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Hormone replacement therapy (HRT) is considered, for most women, to be a safe and effective method for treating menopausal symptoms for up to five years. However, there are alternatives available. It's important to take into account your age, medical history, specific risk factors and personal preferences when talking through your options with your GP before making your decision. According to Dr Sarah Brewer, GP and medical nutritionist, 'HRT is effective in overcoming menopausal symptoms, but not everyone is willing or able to take it. Natural alternatives are available'.
Here Dr Brewer looks at the experiences of four women who each sought different solutions to their menopausal problems.
Julie, 48, experienced night sweats, which woke her at night and were so bad she had to shower and change. She also noticed her skin becoming much drier. Although her doctor suggested HRT, she was keen to find a more natural solution.
'In Asian cultures, few women experience troublesome symptoms at the menopause as they have a high intake of plant-based, oestrogen hormones, naturally in their diet - which helps to smooth this mid-life transition,' explains Dr Brewer. 'Asian women obtain high levels of plant hormones with an oestrogen-like action such as isoflavones (found in members of the pea and bean family, especially soy beans and chickpeas), lignans (found mainly in ground linseed but also in sesame seeds, beansprouts, chickpeas, lentils, and sweet potatoes) and flavonoids (present in high concentrations in apples and onions, plus green and black tea leaves). Although these plant oestrogens are several hundred times less active than human oestrogens, they provide a useful oestrogen boost at the menopause.
'After switching to a more plant-based diet and using soy milk and yogurt, Julie noticed an improvement. She also started taking an isoflavone supplement too, and she no longer woke at night feeling drenched. Taking evening primrose oil has also helped to improve her dry skin.'
Sheila, 50, has a family history of osteoporosis and wants to help reduce her risk of developing it in the future now that she is perimenopausal.
'A good intake of calcium is vital for strong bones throughout life,' says Dr Brewer. 'The easiest way to ensure you obtain enough calcium is to have the equivalent of a pint of milk (skimmed or semi-skimmed and equivalents such as cheese or yogurt) per day. Sheila has been avoiding dairy to lose weight, but has now started to take a bone support supplement, supplying calcium, magnesium, zinc and vitamin D.
'Vitamin D is essential for the absorption of calcium and phosphate from the diet. As she eats little fish, I suggested Sheila start a cod liver oil supplement which supplies omega 3s plus additional vitamins A and D for bone health and take regular exercise to help build bone strength. To help boost her weight-bearing exercise, essential for strong bones, Sheila bought a pedometer and is aiming to build up to 10,000 steps of brisk walking a day.
'She has a few menopausal symptoms at present which are not too troublesome, but has decided to increase her intake of isoflavones through drinking soy milk and taking a supplement. Isoflavones help to improve bone mineral density, too.'
Helen started HRT at the age of 45 when hot flushes affected her ability to concentrate at work. Since starting on HRT she has put on weight and has noticed her hair is thinning and so was keen to switch to a more natural alternative.
'There is no strong evidence that HRT is associated with weight gain - the metabolic changes occurring at this time of life are more likely to be the cause,' explains Dr Brewer. 'Similarly, female-pattern hair loss is associated with the genes you inherit and the way your hair follicles respond to changes in hormone levels at this time of life. Even so, Helen had lost confidence in her HRT and wanted to stop taking it.
'I recommended she switched to a multivitamin and mineral designed for the menopause, which included isoflavones. She also started taking a sage leaf supplement, a traditional herbal remedy used to relieve menopausal hot flushes and night sweats and to improve memory. For her thinning hair, she started using a shampoo containing caffeine which stimulates scalp hair growth by relaxing hair follicles and improving blood flow. Caffeine also penetrates into the follicles to inhibit the production of a hormone, DHT, which is associated with both male and female pattern hair loss. Within three months, her hair was noticeably thicker and her menopausal symptoms more manageable'.
Danika, 42, experienced a premature menopause following a hysterectomy and is currently taking HRT. She has irritable bowel syndrome and realises that her diet has been poor for many years. She is interested in nutritional approaches to help improve her general health and fatigue.
'Diet should always come top of the list when it comes to looking after your health,' says Dr Brewer. 'However, with Danika's digestion problems, it is difficult for her to include too much fruit and veg. I therefore recommended she started taking a multivitamin and mineral supplement as a nutritional safety net and, because she suffers from IBS, I suggested she chose one that also provided probiotic digestive bacteria. Other dietary tweaks included eating oily fish twice a week and adding an omega-3 fish oil supplement to her daily regime.'
Dr Sarah Brewer is Healthspan's Medical Director and holds degrees in Natural Sciences, Surgery and Medicine from the University of Cambridge. Having worked as a GP and hospital doctor, Dr Sarah now holds an MSc in Nutritional Medicine from the University of Surrey and specialises in nutrition. She is also an award-winning writer and author.
Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn't possible, supplements can help. This article isn't intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.