What are the alternatives to HRT?
The 2 questions I get asked all the time are:
- Should I take HRT?
- If I can’t or don’t want to, what are the alternatives to HRT?
Today we’re looking at question 2 – What are the alternatives to HRT?
NICE/NHS Treatment Guidelines
The main treatment available through the NHS in the UK for managing the menopause is HRT (Hormone Replacement Therapy). This medication provides synthetic versions of the hormones which naturally decline during menopause.
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.
HRT may also be prescribed if your doctor believes you are at risk of osteoporosis, because of the effect of oestrogen in supporting bone health.
However, HRT has been shown to increase your risk of ovarian and breast cancer. For some women with certain risk factors, HRT is not recommended.
So, 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.
As a Health Coach I’m all about getting as many necessary nutrients as possible from food. In an ideal world, you could get ALL your nutrients from the food you eat. But….in the real world, even if you’re really focused on what you eat, it’s usually not entirely realistic.
I’ve spent a lot of time researching the main deficiencies and what women need as they approach and go through the menopause. Please be aware supplements come in many different price and quality ranges. Many are made from synthetic vitamins and minerals which are worse than useless to the body, adding to the toxic load already being experienced from pesticides and environmental toxins. And your results will vary greatly dependant on the quality of the products used.
I currently use and recommend Phil Richards or Nature’s Sunshine products because they are natural and I have seen great results for both myself and my clients.
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. 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. Weight gain, low bone density, fatigue, joint pain, sleep problems and depression can all be symptoms of vitamin D deficiency.
Magnesium plays an important role in producing energy for the cells and helping with the absorption of several other vitamins and minerals. When the body becomes deficient in energy-producing fuel, it breaks down muscle protein to create energy. This process can cause fatigue and other problems. Magnesium contributes to normal energy-yielding metabolism, muscle function, protein synthesis, and contributes to the maintenance of normal bones. It is required for normal psychological function and contributes to a reduction in tiredness and fatigue.Taking a magnesium supplement before bed can help you to relax as it helps to increase the natural levels of melatonin.
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.
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.
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. Nature’s Sunshine Nutricalm is a great choice if you’re struggling with high stress, low mood and anxiety.
Zinc is an essential mineral that is a component of more than 300 enzymes, needed for, amongst other things, the synthesis of proteins, good immune function, tissue healing and repairing wounds. It is also an antioxidant, which contributes to the protection of cells from oxidative stress, and is required in threshold amounts to maintain normal levels of testosterone. More zinc is found in the body than any other trace element except for Iron. Relatively large amounts are found in bone and muscle, and it’s also prevalent in the prostate and retina. Zinc also contributes to normal cognitive function,
This is an area I have not tried myself but I have researched and even though the research is very unclear, there are still some potential benefits. Anecdotally, I have come across hundreds of women who have had a positive impact from trialling different herbal remedies.
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). 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
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. I don’t have any specific recommendations for this product.
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.
Evening Primrose Oil:
Evening Primrose Oil contains Gamma-Linolenic Acid (GLA), an essential fatty acid that assists the body in producing messengers in the body that perform hundreds of important functions.
Not all fatty acid can be made in the body so you must get them through food or supplementation. Along with omega-3 fatty acids, omega-6 fatty acids play a crucial role in brain function, and normal growth and development. There have been some success stories using EPO as an effective menopause treatment.
Maca is used in perimenopausal and postmenopausal women for improving hot flashes and other symptoms of menopause. Some studies have shown reductions in anxiety and depression and some limited evidence that Maca improves sexual function. I do recommend Maca to my clients who are perimenopausal to postmenopausal and who need support with depression, anxiety, low libido, and reduction of menopausal symptoms. However, I do not use it with women who are struggling with estrogen dominant issues (endometriosis, ovarian cysts, and fibroids) as it seems to exacerbate them. Because of the limited data available on Maca, I prefer to use it as a food based supplement, and add it to smoothies when my client feels that she needs support for her mood, libido, energy, or menopausal symptoms such as hot flashes. The brand that I use regularly in my smoothies include Navitas Naturals.
Cannabidiol (CBD) is an active compound of the hemp and cannabis plants. CBD Oil is extracted from industrial hemp, which has no-psychoactive effects and is perfectly legal and safe to take, with no risk of addiction.
It is believed CBD Oil acts on our body’s endocannabinoid system and much of the current scientific research focuses on the benefits this non-intoxicating compound can have in our wellbeing.
This is a new ingredient to the UK, so we cannot relay details to the public about relevant scientific research. We however encourage you to research CBD for yourself if it’s something you are considering. Ensure you buy from a reputable company.
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 can lead to a better night’s sleep and a feeling of wellbeing. Sage Tea has been recommended by a lot of women in our group.
I love aromatherapy! It’s something I’d really love to study in the future. Myself and my clients have found that the use of aromatherapy oils helps to relax and improve symptoms of anxiety or depression. Oils like lavender can also help with poor sleep. Although there’s not much research on the effects 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. Watch out for more on this coming soon.
CBT (Cognitive Behavioural Therapy)
Cognitive behaviour therapy is a brief, non-medical approach that can be helpful for a range of health problems, including anxiety and stress, depressed mood, hot flushes and night sweats, sleep problems and fatigue.
CBT helps people to develop practical ways of managing problems and provides new coping skills and useful strategies. For this reason, it can be a helpful approach to try because the skills can be applied to different problems, and can improve wellbeing in general.
