Is Stopping Estradiol Cold Turkey Safe?

September 07, 2020.

Hormone replacement therapy (HRT) is an effective solution for treating some of the most troublesome menopause symptoms. Whether you struggle with hot flashes, mood swings, vaginal dryness, low libido, bloating, or all of the above, HRT can help you sail through your menopause journey more comfortably. But, how does it work when you are ready to stop taking HRT? Many women ask, is stopping estradiol cold turkey okay? Here’s the rundown on stopping estradiol cold turkey.

What is HRT?

Hormone replacement therapy helps increase hormone levels in women with low estrogen, low progesterone, or both. Women naturally have lower estrogen and progesterone once they hit menopause. However, some medical treatments can also lower these predominately female sex hormones, such as removal of the ovaries or uterus. 

When estrogen and progesterone levels are low, it can create several uncomfortable symptoms. It also can increase a woman’s risk for certain health conditions like heart disease and osteoporosis. In particular, estrogen is cardioprotective and bone-protective, meaning that when levels fall, it puts you at greater risk for health issues in those body systems. Thus, many women use HRT not only to relieve their menopause symptoms but also to protect other body systems. 

What are the different types of HRT?

There are two main types of HRT: combined HRT and estrogen-only HRT. 

  • Combined HRT is a combination of estrogen and progesterone. Women who still have their uterus most commonly take this type of HRT as estrogen-only HRT can increase your risk for uterine cancer
  • Estrogen-only HRT (referred to as ET for estrogen therapy) is commonly prescribed in women who have had a hysterectomy. 

There are over 50 different kinds of HRT available to women to meet a variety of needs. HRT not only differs in dosing and hormone concentrations, but it also varies based on the route of delivery. Different routes of HRT include

  •  By mouth (via a pill)
  • Transdermal (through your skin as a gel or patch)
  • An implant
  • Vaginal ring or cream

How do you take estradiol?

Estradiol is a form of estrogen produced by the ovaries. This type of estrogen has been replicated in a lab to act like estrogen in the body when used as a medication. Women can take estradiol in a variety of forms, just as you see above. For women with vaginal-only symptoms, such as dryness, frequent vaginal infections (like yeast and bacterial vaginosis), and painful intercourse, using a vaginal cream or ring can help alleviate those symptoms without causing systemic effects. Examples of vaginal estradiol include Yuvafem, Vagifem, Estrace, and Femring.

How you take estradiol depends on what route of delivery the medication is and what you are treating. Your doctor should tell you exactly how to use your medication to treat your symptoms. 

Stopping estradiol cold turkey?

How you stop estradiol also depends on the route and what you are using it to treat. It also depends on why you need to stop taking ET. In general, stopping estradiol cold turkey is normal with your doctor’s approval, as there are no set medical guidelines for how to taper off ET. Some providers may wish to create a taper schedule, so you slowly wean off the dose to prevent a sudden onset of menopause symptoms. Yet, many providers will recommend you go ahead and stop your medication, especially if you have a medical condition worsened by estrogen. For example, women diagnosed with breast cancer should stop taking HRT right away.  

One of the most significant issues women face when stopping estradiol cold turkey is that they get intense menopausal symptoms once they quit taking their medication. These symptoms include hot flashes, moodiness, fatigue, and vaginal discomfort. However, once your hormones stabilize after stopping ET, you should see an improvement in your symptoms. 

Women may choose to stop ET for several reasons. If you are thinking about stopping estradiol cold turkey, make sure to talk to your doctor. Open communication with your doctor will help you feel confident that you are making the right decision and are prepared for side effects and symptoms associated with going off of ET.

Disclaimer: this is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment. 

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Julia Walker
perry expert Julia (RN, BSN, BA) is a registered nurse based in Colorado. Julia's nursing background in women’s health has ranged from neonatal and postpartum care to labor and delivery, to outpatient gynecological medicine for both adolescent and adult populations. She specializes in helping women optimize their health during perimenopause and beyond.

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