing that gradually!
Here’s what I did when coming off HRT and what I continue to do now. Maintaining hormonal balance is a life-long thing!
- I eat healthy food regularly. I learnt the importance of balancing blood sugar levels so I try to limit sugar and processed foods as much as possible. I have not had any caffeine since my early menopause diagnosis and I know that I am better when I’m not drinking alcohol but I do still enjoy an alcohol beverage from time to time. It’s a choice you can make when you have the information you need. I also replaced dairy milk with organic soya milk though I do still eat cheese and occasionally yogurt.
- I added natural plant-based phytoestrogens to my diet in the form of soy, ground flaxseed and other seeds daily. I believe these have probably helped the most to keep my hormones stable. I find it fascinating that these foods are a major element of diets in countries where women appear to report less issues with menopause.
- I try to eat organic food as much as possible, especially for high risk food, to avoid any hormones or pesticides that might be in it and impact my hormones.
- My personal care products and cleaning products are also as natural as possible, to avoid anything getting easily through my skin that may impact my hormones.
- I found better ways to manage my stress including exercise, meditation and journaling. I have no doubt that the initial early menopause diagnosis was brought about because of the very stressful life that I lived.
- I was not overweight, but I have tried to maintain a healthy weight throughout this period, because I know that weight can have a big impact on hormonal balance and how well we cope with menopausal issues. A bit of extra midlife weight gain is not necessarily to be worried about. But there is much we can do if it starts to get out of hand and fat around the middle is not good for our long-term health.
- I increased my exercise and currently I try to do something every day. I think every midlife woman should be doing yoga because it is so good for achy joints and muscles. Running, being weight-bearing, helps maintain my bone density, and I also lift weights to further strengthen my bones and maintain muscle mass, and avoid the slowing of my metabolism which can lead to weight gain.
Immediately after coming off HRT, I was my own guinea pig. When I had an alcoholic drink or some chocolate I immediately had a hot flush, so I could see the impact these things had on me. This hasn’t meant that I have stopped drinking or eating chocolate. When I first came off HRT, I just thought of the hot flush as my little power surge and it was worth it! As time has gone on, these things don’t impact me anymore as they did when I first stopped the hormone treatment.
One hormone treatment I do still continue occasionally is vaginal estrogen as vaginal dryness can be an issue. But I only take this when I remember and it’s not a problem if I forget. I now prefer a vaginal estrogen cream, as the Vagifem pessaries, each with a plastic applicator, seem environmentally very unfriendly! I feel more comfortable with this as it is so localized and not impacting my whole hormone system.
I recommend a brilliant lubricant Pjur silicon lubricant. I’ve also talked elsewhere about the power of vibrators which can be particularly useful post menopause. If you haven’t indulged already now is seriously the time!
I’ve written extensively about the many natural ways to manage the menopause transition and remedies for specific issues too. You can find lots more information about things that will help here.
I believe how we feel about midlife, aging and menopause has a dramatic impact on our experience of each. I’m so passionate about giving women the information they need to thrive, not just survive through menopause, that I wrote a book: Magnificent Midlife: Transform Your Middle Years, Menopause and Beyond. There is loads more in there about how to transition through the change and create your own magnificent next chapter. Good luck!
Rachel Lankester is the founder of Magnificent Midlife, author, host of the Magnificent Midlife Podcast, a midlife mentor and editor of the Mutton Club online magazine. After an initially devastating early menopause at 41, she dedicated herself to helping women vibrantly transition through the sometimes messy middle of life, helping them cope better with menopause and ageing in general, and create magnificent next chapters. She’s been featured in/on BBC Woman’s Hour, The Huffington Post, The Sunday Times, Thrive Global, Authority Magazine, The Age Buster, Woman’s Weekly, Prima Magazine, eShe, Tatler HK and Woman’s Own amongst others. She believes we just get better with age. Get her book Magnificent Midlife: Transform Your Middle Years, Menopause and Beyond.