Q: I am 56 years old and have been on HRT for nearly six years now and I would like to come off it, what is the best way to do this?  Also can eating phytoestrogens be used to help me come off HRT?

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If like many women you are concerned about the side effects of HRT or hormone replacement therapy there are many natural options to consider. Listed below are alternatives that have solid research backing. In other words, they are solutions you can trust.

Dietary changes:

Whether you are in your 20s or your 50s it’s never too early to start preparing by making sure you have a good balance of nutrients. A healthy diet is the foundation stone of good health and is crucial during menopause for bone health and hormonal balance.

Coffee, sugar, alcohol and soft drinks should be avoided as they are known to increase the risk of osteoporosis. Instead of refined and processed food make sure you are eating plenty of fruit and vegetables, healthy protein and whole grains. You also need lots of nuts, seeds, oily fish like salmon and trout to ensure you’re getting essential fats.

Phytoestrogens are substances found in food that have a similar chemical structure to the oestrogen your body produces, and this may explain their hormone balancing effect. Studies show that they can not only take the place of natural oestrogens and increase oestrogen levels when they are too low but they can also reduce them when they are too high. As well as helping to balance hormones, phytoestrogens are also thought to have a protective effect on the heart. Research indicates that they can lower levels of bad cholesterol.

In addition, they may contain compounds that can inhibit breast and endometrial cancer (often due to excess oestrogen), fibroids, endometriosis and osteoporosis. Food sources of phytoestrogens include virtually all fruit, vegetables and cereals. However, ‘isoflavones’ — found in beans and lentils — are an even better source of phytoestrogens. Other excellent sources include: hummous, tofu, linseeds, lentils, garlic, kidney beans, mung and alfalfa bean sprouts, asparagus, plums and oats.

Food supplements:

If you suffer from dry skin and hair, aching joints, breast pain, vaginal dryness and have difficulty losing weight, you could be lacking in Essential Fatty Acids.

Food sources of essential fatty acids include oily fish, nuts and seeds but you could also supplement with fish oils to make sure you are getting enough Omega 3. The thinking nowadays is that we actually need more Omega 3 oils as we are not getting enough from our diet.

In addition to essential fats a good quality multivitamin and mineral should form the foundation of your supplement programme to make sure you have adequate nutrients for hormone balance and healthy bones, especially if you are over the age of 40 and already experiencing peri-menopausal symptoms. A good multivitamin and mineral I use in the clinic is Menoplus. You can then, if you feel you need an extra helping hand, add in other supplements which have suggested positive results in connection with the menopause; supplements like vitamin E, vitamin B, calcium and magnesium (or a combined calcium & magnesium supplement).

Vitamin E has been studied for many years for its ability to help reduce hot flushes. It is also beneficial for vaginal dryness and is a protective antioxidant that keeps skin healthy and supple. Good food sources of vitamin E include asparagus, avocados, brown rice, egg yolks, lima beans, peas, sweet potatoes, and vegetable oils.

The B vitamins (and vitamin B5 in particular) are renowned for their ability to relieve stress and support the adrenals. B vitamins also help to alleviate symptoms of anxiety, low energy levels and poor concentration that are often associated with the menopause. To boost your B vitamins go for a vitamin B complex (50mg a day of most of the B vitamins) and eat plenty of vitamin B rich food such as fish, eggs, nuts, seeds, soya beans, bananas, and leafy green vegetables.

Osteoporosis is usually a symptom of advancing age, but it can also be a consequence of the menopause. Oestrogen protects the bones by keeping calcium in the bones and thereby maintaining bone density. During and after the menopause when oestrogen levels are reduced, bone density decreases at a more rapid rate and studies have shown that supplementing with a combined calcium citrate and magnesium supplement can help maintain strong bones.

Herbs:

Agnus Castus is a great hormone balancer. It works best taken first thing in the morning, every morning and is especially for the premenopausal symptoms such as mood swings, irritability and depression which may start before the hot flushes and night sweats. Agnus Castus stimulates the pituitary gland which is in charge of producing and setting hormone levels.

Black Cohosh is the herb of choice for the menopause, hot flushes and night sweats and one of the medical journals in 2006 stated that black cohosh is ‘one of the most effective botanicals for vasomotor symptoms’. There have been concerns that black cohosh might have an oestrogenic effect and not be helpful for women with a history of breast cancer but a study showed that adding black cohosh to breast cancer cells actually slowed down the rate at which they multiplied.

There were also some suggestions that black cohosh might have a negative effect on the liver but the National Institutes of Health in America said there is no evidence of this.

Dong Quai is a herb which is often used in traditional Chinese Medicine as a tonic for the female reproductive system. During premenopausal phases, less active versions of female hormones are produced in the body e.g. oestrone instead of oestrogen. Dong Quai is believed to work by increasing the effects of these naturally produced hormones.

New research suggests that Dong Quai also contains phytoestrogens so it can work to boost oestrogen levels at the menopause and achieve a balance. The herb has proven to be most effective for relieving symptoms of the menopause, in particular hot flushes as well as vaginal dryness. (Call 0845 8800915 for details)

Milk thistle is also another useful herb around the menopause as it helps to improve liver function which is important for the detoxification of hormones.

I use a combination of organic herbs in the clinic called Black Cohosh Plus which are in vegetarian capsules.

Finally, herbs such as horsetail, nettle and alfalfa may also be used alongside dietary recommendations, supplements and exercise for the treatment of osteoporosis.

In a nutshell:

The menopause is a natural event in women’s lives and not an illness. There are many natural and effective alternatives to the drug approach of HRT, the most reliable of which have been detailed above, and these can really help to ease the emotional and physical discomfort associated with this time of life.

Eating well, exercising and using natural remedies around the menopause enables you to get on with your life and keep living it to the full.