Why can’t some women take HRT?
Some women are unable take HRT for medical reasons (following treatment for certain cancers, for example), while others decide not to take HRT out of personal preference. I often see women who are taking alternatives to HRT. Many of my patients have spent small fortunes on various preparations and there are thousands of different products currently marketed in shops, chemists and over the Internet.
One of the reasons for choosing alternatives to HRT comes from the belief that an alternative treatment is more natural and safer than HRT. Many women also do not go and see their doctor with their menopausal symptoms, as they feel they should not be pestering them. The majority of women still do not realise that the benefits of HRT usually outweigh the risks for women under the age of 60 years.
Are HRT alternatives effective?
It is important to think about why you might be taking an alternative treatment. Although alternative treatments may help with some individual symptoms of the menopause they are usually not as effective as HRT. In addition, they do not reduce your risk of osteoporosis or heart disease, whereas HRT can.
There are some alternative medications that your doctor can prescribe for some of your symptoms. Certain types of anti-depressants such as citalopram or venlafaxine may improve hot flushes in some women, even those who are not depressed.
Other medications, e.g. clonidine and gabapentin, may sometimes be given and can help some women. However, their use is often limited by side effects (such as nausea, insomnia or worsening libido).
What about herbal supplements like Red Clover and Black Cohosh?
Some women consider taking complementary and/or alternative treatments to HRT for their menopause symptoms. However, herbal products do not necessarily mean safe products, and many herbal medicines have unpredictable doses and purity.
The MHRA (Medicines and Healthcare Products Regulatory Agency) have developed a certification trademark called Traditional Herbal Registration (THR), which means that these products are considered safe (when used as intended) and have a standardised dose (although effectiveness has not been assessed).
There is a huge market of options available and products include red clover, black cohosh and St John’s wort. However, many have very limited research or evidence to support their effectiveness and some are associated with significant health risks, especially if you have a history of breast cancer or are taking other prescribed medications (as there may be interactions). Some preparations of black cohosh, for example, have been shown to be associated with liver toxicity. These products are not currently recommended by the NHS for their use for the treatment of menopausal symptoms. However, if you do choose to explore herbal medicine as a treatment option, it would be best to consult with a qualified medical herbalist: http://www.nimh.org.uk/find-a-herbalist/
Can acupuncture help with menopause symptoms?
While there is little scientific evidence to support their use in alleviating menopausal symptoms, some women use acupuncture or magnet therapy (e.g. LadyCare) with some success. Others find drinking certain herbal teas, for example, can lead to a better night’s sleep and a feeling of wellbeing, while some find that the use of aromatherapy oils helps to relax and improve symptoms of anxiety or depression. Oils like lavender may also help with poor sleep.
Although little is known about the effect of aromatherapy specifically on menopausal symptoms, any therapy which allows you to relax and focus on yourself as an individual is an investment in yourself and can help you cope better with menopause symptoms.
What about exercise and weight loss?
There is evidence that healthy lifestyle changes/behaviours e.g. smoking cessation, weight loss and undertaking regular exercise, can improve some symptoms of the menopause – for example, hot flushes and night sweats. In addition, cognitive behavioural therapy (CBT) has been shown to have a mild-to-moderate beneficial effect.
Any other tips to help menopause symptoms?
Wearing lighter-weight clothing, sleeping in a cooler room and reducing stress (e.g. through mindfulness, breathing exercises or yoga, for example) may reduce the number of hot flushes. Some women find that things such as spicy foods, caffeine (in tea, coffee, cola, chocolate, etc), smoking, and alcohol may trigger hot flushes. Avoiding these may help for some women.
Weight-bearing exercise (e.g. running, strength-training, dance, tennis) is of particular importance to maintain bone health. Eating a healthy, balanced Mediterranean-style diet is beneficial for overall good health, and is recommended.
So, you may find some of these alternative treatments helpful, either used on their own, in combination with each other or in combination with HRT.
Whichever route you decide to go down, it is important to tell your doctor or menopause expert if you are taking any over-the-counter medication that you have bought for your menopausal symptoms, or have been prescribed by a complementary therapist.
Find out more about Dr Louise Newson and the Newson Health Menopause and Wellbeing Centre at www.menopausedoctor.co.uk