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Is HRT Dead?

Is Hormone Replacement Therapy dead?

Helen Franks reports 

I never thought I would hear a consultant gynaecologist ask the question: ‘Is HRT dead?’ but that’s exactly what Michael Dooley of Dorset County Hospital called his talk at a recent gathering of health writers.

Following the halt of a large, long-term trial of women on HRT, because of increased risk of breast cancer, heart disease, stroke and blood clots among women on the treatment, a great many questions need to be answered before doctors can prescribe it with the confidence they once had.

Even the protective qualities of HRT are being revised.

 

Fractures: Yes, HRT does appear to reduce risk of vertebral fractures, but no, according to the latest research, it doesn’t offer protection against other fractures, such as arm, hip, thigh.

Heart disease prevention: No, HRT turns out to be a risk factor, not a protection against heart disease.

Alzheimer’s disease: Case for protection against this condition not proven. 

Mr Dooley concluded that an integrated approach to the menopause was the way for the future, and that included alternative therapies.

Menopause symptoms

Every woman’s experience of the menopause is different. Some find it a frustrating and difficult time, others seem to sail through it without any problems.  In physiological terms, the menopause occurs when a woman’s ovaries stop producing eggs and she has her last period. In the approach to the menopause women may experience symptoms due to hormonal changes. Such as: irregular periods, aching joints, vaginal dryness and changes in sexual desire, a decreased ability to concentrate or remember things, hot flushes and excessive sweating, particularly at night, a need to urinate frequently, insomnia, mood changes, headaches. (Only an unfortunate minority experience all of them; most women experience one or two at most.)

Different symptoms, different cultures

In the UK and United States, the menopause is medicalised. Women are told to expect unpleasant symptoms and to look to their doctors for treatments and  remedies.

In Greece and Japan, fewer symptoms are recorded. Studies in Japan have revealed that women experience few if any adverse symptoms at the time of the menopause (there is no Japanese translation for “hot flush”) and they have half the hip fracture rate of women in the West. But there is another cultural difference to take into account: Japanese women are discouraged about expressing symptoms.

In China, the menopause is considered a natural part of ageing. 

In Indonesia, the menopausal woman is venerated.

In Canada, menopausal women are considered to have healing powers.

In Africa, the menopause is associated with sexual liberation.

 

What do you do if you don’t want HRT?

There are several alternatives for bone preservation or reversal available on prescription, such as biphosphonates which have been used for several years. New treatments are in the pipeline too. Scientists are pinning their hopes on a drug called Actonel which is showing good results in research trials from Columbia University in New York. But it is the holistic approach, using natural supplements, good diet, exercise and a healthy lifestyle, that is attracting most interest. 

Natural remedies

There’s a growing body of evidence to support claims that isoflavone supplements reduce symptoms of menopause such as hot flushing, sleep disturbance, mild anxiety or depression, and loss of libido. Dr Paola Albertazzi, Clinical Lecturer at the Centre for Metabolic Bone Disease, Hull and East Yorkshire Hospitals, has found that women experienced relief of hot flushes by 45% with soya isoflavone supplementation. 

Producers of Arkopharma, a soya isoflavone, back this up with a double-blind study showing a reduction of symptoms of between 40 and 60%. Novogen, makers of another isoflavone, Redclover, report a 44% reduction of hot flushes in users after a 12-week trial. Isoflavones are plant-based oestrogens (another word for them is ‘phyto-oestrogens’), and there is a questionmark about their safety. The theory is that they could have an effect on breast cells similar to that from HRT, and therefore there is a possible small risk of triggering breast cancer if used on a long-term basis.  Anyone with a family history of breast cancer should discuss the situation with their doctor. Both products are available from chemists and health food stores.

Other alternative remedies include taking fish oil supplements, calcium and vitamin D.  Herbal remedies include boron, St John’s Wort, black cohosh which are said to relieve hot flushes, depression and vaginal dryness. Acupuncture and homeopathy have been known to help reduce various symptoms.

Diet and lifestyle

     Many women find that keeping alcohol consumption low minimises hormonal fluctuations.  Avoiding caffeine can reduce the incidence of night sweats, mood swings and headaches.   

     Hot spices can make even non-menopausal women (and men) break into a sweat.  Compensate with  use of fresh herbs and other flavour enhancers such as lemon and lime juice. 

     To reduce night sweats,  keep a jug of water infused with some lemon slices and mint leaves by the bed to drink.  Wear cotton nightwear, not synthetics.

     A diet low in fatty foods may help, which means keeping a strict eye on intake of cheese, cream, and fatty animal products.  Use olive and other vegetable or nut oils instead of butter.   These oils also contain vitamin E (as do avocados, mangoes, blackberries and seeds) which has been linked with an improvement in menopausal symptoms. 

     Exercise becomes even more important than usual.  It can reduce cholesterol, improve circulation, bone mass density and general well-being. 

     Find the exercise which suits you and your fitness level, whether it is going for a walk in the morning or evening two or three times a week, going swimming once a week or joining your local gym. Try yoga or pilates to increase flexibility and core body strength. 

     Relaxing during the menopause is also important to reduce stress.  A regular massage, aromatherapy oils in the bath,  listening to classical music have a calming effect.  

Contacts

National Osteoporosis Society www.nos.org.uk  publishes booklets, runs helpline

Women’s Nutritional Advisory Service offers diet advice, alternative treatments 


  
    


 

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