The good news is that CBT can alleviate low mood and anxiety which arise as a result of the menopause, and now we realise CBT can also improve hot flushes and sweats. The NHS, the British Menopause Society and the North American Menopause Society (NAMS) recommends a CBT approach that combines relaxation techniques, sleep hygiene and learning to take positive healthy attitude to a menopause challenge. CBT is now a recommended treatment option for anxiety experienced during the peri and post-menopause. A CBT approach which is theory based can improve hot flush perception and reduce stress and sleep problems.
To me this is the big one! It’s hard because a lot of us are looking for that magic pill, or that one action that will make all of this go away. I wish I had one, I really do, but now is the time for true “self-care”. You need to make a 100% commitment to your well-being. You are so worth investing in! Here’s a quick reminder of the key things to tackle if you want to really manage your menopause:
Disrupted sleep is one of the most debilitating issues facing women as they approach the menopause.
“If I could just get a decent night’s sleep, I feel I could actually cope with life.”
Here are some ways in which a good night’s sleep can boost your health:
- Sleep boosts immunity
- It can help maintain a healthy weight
- Sleep boosts mental wellbeing
- It prevents diabetes
- Sleep wards off heart disease
Sleep is the best thing you can do for your body. This should be your number one priority if you want to feel strong and healthy.
We don’t always understand how much every day events can build up and cause significant damage to our bodies and minds.
Stress is not entirely bad, it is a normal part of life and we’re built to handle it. In fact, a reasonable level of stress can be good for us. Too much, over a long period can cause harm to our physical and mental health.
At this time in our lives we have a lot to deal with – work, kids, relationships, kids leaving home, ageing parents, teenagers, social media, email, internet, hot flashes, fatigue, our changing bodies etc. It’s no wonder we’re so exhausted.
So, what can we do about it:
- Establish our list of stressors – how do we tackle, remove or accept these?
- Brainstorm solutions, evaluate and decide on the best options
- Reduce alcohol and caffeine
- Add gentle exercise every day
- Practice yoga, meditation or breathing exercises daily – find what works for you
- Take a vitamin B complex supplement
- Set up a quiet uncluttered space for you to relax
- Take up daily journaling – let everything out onto paper
- Ask for help
- Take a break from social media
How we feed our bodies is essential at this time in our lives. Here are 12 areas to focus on to ensure you are nourishing your body to feel stronger, fitter and healthier ever day:
- Hydration – I cannot stress enough how important drinking enough water is for your health – at least 4 pints a day
- Adequate protein – you should have a good quality protein source with every meal
- Beware of sugar – we have no nutritional need for processed sugar – it does us no favours
- Healthy fats – think oily fish, nuts, healthy oils, avocado
- Make vegetables the star of the show – every meal, all the time
- Eat REAL food … most days, most of the time
- Nutrient dense – get all you need from the food you eat – you shouldn’t be hungry
- Anti-oxidants – a natural source of anti-ageing – They are abundant in fresh fruits and vegetables, as well as in other natural un-processedfoods including nuts, grains and some meats, poultry and fish. The list below describes food sources of common antioxidants –
- Detoxification – look at what you are exposed to – does your liver have a chance to do its job properly – eat real food, stop smoking, exercise regularly, manage your weight
- Look at your relationship with food – why do you eat what you do? – download our free food diary template to monitor and review
- Take an honest look at what you’re eating – use our food diary template to record what you are eating
- It is so important to enjoy your food, think of it as nourishing your body – eat beautiful food, food that brings you joy and moves you towards wellness
- Reduce Alcohol and Caffeine
Exercise is beneficial in so many areas. We’ve already talked about how exercise can help you lower stress, encourage a more restful sleep, increase your energy levels, and release endorphins that boost your mood and reduce the incidence of depression.
Certain types of exercise will also help to strengthen your bones. This is very important as we age and bone loss becomes a problem.
And, obviously, it can play a big part in fat loss and weight management too.
“Weight bearing activities” involve doing exercise on your feet with your bones supporting your weight. And this is the type of exercise that will help to strengthen your bones. Examples include walking, running, tennis, dancing, stair climbing, and elliptical training. These activities are excellent for your cardiovascular health, and will make your heart stronger.
Cycling and swimming are great for your heart and your overall health too, but they aren’t considered weight bearing. That makes them great options if you’re working around an injury.
Strength or resistance training helps strengthen bones and improve posture too, and also increases your muscle mass. There are several reasons why this is both important and desirable.
Strength and muscle mass decline naturally from the age of 30. If we don’t do anything about it our bodies will naturally get fatter, Strength training is the best anti-ageing exercise you can do.
Embrace this stage in your life!
Really? I hear some of you say! I know this is hard when you’re right on the middle of it but you can take control. You can address key issues and improve your quality of life. I’m not saying it’s going to be easy but I am saying it’s going to be worth it!
What is right for you?
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, that’s your choice. Embrace it and focus on feeling better and stronger every day. Remember, it is important to tell your doctor or menopause specialist 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.
There is no right or wrong answer. If something is working for you then that’s great. Tackling your lifestyle and habits will not only have a huge impact on your menopause symptoms but also on your overall health. If you try all of these things and you are still struggling, do speak with your GP, don’t suffer in silence. Even if HRT is not an option for you, there is still a lot you can do. You are not on your own.
Here’s my guide to daily supplements during the menopause.