Article by Dr Marilyn Glenville
Women going through the menopause are now facing a national shortage of hormone replacement therapy (HRT) as was recently reported. The Department for Health and Social Care said it was aware of on-going supply issues due to manufacturing delays. In pressing times, it is reassuring to know that alternative treatments for menopausal symptoms are available. The UK’s Leading Nutritionist Dr Marilyn Glenville offers her advice for alternative natural treatments to HRT…
Shortage of HRT
Marilyn discusses, “You may have heard that there is a shortage of HRT drugs and that this shortage could last until 2020. Half of all HRT drugs brands are out of stock at the moment and this is affecting all High Street pharmacies so they can’t fulfil the prescriptions the GPs have written. Some women are being prescribed different forms of HRT because their original prescription is unavailable and it may not be a form that suits them. If you can’t get your usual HRT medication or know that you won’t be able to get another supply after a month or so then it is definitely thinking about putting in some natural alternatives to help you through this stage in your life. Remember that the menopause is just a transition, as women we are moving from one stage in our life to another. Not all women have a miserable time during the menopause. Symptoms can vary and some women sail through – the only thing they notice is that their periods have stopped. While others can experiences such extreme night sweats that they have to get up to change their night clothes two or three times a night, or even taking a shower in the middle of the night. There are good natural alternatives that can work well to control the symptoms if you can’t get hold of your usual HRT medication.”
Tips to help you prepare and transition through the menopause
“The menopause is a natural stage in your life and there a number of top tips to help you prepare and pass through this transition easily and comfortably. Symptoms that your body is preparing for the menopause can start in the mid-40s (or earlier) and can include changes in the frequency or heaviness of your periods, premenstrual tension, mood swings and irritability. As your body produces less and less oestrogen, other symptoms may appear, including aching joints, depression, lack of energy, joint pains, declining libido, weight gain, headaches and, most commonly, hot flushes and night sweats. Hot flushes and night sweats are among the most common and uncomfortable symptoms and their frequency and severity can vary from woman to woman. Certain foods and situations can trigger some hot flushes and these can include spicy foods, caffeinated drinks, alcohol and stressful situations.”
1) Increase Your Intake Of Phytoestrogens
Pay particular attention to adding phytoestrogens to your diet as these foods will help cushion the effects of the hormone roller coaster as you go through the menopause. We know that women who eat a diet rich in phytoestrogens have significantly fewer hot flushes, up to half the amount experienced by women who eat very few phytoestrogens so make sure these are included in your diet and go for variety. Contrary to popular opinion phytoestrogens do not supply oestrogen but have a balancing effect on your hormones.
Phytoestrogens (isoflavones) work literally like a key. The cells in your body have oestrogen receptors on them that act like a lock; they need a key that fits into that lock to ‘stimulate’ them into activity. This activity can be beneficial in certain places in the body like your bones and brain where you want the cells to stay active but can be negative in other places like the breasts and womb where you do not want cells to be too stimulated, causing them to multiply and then mutate. There are two different kinds of oestrogen receptors, alpha and beta.
You have alpha-receptors in your breasts, ovaries and womb and beta-receptors in your brain, bones, blood vessels and bladder as well as in your breasts, womb and ovaries. Your breasts, ovaries and womb have both alpha and beta-receptors. HRT triggers both alpha and beta-receptors, which is why it can increase the risk of breast, ovarian and womb cancer when it stimulates the cells in those areas. Isoflavones, as found in chickpeas, lentils and soya, work in a completely different way. Isoflavones bind to beta-receptors and stimulate beneficial effects in the brain, bone, heart and bladder. In the breast, womb and ovaries they bind to the beta-receptors and this prevents the over-stimulation of the alpha-receptors and can block proliferation and prevent cancer. It is this SERM effect (Selective Estrogen Receptor Modulator) that is why they are beneficial.
2) Get A Helping Hand From Herbs
There are a number of herbs that are helpful for the menopause including soya, sage, flaxseeds, hops and red clover. Sage has been shown to decrease hot flushes by 50% after 4 weeks and by 64% after 8 weeks. It also helps with decreasing insomnia, irritability, anxiety, physical and mental exhaustion by up to 47%, which can all be symptoms around the menopause. Hops have been shown to help with both hot flushes and night sweats. Red clover is one of the most extensively studied herbs and research indicates that it significantly reduces vasomotor symptoms compared to a placebo. I use a combination of these organic herbs in my clinics called Meno Herbal Support available from (RRP£23.77,www.naturalhealthpractice.com)
3) Balance Blood Sugar Levels To Help Your Mood
If you are suffering from increased mood swings, irritability and depression then taking measures to balance your blood sugar is absolutely crucial. This means not only thinking about the quality of the food that you eat but also the timing. You need to completely eliminate added sugar and refined carbohydrates in order to see a marked improvement in your moods. The other important consideration is to eat little and often. This means not going more than three hours without eating. If you wait longer than this, your blood sugar will drop and the stress hormones adrenaline and cortisol will be released. It is the release of these hormones that gives rise to many of the symptoms relating to anxiety, tension, crying spells, depression and irritability.
