Women are understandably confused about whether they should take hormones to treat their menopausal symptoms, and for how long they can safely use the therapy.
As its name suggests, HRT works by replacing the hormones which the body stops producing at menopause.
As a woman approaches menopause, the production of hormones (such as oestrogen) by the ovaries starts to slow down.
Hormone levels tend to fluctuate and changes in the menstrual cycle occur. Cycles may become longer, shorter or totally irregular, bleeding may become lighter or unpredictable and heavy.
Eventually hormone levels fall to a point where menstruation stops altogether and menopause is reached.
Some of the symptoms that women may experience include hot flushes, night sweats, irritability, headaches, aches and pains, sleeping problems, reduced libido, vaginal dryness, tiredness and forgetfulness.
A decrease in female hormones after menopause may lead to thinning of the bones (osteoporosis) and increased risk of heart diseases, high blood pressure and stroke.
For most women in Australia menopause occurs between 48 and 53 years of age. Although in some women it is earlier or later, or may be brought on by surgery or drugs early in life.
Hormone replacement therapy (HRT) was introduced in the sixties with a powerful marketing campaign promising women, health, happiness and long life if they take synthetic hormones on a regular basis.
It has been prescribed to relieve or prevent the immediate symptoms of menopause, and as long-term protection against osteoporosis.
Hormone therapy includes both estrogen and progestin. Using estrogen alone causes the lining of the uterus to grow and increases the risk of endometrial cancer.The progestin keeps the lining of the uterus from growing too much.
Women who have had a hysterectomy are usually given HRT containing estrogen on its own. With these combination treatments, women experience a withdrawal bleed each month similar to a period.
Period-free treatments are now also available for women who are at least a year past their final menstrual period.
HRT can be taken in several ways: orally (tablets or gelcaps), vaginally (pessaries, creams and vaginal rings), on the skin (patches and gels), or under the skin (implants).
Do The Benefits Outweigh The Risks?
Hormone replacement therapy (HRT) – which was hyped for decades as a way to prevent health problems in women while boosting libido and moods can have very serious side effects.
Large-scale randomized clinical trials and observational studies have consistently found that use of hormone replacement therapy (HRT) increases the risk of breast cancer.
The Women’s Health Initiative (WHI), 15-year study launched in 1991, was designed to address the most common causes of death, disability, and poor quality of life in postmenopausal women.
The study, following 16,608 women, was stopped a little after five years,because the risks associated with HRT exceeded the benefits.
The study found the women taking Prempro in the study had 41% more strokes than those taking the placebo, 29% more developed cardiovascular disease, and 26% more women developed breast cancer.
The findings of the study raised serious concerns about the long-term safety of menopausal hormone therapy.
A study published in the Journal of the American Medical Association concludes the ability of HRT to trigger ovarian cancer is so strong that women are at risk whether they are currently taking the hormones or if they took it at all in the past.
The increased risk of ovarian cancer persists regardless of the duration of use, the formulation, the dose of estrogen taken, the prescribed regimen of HRT, or the route of administration (by mouth or patch).
Research has indicated that starting hormone replacement therapy at or after age sixty-five may also significantly increase the risk of developing Alzheimer’s disease.
Bio-identical Hormone Replacement Therapy
Many women are turning to bio-identical hormones, which are synthesised from plant products and have the same biochemical structure as the hormones the body makes.
They are custom-made products prepared by compounding pharmacies and may contain any variation of hormones including estrone, estradiol, estriol, progesterone, and testosterone.
These hormones have been popularised on the basis that they are safer option with less side effects but still they haven’t been adequately trialled.
Treatment with Natural Medicine
Natural therapies have always viewed menopause as a normal transition.
As we age the natural reduction of reproductive hormones is not necessarily a negative thing.
The body is actually reducing hormonal output to preserve and save bodily resources for the sake of longevity.
Eagle Femi-Nan is used to relieve menopausal problems and treat hot flushes, sweating, sleep problems and nervous irritability.
Femi-Nan contains Black cohosh, which is also regarded as anti-rheumatic, and is beneficial in myalgia and arthritis.
