Dr Sarah Jarvis
My Weekly’s favourite GP from TV and radio writes for you
Hot flushes and night sweats affect 4 in 5 women around the menopause. For some, they’re a minor inconvenience. For others, they can make every day a misery. HRT is very effective – but what are the alternatives?
Hot flushes and night sweats can start a couple of years before your menopause and may last several years. Usually (not always) they go away on their own. Lots of women who take HRT complain of a “second menopause” when they stop, but this usually lasts only months. Tailing off the dose slowly may help prevent this.
There’s no question that the single best way to relieve menopausal flushes, sweats and vaginal dryness is HRT. The jury is out on whether it helps with the mood swings so common around the menopause, but it won’t do any harm. It may cut your risk of “cognitive decline”, linked to dementia, and some studies show it may reduce the risk of colon cancer. It also protects against osteoporosis or thinning of the bones.
So far, so promising. But why are so many women worried about taking HRT?
It all went horribly wrong for HRT about 15 years ago. A study in America suggested HRT could increase risk of heart attack. Hot on its heels came a UK study suggesting it increased breast cancer risk. Doctors were flooded with worried patients and the number of women taking HRT plummeted.
Some of these concerns turned out to be nonsense. The US study involved giving very high doses of HRT to women in their 60s or 70s,
SOYA IN ALL ITS FORMS – SOYA MILK OR YOGURT, TOFU, EDAMAME BEANS – MAY HELP WITH MENOPAUSAL SYMPTOMS, AND IT’S HEALTHY TOO!
years after they went through the menopause. We now know that if you start HRT in your 40s or 50s, the time most women go through the menopause, it doesn’t increase your risk at all.
As for breast cancer, the evidence is less clear. Some studies have shown that for every 200 women who take HRT for 7.5 years, one will get breast cancer as a result. Other studies suggest the figure is closer to 1 in 50. We do know that the longer you take HRT, the higher the risk – and that the risk drops off when you stop HRT. We also know women who’ve had a hysterectomy, who can take “oestrogen only” HRT, don’t have the same risk.
The type of HRT may also affect your risk. Oestrogen HRT in patch or gel form isn’t linked to a small increase in deep vein thrombosis, as tablet forms are. The breast cancer risk may be lower with “body-identical” kinds of HRT, such as Utrogestan.
With all this concern, there has been keen interest in “natural” alternatives. The biggest issue has been if they actually work, or if women feel better because they expect to.
“Isoflavones” may have natural oestrogen-like effects, and it’s falling oestrogen that causes menopausal symptoms. Soya and red clover isoflavones (60-80mg a day, from your pharmacist) may help. Black cohosh such as Menoherb also does the trick for many. There’s little evidence that evening primrose oil, ginkgo biloba or ginseng make a difference.
Lifestyle changes can make a real difference. It’s worth trying cutting out caffeine and alcohol. Wear layers of loose clothing in natural fibres and invest in twin duvets for your double bed (his warm, yours not!). You might think exercise would make you more sweaty, but there’s good evidence that jogging, cycling or swimming can relieve hot flushes. Next Week: Looking at Lyme Disease
TOPICAL HRT RELIEVES VAGINAL DRYNESS, BUT SO CAN NON-HORMONAL VAGINAL MOISTURISERS LIKE REPLENS (FROM YOUR PHARMACIST OR ON PRESCRIPTION)
IT’S MOST DEFINITELY WORTH TRYING CUTTING OUT CAFFEINE AND ALCOHOL TO SEE IF HELPS’’ THAT