The pros and cons of HRT
Some women swear by HRT and have found great comfort in relief from their symptoms of night sweats, insomnia, continual hot flushes and vaginal dryness. Unfortunately, when you stop taking HRT, you’ll go through menopause again as your hormones decline.
HRT may also be prescribed if your doctor believes you are at risk of osteoporosis, due to the effects of oestrogen on supporting bone turnover. However, HRT has been shown to increase your risk of ovarian and breast cancer, with a review in the Lancet in 2015 showing that even short term use of HRT could increase ovarian cancer risk by up to 43%.
Natural Alternatives to HRT
Vitamin E: Around 75% of menopausal women experience hot flushes, and research has shown a significant reduction in their severity and frequency from taking 400IU of vitamin E per day. The same dose of vitamin E has also been shown to help reduce vaginal dryness. Good food sources include avocados, seed oils, nuts, leafy green vegetables, whole grains and wheat germ. If you opt for a vitamin E supplement, look for one that contains d-alpha-tocopherol, as this is better absorbed.
Omega 3 essential fatty acids: The signs of omega 3 deficiency are similar to many symptoms experienced during menopause: dry skin, fatigue, depression, and aching joints. Omega 3 essential fats also support hormone balance, and have a lubricating effect in the body, so may help with vaginal dryness, and have been linked to a reduction in risk of breast cancer. Good food sources include oily fish (salmon, mackerel, herring, sardines, seafood and fresh tuna), nuts, seeds and green leafy vegetables.
If you don’t like fish, it’s worth supplementing fish oil daily. Look for one with at least 200mg of EPA per daily dose. For vegetarians, include flax and chia seeds in your daily diet, and look for a vegetarian omega 3 supplement.
Black cohosh: This medicinal herb has been used for centuries to support menopausal women, and may help with hot flushes, depression, night sweats and vaginal dryness. Research has shown an improvement in symptoms in up to 80% of women using black cohosh within six to eight weeks.
There’s been a lot of controversy over this herb, with some calling into question the safety of black cohosh on breast tissue. However, most recent research suggests that black cohosh is a selective oestrogen receptor modulator (SERM), which means that it stimulates only certain oestrogen receptors in the body: namely, the bones and the brain, and not womb or breast tissue. The best way to take black cohosh is as a supplement, and some menopause supporting supplements contain this herb. Or you could visit your local medical herbalist who can make you a bespoke tincture containing black cohosh.
Phytoestrogenic foods: Foods rich in phytoestrogens may help to moderate symptoms of menopause due their effect on oestrogen receptors on the cell membrane. In cases where oestrogen levels are low, they lock into receptors and stimulate a mild oestrogenic effect. Where there is an oestrogen excess, the phytoestrogens block cell receptors. Foods rich in phytoestrogens include soya foods such as miso, tempeh and tofu, lentils, linseeds, mungbeans, garlic, fennel, parsley and celery.
Milk thistle: The active ingredient in milk thistle is a bioflavonoid called silymarin, which can help to support hormonal balance through its protective action on the liver. Any excess hormones we have in our body are detoxified and excreted via the liver and gut, which makes milk thistle an excellent herb to help support hormonal balance, and to help protect ourselves against hormone related female cancers.
Vitamin D: Many women are prescribed HRT as a prevention for osteoporosis, particularly if they have gone through an early menopause or have had a full hysterectomy. However, supporting bone density doesn’t rely on just having the right hormones present. There are key nutrients as well, and vitamin D is one of them. Calcium absorption depends on vitamin D, and it’s made through the action of sunlight on the skin. Our ability to absorb it decreases with age, and given the food sources are limited, it’s important to supplement. So alongside sensible sun exposure when the sun is out, supplement around 1000 – 2000 iu per day (25mcg to 50 mcg), of the D3 form, which is better absorbed.
B vitamins: If you’re experiencing stress, panic attacks, anxiety or depression, then B vitamins can be very supportive. Known as the ‘stress nutrients’, B vitamins help to support your nervous system, the production of your feel good neurotransmitter serotonin, and help your adrenal glands to manage stress. As the B vitamins work in harmony, it’s best to choose a B complex that provides a range of B vitamins from B1 to B6, plus B12 and folic acid. Food sources of B vitamins include green leafy vegetables, meat, fish, eggs, dairy and fortified foods.
But how safe is HRT?
Going through the menopause is a natural part of life for most woman and symptoms range in severity from almost none (for the lucky few) to raging hot flushes, pelvic problems, emotional flare-ups and sleepless nights. So how safe and helpful is hormone replacement therapy (HRT) and should we all be taking replacing our hormones to improve our menopausal wellbeing?
What is Hormone Replacement Therapy?
The concept of replacing lost or declining hormones has been around since the late 1800s, but HRT has come on a long way since its original use of bovine ovarian tissue (extracted from cows) and pregnant horse’s urine (popular in America). Today, the vast majority of the commonly prescribed UK and European HRT formulations are plant-derived and come from the oestrogen-rich yam plant. These hormones include oestrogen and progesterone (to boost naturally declining supplies) and occasionally testosterone too (yes, women do produce testosterone and this decreases in later life, alongside oestrogen and progesterone). Not only can replacing these lost hormones improve a range of menopausal symptoms, but HRT has also been shown to lower the risk of heart disease and osteoporosis. It’s the most effective, clinically proven treatment there is for relieving symptoms such as hot flushes, night sweats, joint pains, mood swings and urinary incontinence, and for the vast majority of those under 60 years old, overall the benefits of HRT would definitely seem to outweigh the risks.
Should I be taking Hormone Replacement Therapy?
The elephant in the room during the menopause is often ‘should I take HRT to help my menopausal symptoms?’. Most symptoms of the menopause are due to fluctuating (and then low, or no) levels of the hormone oestrogen. All types of HRT contain an oestrogen hormone and this is what replaces the body’s natural supplies. Other hormones that may be taken as part of HRT are testosterone and progesterone (in the form of progestogen). The doses and types of hormones very much vary according to your own personal medical history, symptoms and need, so it’s important to discuss your symptoms in detail with your GP and, if necessary, get a second opinion from a doctor who specialises in this area. The good news is that even low levels of HRT taken temporarily can be of significant benefit and may dramatically improve your day-to-day well-being.
What's best for me?
It’s easy to feel confused about the different types of HRT, as well as about the benefits and risks of taking it, so it’s very important that your own individual health is taken into consideration by your doctor here. HRT brings many benefits, including the treatment of vaginal dryness (which can lead to urinary tract infections), depression and loss of libido. Other positives are HRT’s ability to increase bone density and the protection of discs in the spine.
Ways of taking Hormone Replacement Therapy
HRT is taken as tablets, skin patches or gel – or as a combination of these. As the hormones in skin patches and gels are absorbed through the skin, they’re sometimes a better option to pills that are processed via the liver. As the skin is so protective, it’s hard for substances to get through, but HRT skin patches and gels are made in a different way from everyday skincare. The patches work by forming an occlusive sticking plaster-like barrier over the skin, keeping the hormone loaded onto the patch and in direct contact with the skin 24/7. The gels are normally made with the emulsifier triethanolamine, an ingredient unusually compatible with both oils and water, making it more easily absorbed into the body through the skin. One or two pumps of oestrogen-rich gel are usually applied each night. Tablets are relatively straightforward to take and it’s often handier to take the progestogen tablets, such as Utrogestan, last thing at night as they can make you feel slightly sleepy (a helpful side-effect at bedtime!). Your doctor may also suggest having a Mirena coil (IUD) fitted to release small amounts of progesterone internally. This is especially convenient as it stays in place for several years without a further thought.