Is there any criteria for How Long to Stay on HRT?

With all the discussion on whether to go on HRT and what are the benefits and risks, the debate encourages us to continually question and be open to seeking out and listening to new information. This is so important even when the information may difficult to hear.

I am constantly trying to weigh risks vs benefits. I also think there is a quality of life issue, that each person has the right to play into their risk/benefit decision.

The reason it is difficult to determine when to "come off" the estrogen replacement even for our sisters who are on replacement therapy after surgery, of course , is because we are all so different. Different histories, different lifestyles. I think that is going to be our doctor's greatest challenge.

Currently, I am 47 (TVH/BSO)and I am apparently replacing what I would be making on my own, BUT, no one seems to have a good idea or protocol for when I should go off and when I would really just be "supplementing like our non-surgical sisters." I live in an area with top docs and still it is very complicated . I agree...taking something that has not been "time tested" seems absurd, yet here we are...we can't or don't chose to always "wait for the research". I guess the part that is most frustrating is the idea that an appropriate time to "come off" the medication, is as an ambiguous question as how long to stay on!

Joy,
In the beginning I thought that I would be on hrt for the rest of my life. I am rethinking that opinion now. I know for sure that I'll be on my hrt for the near future, but I, like you am not sure when I should look at tapering off.

Sorry I don't have the answer here for you, but I'm interested to see what others have to say. That's a very good question that you have raised.

Since I'm 44 my doc said to stay on it until the time when i would naturally go through meno (about early 50's) and then decide if I want to continue. It seems to make sense to me. Even if I didn't have meno symptoms now I still want the estrogen for my bones. I work in healthcare and see what the silent disease of osteoporsis does and it's not pretty.
It is frustrating because HRT studies take years and years - too long.

Well, I've chosen to go the 'natural route'....but if I were on HRT, Id go off of them when I felt it was time. Talk, talk, talk to your doctor...YOU are the one who has to make that decision...no one else. If you ask 12 different women, you're going to get 12 different responses. My doctor left this up to me...it's your choice.

As I've written before on this board, my doctor and I decided before the hysterectomy that I would stay on HRT for six to eight months to get me over the "hump" but I would have to be sure to keep up all the weight-bearing exercises I do to try to avoid osteoporosis. By the way, one of the many books I've read has a test for whether or not you're a good candidate for osteoporosis- based on relatives, diet, lifestyle, etc - and I was not a good candidate. Hopefully it's right.

So, I have been easing myself off my Vivelle Dot, which started out as .1mg trice a week and is now .05mg just once a week. I am also taking Estroven, which has black cohosh (among other things, including the feared kava kava root) and has been recommended to me by many women. I also take One a Day vitamins for women over 50 (even though I'm 46, LOL), Flax Seed gel tabs, Vitamin C, thyroid medicine (Armour), and sinus medicine.

I think I've had two hot flashes (having nothing to compare them to, I'm not sure!) that each lasted about 45 seconds and cut off abruptly, but that was the first time I went a full week without changing the .05mg patch; now it's no problem.

I'm just keeping notes of how I feel and everything, and I'll see how it goes. So far, so good!

Well, based on what's known now (and take that with a grain of salt), I think a rule of thumb in the Jungle is that HRT does not raise risks--in general--until the age of natural menopause, circa 53. After that, it's like anyone else and HRT should be evaluated every few years, with risk starting to edge upward around age 57. A lot of the risks involve total lifetime exposure to hormones. If I already had heart disease, I would think long and hard before taking it though because there's a spike in risks of an event the first year. I think the real lesson right now is that HRT is not one size fits all.

So, I think the best criteria is your own body. I went 6 months without HRT. I didn't struggle with hot flashes--just a thermostat set high Where I used to never sweat, I pour it out at teh least exertion now. I didn't think I needed HRT to manage symptoms. But at the end of that 6 months, I had urge incontinence that was severely restricting my life, brain fog that was endangering my job, and joint pain. Way back when, we weren't as clear on what vines made up the Jungle, so I didn't add it all up until I started HRT. I started it because at the time they were so sure it helped heart disease, which is rampant in my family. They all cleared up. Whenever I try to stop, they all come back. I'd even forgotten about the joint pain, until whammo back it came.

So, my body tells me that it needs my very low dose of Estrace. Osteoporosis does run in my family. And considering how restricted my activity is when off hrt, that's far more unhealthy than any of the general statistics involving HRT. So, I'm suspicious that it'll be a long time before I'm off it. I'm 50. It also helps my depression which I've battled all my life (and severe depression has a 20% mortality). So, for me, I'm far healthier on it than off.

I'm suspicious based on the evidence (the hundreds of studies in vitro and in mice showing the actual mechanisms why estradiol would improve artery health etc. and the epidemiological studies, such as the massive nurses' study, that show that women on HRT live up to 10 years longer) that what they'll find is that there are certain women who should not take HRT, that there are certain kinds of hrt that work better than others for different purposes, and that there will be screening mechanisms sometime in the future to match women with a plan. But if all the funding for research gets yanked, we may never get to that point of sorting out the contradictions.

Hope this helps!

Thanks for taking the time to post your thoughts on your decision-making process regarding HRT. I too have heart disease rampant through my family...so I was disappointed to hear that it may not have the benefit it was once suspected of having. It is also helpful to hear from everyone, as we can at least "compare notes" on our understanding of the medical community's thinking on HRT.
I do plan to stay on my HRT. I had not experienced any menopausal symptoms prior to my TVH/BSO. I also rarely sweat, and now I am dripping, some of it has to do with this east coast heat, but I notice a change.
I hope more women respond to this post, as I think it is helpful to hear each individuals experience.
JOY

Hi gals!

I just had my hsyt a month ago and began HRT at that time based on my DR's advice.

My DR and I discussed how long to continue it (I'm only 40). She said "Good Question!!" She indicated that since the research and studies are so contradictory, every woman now on HRT should stay abreast of the findings and continue to question/make decisions as new info becomes available.

For me, she suggested to plan to continue HRT till I'm 50 years old, and by then (?hopefully) there may be some better quidelines about how long to say on it.

Each one of us is such a *unique* individual, with different chemical and genetic makeups, different lifestyles, different stages of maturity and health, that I doubt there will ever be a standard "recipe" to follow.

KUDOS to all of us for trying to get as much info as we can and for making the best choice based on that!!!

Hi Ladies,
I have been reading messages on this site off and on for about a year now. I had a hyst 9/18/01. I have been on Premarin since. I am really not having any problems but I am having doubts as so whether it is the best thing for me. I am so confused! The more I read though, I realize that it is a personal decision. I plan to call my doc and discuss it with him. Thanks to all for this site. It is so helpful to see that I am not alone.
Cathy

This is a great discussion --

You know rather than talking about absolutes - stay on for a year. five years or ten, I've decided to just rethink the issue every year - I have both cancer and heart disease in my family, so I doubt that HRT will be a lifetime thing - but at this point the science is just changing so fast that I really don't know what I will do next year.

Dorrie