Black cohosh acts as a selective oestrogen receptor modulator (SERM). This means that it does appear to exert oestrogenic effects on one tissue (bone), but not on others (uterus, vagina).
So there should be no increased risk of breast or uterine cancer from taking black cohosh, because it has no oestrogenic effect on these organs.
Many clinical studies have confirmed that Black Cohosh does not have an adverse (oestrogenic) effect on endometrial or breast tissue. Two studies found that Black Cohosh demonstrated a breast cancer protective effect.
In three randomised controlled trials assessing the efficacy of Black Cohosh among breast cancer survivors, the herb significantly reduced hot flushes.
Although some cases of suspected hepatotoxicity have been reported for Black Cohosh, rigorous diagnostic assessment in 2009 of this data found no evidence that Black Cohosh can cause liver disease.
St Johns Wort
Black Cohosh combines well with St John’s Wort in the treatment of hot flushes, depression and anxiety.
Mediherb Nevaton contains St John’s Wort (Hypericum perforatum) which has been traditionally used in the treatment of menopausal neurosis, excitability, mood swings and depression.
Clinical studies have found St John’s Wort extract to be beneficial for the treatment of menopause.
Wild Yam Complex may relief menopausal symptoms including excessive sweating, hot flushes, and vaginal dryness.
Steroidal saponins in Wild Yam (Dioscorea villosa) may have oestrogenic effects by binding with oestrogen receptors in the brain and may alleviate symptoms of oestrogen withdrawal by convincing the body that more oestrogen is present in the bloodstream than actually is.
Traditionally Sage (Salvia officinalis) has been used as a drying agent to reducere excessive sweats and for debility of the nervous system including nervous exhaustion. Sage reduced sweat production in patients with excessive sweating in a number of open studies.
Mediherb Withania and Ginseng tablets may assist general wellbeing and promote endurance and stamina during stress.
Panax ginseng root is used as an adaptogen and tonic indicated for physical or mental exhaustion and depressive states associated with sexual inadequacy.
Korean Ginseng is highly regarded in traditional Chinese medicine (TCM) as a tonic and restorative, to calm the nerves, to improve libido and is useful in fatigue and debility.
Withania in combination with St John’s Wort and Ginseng is particularly useful in treatment of hot flushes and sleep disturbances accompanied by depression.
A Hormone Balance Formula is designed to assist during menopause by exerting modulating effects on oestrogen receptors.
A Advanced Nutritional Bone Support with Calcium, Magnesium, Vitamin D3 and other synergistic nutrients is used to enhance bone density, and prevent osteoporosis and fractures.
Vitamin E 500 IU may be useful in treatment of hot flushes.
Dietary and Lifestyle Advice:
- Phytoestrogens are particularly important for women and are known to have bone-density enhancing effect, protective effect on the cardiovascular system and against breast cancer and a non-proliferative effect on the endometrium.
- A diet high in phyto-oestrogenic foods may improve many of the menopausal symptoms, such as hot flushes.
- Good food sources are tofu, soy milk, chickpeas, lentils, flaxseeds and barley.
- Adding 100 g of tofu and 1 tbls of ground linseed to your diet every day can reduce hot flushes and reduce vaginal dryness
- Eat foods rich in calcium ( dark green leafy vegetables, salmon, almonds, sesame seeds, tahini, hommus,etc)
- Have a high fibre, low fat a low salt diet. Eat variety of wholegrain and nutrient dense food – whole grains, legumes, fruits and vegetables and low fat dairy.
- Regular weight – baring exercise exercise, such as walking or weight training, to reduce bone mineral loss, maintain muscle mass and strength and improve coordination and stability.
- Avoid caffeine – coffee, tea, cola, chocolate, soft drinks, alcohol and spicy foods
- Stop smoking!
- Drink plenty of water, at least 2L (8-10 glasses) daily.
Menopause is a time of change and making it a time of positive change is not just pot – luck!
There is now plenty of evidence to suggest that preparing sensibly for mid life with good diet, lifestyle and an exercise program will greatly influence the way a woman experiences this transition period.