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?

A: The question I am most asked is ‘should I just stop HRT or should I come off it gradually’? You should talk to your doctor about your decision to come off HRT and have any check ups that might be needed. My recommendation is always that a gradual weaning process is actually going to be easier on your body. Stopping HRT suddenly is similar to going ‘cold turkey’ and there have been reports of ‘rebound’ effects from the quick withdrawal of the hormones. The rebound effects can actually give tremendous hot flushes and seemingly worsened menopausal symptoms. 

 

It is better to take three months to gradually wean yourself off HRT. Ask your doctor for a lower dose and if you cannot reduce the dose of the HRT, you could switch to a patch. Because the patch delivers oestrogen through the skin and does not have to be broken down by the liver first, you can get by with a lower dose than if it is taken by mouth. Alternatively, you could use an oestrogen gel, rubbing in smaller amounts of oestrogen each time. Remember, though, that the dose of the progestogen must not be altered if you are on a type of HRT that stimulates a withdrawal bleed. It is important that this happens each month until you come off HRT entirely. 

 

During that three month weaning process, you would then start to introduce phytoestrogens (like soya, chickpeas, linseeds etc) into your diet so that when you stop the HRT you are cushioned by plant oestrogens already circulating in your system and any effects from stopping the HRT should be minimal. If you need extra help then you can use herbs like black cohosh (see Black Cohosh Plus on Resources page). For more information on the menopause see my book ‘The New Natural Alternatives to HRT’.

Because they tend to work gently without severe side effects, natural menopause herbal supplements have been on the rise, and many women have found relief from their menopause symptoms by using them. The main herbs used to treat symptoms of menopause are called adaptogens which means that if you have a low level of one hormone or have an excess of another the herb will have a balancing effect on your hormones and your body.

Agnus Castus

 

Agnus Castus is one of the most important herbs you can take at the menopause, especially at the peri-menopause, because it works as an adaptogen, which means it helps to balance your hormones. It appears to stimulate and normalise the function of the pituitary gland which controls and regulates the hormones in the body and is a potent remedy for mood swings and hot flushes.

 

Black Cohosh

 

Black cohosh is an herbal remedy that has been used for centuries in helping to alleviate menopause symptoms, especially hot flushes, night sweats and vaginal dryness. You probably heard about the negative reports on black cohosh but these need to be looked at carefully.  The European Medicines Agency (EMEA), reviewed all the evidence worldwide and concluded that there were only four cases where black cohosh might have caused a liver problem and this needs to be weighed up against an estimated 9 million treatment days of black cohosh used each year.

 

The National Institutes of Health in the US believes there’s no case to answer and their website states that black cohosh has few side effects and that ‘liver damage has been reported in a few individuals using black cohosh, but millions of people have taken the herb without apparent adverse health effects. There is no scientific evidence to show that the herb causes liver damage.’ 

 

Also worryingly, researchers have found that some black cohosh products on the market contain an Asian species of black cohosh which is cheaper than the North American black cohosh.  Compared with the species cultivated in North America, the Asian variety has different chemical properties and may have different effects on the body.  So make sure you get a high quality brand (I use an organic black cohosh combination in the clinic called Black Cohosh Plus, which also contains dong quai – see the Resources page).

Dong quai

 

This is actually a Chinese herb but it is widely available.  It can be used for long periods of time because it is a tonic herb. It nourishes the liver and is said to help ease menopausal symptoms, such as hot flushes and vaginal dryness.  It is widely used among Chinese women because of its reputation as a libido and energy booster and has been dubbed “the female ginseng.”

 

Isoflavones

 

Another one of the most popular natural menopause remedies is isoflavones. The isoflavones contain phytoestrogens, which are thought to mimic the function of the female hormone estrogen, thereby possibly reducing hot flushes and some other menopause symptoms. I would suggest that, as the research stands only use the phytoestrogens in food form, such as soya, lentils, linseeds (flax), chickpeas etc and not as supplements.  (For more information on this see my book ‘The New Natural Alternatives to HRT’.)

 

Milk thistle

 

At menopause milk thistle can be an important herb because it helps boost liver function and makes sure old hormones are being excreted efficiently.  (Organic milk thistle is contained in the Black Cohosh Plus – see the Resources page).

 

Valerian

 

This herb has been used for thousands of years to ease insomnia and improve sleep quality.

 

Suggested supplement plan

 

• A good multivitamin and mineral supplement that includes boron, vitamin C, vitamin E, vitamin B complex, magnesium and calcium (like MenoPlus)
• Omega 3 oils – like fish oil (e.g. Omega 3 Plus which contains good levels of both EPA and DHA)
• A combination of organic herbs e.g. black cohosh, dong quai, and milk thistle. 

 

WARNING:  Nutritional supplements are fine to take with HRT but I would not recommend taking herbs as well.  If you are taking HRT, you should not need to take herbs to help with the symptoms because the HRT should be doing that.  If the HRT is not working then you need to see your doctor about changing the dose or the product.

To protect your heart, bones and health in the years approaching the menopause a good quality multivitamin and mineral containing vitamins A, D, E, C, B1, B2, B3, B5, B6, B12, folic acid, calcium, magnesium, iron, zinc, chromium, selenium, boron and manganese should form the foundation of your supplement programme. (The one 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 been shown to be beneficial in connection with the menopause.

