Q:I'd like to know a good alternative to HRT as at 54 I'm finding the following problems difficult to cope with: confusion, forgetfulness, hot flushes, lack of enthusiasm, something I always had plenty of, and feelings of panic. I have not tried HRT. I prefer not to. I am a yoga instructor and do practice, which helps a little. N. M. A., Rainham. and also Does female sterilization quicken the onset of the menopause? S.P., Cheshire.
A:It is generally known that removal of the ovaries may bring on an early menopause, according to Linda Ojeda, who has made a study of menopause (Menopause without Medicine, Thorsons), as often will hysterectomy, which can bring on a sudden and violent change as much as a couple of years earlier than it would have come naturally. Less well known is the fact that the standard means of tubal ligation (tying of the fallopian tubes) can as well. This is true of any procedure like tubal ligation which diminishes blood circulation (such as radiation treatment, chemotherapy and certain diseases) .Interestingly, this autumn, this formally taboo subject seems to be coming out of the closet. Two distinguished writers in England and America have almost simultaneously released large scale studies of menopause, both examining the current popularity of hormone replacement therapy, and also the stigma attached to women during and after "the change". Whatever you think of her former politics, Germaine Greer has written a highly intelligent book entitled The Change: Women, Ageing and the Menopause (Hamish Hamilton, lb16.95). (The American counterpart is written by Gail Sheehy, in the October 1991 British and American issue of Vanity Fair).
We particularly applaud Greer's book for its unqualified stance against HRT a lone voice in the desert against the propaganda of the Amarant Trust. As she and Sheehy make clear, no one knows why HRT works, as doctors cannot show any physiological improvement. "The effect with HRT is so mysterious that the most knowledgeable of the menopause doctors on the planet has had to posit a 'mental tonic effect' to account for it. The pedlars of snake oil relied on much the same thing," writes Greer.
HRT is being accepted so unqualifiedly that John Studd, consultant gynaecologist at King's College Hospital, the main proponent of HRT, predicts, as Greer quotes him, that in 20 years time, "a lot of women will elect to have a hysterectomy when their families are complete at 40 or 45, in the way that women are choosing to become sterilized now. That operation will remove their ovaries, cervix and endometrium, the three major sites of gynaecological cancer. They will then start taking hormone replacement therapy and continue it indefinitely."
Basically, Greer, Ojeda and Sheehy all make the point that menopause is a very little understood collection of symptoms marking the end of the body's reproductive usefulness, which can go on for years. These mainly include hot flashes (or flushes), insomnia, fatigue and forgetfulness, as well as irregular periods, vaginal dryness and lack of sexual interest. Ojeda, for one, finds that numerous complementary approaches can help to eliminate or alleviate symptoms.
For hot flashes, she recommends that you take moderate, regular exercise, avoid what she terms "triggers" such as coffee, alcohol, sugar, spicy foods, warm clothes and hot drinks, and keep your blood sugar level constant. Both she and others advocate the use of nutritional supplements, including vitamin E (800-1200 IU of mixed tocopherals, taken one to three times a day); a good multi B vitamin, with a high B6 content, zinc, essential fatty acids (such as evening primrose oil), selenium, lecithin, vitamin C with bioflavonoids (1 to 3 grams taken throughout the day), l gram of calcium (orotate seems best absorbed). Ginseng has also been used to correct temperature imbalances. Gail Sheehy notes that one of the women she interviewed successfully controlled hot flashes with acupuncture.
A blood sugar imbalance could account for the spaciness and panic attacks. Besides regular meals of unrefined, unprocessed foods, Ojeda suggests, in addition to the other vitamins listed above, magnesium (500 mg), chromium (200 mcg), and vitamin A (5,000-10,000 IU).
The good news is that it seems that, as with PMT, many other symptoms like insomnia can be alleviated through diet and nutritional supplementation. (Indeed, readers might also contact the Women's Nutritional Advisory Service (PO Box 268, Hove, East Sussex BN3 1RW), the PMT experts, who may also have advice on menopause.
(We'd also like to hear from any of our readers who practice alternative or complementary medicine who have successfully treated various menopausal symptoms.)
What Greer and Sheehy have also tried to do is to effect a change in attitude, so that women don't look to postpone the inevitable. Says Greer: "We might develop better strategies for the management of the difficult transition if we think of what we are doing not as denial of the change or postponement of the change, but as acceleration of the change, the change back into the self you were before you became a tool of your sexual and reproductive destiny. You were strong then, and well, and happy, until adolescence turned you into something more problematical, and you shall be well and strong and happy again."