If you’ve talked to your doctor about menopause, it’s quite likely you’ve been offered HRT: hormone replacement therapy. This medication provides synthetic versions of the hormones which naturally decline during menopause, usually given in a combined form with oestrogen and progesterone. It’s natural to want to find a solution to the symptoms you’re experiencing, and many in the medical profession see HRT as a solution for all symptoms of menopause. However, HRT does have its pros and cons, and there are natural alternatives to consider.
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.
For more advice and information about the menopause, please visit our Menopause Advice Centre.
From Catherine Jeans
Catherine Jeans DipION mBANT CNHC is a nutritional therapist and founder of The Family Nutrition Expert. She has a special interest in women’s health, supporting hormonal balance and optimal wellbeing in women of all ages, through the use of food, nutrition and functional health.