For best results take these additional supplements for the short term, say a period of three to four months. After that re-assess them for improvements in your health and work with your healthcare practitioner to adjust your supplement programme accordingly.

• Antioxidants: If you are eating a healthy diet and taking a multivitamin and mineral supplement you may not need to take additional antioxidants unless you have a strong family history of cancer. Antioxidants are abundant in fruits, vegetables and sprouted grains so make sure you get plenty of these foods in your diet. If, however, you exercise a lot and are exposed to a great deal of stress and chemical pollutants it might be wise to add an antioxidant complex to your supplement programme.  (The antioxidant formula I use in the clinic is called Nutriguard).
• Boron: A study published in the British Journal of Nutrition in 1993 showed that increasing dietary intake of the mineral boron  in postmenopausal women decreased the amount of calcium excreted in the urine. That means less risk of bone loss. U.S. Department of Agriculture studies found similar benefits for a high boron diet. Make sure that your multivitamin and mineral contains enough boron. (The MenoPlus multivitamin and mineral contains boron as does the OsteoPlus supplement I use in the clinic.) Three and a half ounces of almonds, prunes, or raisins each contain at least 2 mg of boron. Asparagus, cabbage, figs, peaches, and strawberries are good sources as well.
• B vitamin complex: B vitamins are incredibly helpful during times of stress and symptoms of B vitamin deficiency include anxiety, tension, irritability and poor concentration. If this sounds familiar or if you are under a great deal of stress it might be a good idea to supplement with additional B vitamins for a few months to get your health and energy back. You should be getting about 50 mg of most of the B vitamins a day so if your multivitamin isn’t giving you enough add a B complex to your supplement plan.
• Calcium: This mineral helps guard against osteoporosis. Calcium also appears to improve blood sugar balance and recent studies have shown that extra calcium can help with weight loss. Good source of calcium other than dairy products include brazil nuts, almonds, sesame seeds, salmon with bones and green leafy vegetables.  When choosing a supplement containing calcium, read the label, and choose calcium citrate rather than calcium carbonate.  Unfortunately, calcium carbonate is one of the cheapest forms of calcium, which is otherwise known as chalk.  It is one of the most difficult forms of calcium to absorb, and you need a highly efficient digestive system to order to manage it.  On the other hand, calcium citrate is almost 30% more absorbable than calcium carbonate.  (The MenoPlus and OsteoPlus supplements contain calcium citrate and also magnesium in the citrate form for maximum absorption.)
• C Vitamin: Vitamin C is a powerful immune booster but it is particularly helpful at the menopause. Giving women vitamin C with bioflavonoids has been shown to reduce hot flushes. Vitamin C helps to build up collagen which gives your skin and tissues elasticity and can therefore be useful in the treatment of vaginal dryness and stress incontinence. Collagen is also important for strong bones. Vitamin C is abundant in fruit and vegetables but you may also want to supplement your diet with 1000 mg per day of vitamin C and bioflavonoids. When choosing vitamin C, choose the alkaline form, ascorbate, rather than ascorbic acid as we know that the more acid the diet the greater the bone loss.  (Vitamin C Plus – an alkaline form of vitamin C).
• D Vitamin: This vitamin is crucial for the absorption of calcium so important for bone health and has now been found to be important in cancer prevention.  Dietary intake of vitamin D has decreased over recent years and may be linked to rising cases of osteoporosis. Vitamin D can be toxic in high doses so just take the amount that is your multi-vitamin and mineral and do not add in a separate vitamin D supplement unless you have been tested and found to be deficient. (This is done with a simple blood test).  Get plenty of exposure to sunlight. Fatty fish, such as halibut, mackerel and salmon are rich sources of vitamin D and also egg yolks.
• Essential fatty acids: Dry skin, cracked nails, lifeless hair, depression, aching joint, lack of energy, weight management problems, forgetfulness, vaginal dryness and breast pain are all symptoms of deficiencies in essential fatty acids but can also be part and parcel of the menopause. Components of these fatty acids may protect you from heart disease because they’re believed to increase HDL (‘good’) cholesterol while lowering triglyceride levels and blood pressure. That’s why supplementing with EFAs during the menopause may be able to help not just with your symptoms but also help to decrease your increased risk of heart disease around this time.  In addition to making sure your diet is rich in EFAs from oily fish, nuts and seeds take a good fish oil supplement.  (I use one called Omega 3 Plus in the clinic as you only need to take two capsules a day to get a good dose see Resources)  If you are vegetarian or vegan and prefer not to take fish oil then linseed (flax) or hempseed oils are fine.
• E Vitamin: This vitamin is helpful for the relief of hot flushes, breast tenderness, and vaginal dryness. It can also be used topically for vaginal dryness by piercing the capsule and rubbing the oil into the skin. A dose around 400ius per day is considered beneficial. Asparagus, avocados, brown rice, egg yolks, lima beans, peas and sweet potatoes are the best food sources.
• Magnesium: This mineral has a calming effect, so it eases symptoms like irritability, anxiety, mood swings, and insomnia. It also helps your bones absorb calcium, raises levels of HDL (“good”) cholesterol while lowering LDL (“bad”) cholesterol, and helps muscles–including your heart–to relax. Good sources are almonds, cashews, whole grains and most green leafy vegetables. 

Note: See next months issue for an A to Z of natural herbal supplements for the menopause.