Beware of so-called ‘natural’ alternatives

THEY are touted as safer and ‘more natural’ alternatives to conventional HRT. Yet menopause specialists have warned women affected by the oestrogel supply crisis not to resort to buying so-called compound bioidentical HRT, which is sold by private clinics.

Made from hormones extracted from plants, the products are marketed with claims they cause fewer side effects than the medicines dished out by NHS doctors – because the active compounds they contain closely match the body’s own. But while, in some cases, they contain similar ingredients to standard treatments, they are unlicensed because there is no evidence that they are safe or effective.

Haitham Hamoda, chairman of the British Menopause Society, said: ‘Women should stay away from these products. We have HRT products made from natural sources on the NHS, but these are made to strict manufacturing criteria which regulates things like dosage and purity.

‘These compound bioidentical products are not the same – they’re often made up in small pharmacies and not subject to the same controls, so you don’t really know what you’re getting.’

GP and women’s health expert Dr Philippa Kaye added that

HRT offered on the NHS has been specifically designed to be exactly the same as the chemical structure of oestrogen and progesterone found in the body.

Women should also be cautious if considering taking alternative supplements and herbal remedies, Dr Hamoda continued.

Several, including black cohosh and St John’s wort, and phytoestrogen supplements made from soy or red clover, are reputed to help ease symptoms. But Dr Hamoda said scientific evidence is limited and that some have side effects and can interfere with other medication.

There is some evidence that phytoestrogens, for example, which stimulate the body’s oestrogen receptors, can ease symptoms in the short term. But longer-term data isn’t clear and supplements should not be taken by women with breast cancer as the rise in oestrogen may cause tumours to grow or return.

St John’s wort is another herbal supplement often recommended

to ease symptoms of depression –

and is said to relieve hot flushes. NICE concluded it may have a beneficial effect.

‘But again, you need to be a bit cautious,’ said Dr Hamoda, ‘as it’s a liver enzyme inducer, which means if you’re taking other drugs, such as cancer drugs, they may not work as efficiently.’

Black cohosh, a member of the buttercup family, is ‘probably the most researched supplement’ for menopause, he added. One trial found the herb relieved symptoms more effectively than a placebo, and was as effective as HRT at controlling hot flushes.

But it can cause stomach upsets and rashes, and Dr Hamoda said: ‘Although there is some evidence of effect, it’s the same logic that applies to all of these supplements – and others such as flaxseed, sage and evening primrose oil – that there’s not enough of it to draw meaningful conclusions.

‘With herbal remedies, the other problem is the quality, purity and ingredients vary, so there are questions about what dose might be helpful. But the evidence suggests none of them make a huge difference anyway, and they’re of limited benefit.’

Women struggling to access their usual HRT should look on the British Menopause Society’s website for equivalent alternative preparations, he added. It also contains details of alternative remedies, their reputed benefits and a summary of the scientific evidence behind them.