Also try to control stress as it is well known that the more stressed you are the more severe the menopause symptoms can be as your adrenal glands are the major source of oestrogen through the menopause. Look at the stress in your life and see what you can control, balance your blood sugar to reduce the release of the stress hormones, reduce or eliminate caffeine and take a supplement to help e.g. NHP’s Tranquil Woman Support
4) Look After Your Bone Health With Omega 3 and Vitamin D
Aching and stiff joints are common before, during and after the menopause and this is caused by the decrease in oestrogen. Eat plenty of foods rich in omega 3 fatty acids, such as oily fish, nuts and seeds as these foods help create anti-inflammatory prostaglandins that can ease the pain and inflammation of swollen joints. If you do not eat much of these foods then add in a good Omega 3 fish oil supplement containing at least 700mg EPA and 500mg DHA per day – I use NHP’s Omega 3 Plus in the clinic . Cut down or eliminate red meat as this can contribute to the production of ‘bad’ prostaglandins that will increase inflammation in the joints.
We know that vitamin D is important for bone health around the menopause, but it has now been shown that people who have joint and low back pain can be deficient in vitamin D and when the vitamin D deficiency is corrected the pain is eliminated. The research is showing that having good levels of vitamin D has many benefits e.g. prevention of cancer, especially breast cancer, heart disease, slowing down the ageing process and Type 2 diabetes. Always take vitamin D as D3-cholecalciferol, rather than D2-ergocalciferol, which is not as efficient as D3 in helping to correct low levels of Vitamin D in the body.
5) What About Bioidentical HRT?
I would use the herbs as mentioned above as alternatives to HRT. But some women may be under the impression that bio-identical HRT is a ‘natural’ alternative to HRT. Bioidentical hormones are chemically similar in structure to the hormones your body would produce naturally, so this could include oestradiol, oestriol, testosterone, progesterone or even other hormones like DHEA. In this way, they are considered more ‘natural’ than the synthetic versions used in many but not all HRT drugs. They are often connected to individualised hormone therapy treatment where compounding pharmacies will make up different prescriptions of these bioidentical hormones, often based on the results of saliva or blood tests. It is this ‘tailoring’ of bioidentical hormones for an individual patient that makes them different, and in many people’s eyes, more ‘natural’ and therefore better.
But to be clear from the outset, these hormones are still made in a lab in the same way that the conventional HRT would be made and from the same sources. Would I personally consider bio-identical hormones a ‘natural solution’? Definitely not, for a number of reasons…
Firstly, these are hormones just as in HRT except that that they are marketed as having a molecular structure similar to our own. But, there are conventional HRT preparations that contain bioidentical hormones; they are just not tailored individually based on hormone testing. No matter what stage of the menopause you are in, by replacing hormones that are naturally decreasing, you are basically telling your body that its natural rhythm is ‘wrong’ and that this decline should not be happening. Secondly, when would you stop taking them? If it were indeed correct to replace these naturally declining hormones then you would need to take them forever. And indeed, some women think it is fine to take these hormones indefinitely.
The exception to this I would suggest is when a woman needs HRT because she has gone through a premature menopause (premature ovarian failure). In such a situation you are really replacing those hormones that should naturally be circulating in your body. If you can do that with more ‘natural’ hormones then bioidentical hormones would seem a better choice because you are replacing those hormones in the same molecular form that your own body would have produced them rather than a synthetic version.
6) Coming Off HRT Therapy…
You should talk to your doctor about coming off HRT. My recommendation is a gradual weaning process, which is going to be easier on your body, if this is possible. Stopping HRT suddenly is similar to going ‘cold turkey’ and you can get withdrawal symptoms like hot flushes. It is better to take three months to gradually wean yourself off HRT. Ask your doctor for a lower dose and if you cannot reduce the dose of the HRT, you could switch to a patch. Because the patch delivers oestrogen through the skin and does not have to be broken down by the liver first, you can get by with a lower dose than if it is taken by mouth. During that three month weaning process, you would then start to introduce phytoestrogens (like soya, chickpeas, linseeds etc.) into your diet so that when you stop the HRT you are cushioned by plant oestrogens already circulating in your system, as explained above. If you need extra help then you can use herbs like black cohosh, agnus castus, dong quai and sage, which have, been shown to help with the symptoms of the menopause. A good organic herbal combination is NHP’s Black Cohosh Plus
Making sure that you are eating well during the menopause is not only going to help you with this transition but it will give you a really good foundation for your long term health. You can have another 30 to 50 years to live into the future and so you want to take advantage now of sowing the seeds of good health.
You can read more in Marilyn’s book Natural Solutions to Menopause