Our two part series on HRT (WDDTY vol 4 nos 9 and 10) generated perhaps more mail than any other subject we've ever covered. Among your comments were a number of questions that deserve thoughtful answers, so we decided to devote an entire page to answering them.
Some readers, such as Lisa Saffron (Consumers' Association) wondered how we could condemn estrogen replacement via HRT, but go on to recommend plant estrogens, in food and herbal tablets which haven't been tested and can be toxic if consumed in concentrated dosages.According to our Alternatives columnist naturopath Harald Gaier (Int J of Alt & Comp Med, September 1993), Phytoestrol, the product we mentioned, has been studied since the 1950s far longer than many estrogen replacement drug products. As long ago as April 1963 Dr Albert Lehmacher in his address to the 24th Congress of the Study Group of the Empirical Medicine Alliance reconfirmed the findings of the German Medical Journal (June 1956): namely, that Phytoestrol doesn't work as quickly as conventional hormones but will eventually provide lasting improvement (as opposed to the transitory improvement with HRT, which reverses as soon as you stop taking the drug).
Two decades later Gerhard Gerster, a German doctor who reviewed earlier experimental studies, also showed many successes with the use of Phytoestrol (The Journal of Applied Medical Phytotherapy, 1981, 111/8, 1-8).
Like any conventional drug, says Gaier, this product is manufactured by a German drug company (Chemisch Pharmazeutische Fabrik Goeppingen) and is subject to government control. According to the German Federal Board of the Pharmaceutical Industry, there are no known side effects, drug interactive effects or any known incompatibilities. Each tablet of the Phytoestrol preparation marketed in the UK contains 4 mg rhubarb root extract. At the recommended dosage, 2-4 tablets a day, this level of intake of rhubarb is not dangerous. Phytoesterol is available from the NutriCentre (The Hale Clinic, 7 Park Crescent London W1 Tel: 071-436 5122), but do remember to work with a qualified herbalist if you wish to take it.
Other readers like Bobby Freeman of Newport argued that menopause is a deficiency disease and therefore "needs" hormone replacement. Still others agreed that HRT is untested and potentially harmful but wondered what real alternatives they had in treating patients (Michael Hutchinson, Winchester chiropractor) or being treated (S B, Cheshire).
We rang a variety of doctors, including some panel members with great experience in treating women during the menopause to ask what they believed caused severe menopausal symptoms.
They agreed that it was a "deficiency disease" but not simply of estrogen. The root of the problem was deficiency in one of a number of vital micronutrients, food intolerance or the inefficient function of certain organs. Here are their views, based on extensive clinical work:
Ellen Grant (from her forthcoming book Sexual Chemistry, Cedar, 1994, an essential read for anyone going through or treating the menopause): "Hot flushes are not a sign of estrogen deficiency . . . [but] a result of an allergic reaction. Flushes are very similar to headaches, migraine and rises in blood pressure."
In her book, Dr Grant also notes the work of American Dr Guy Abraham who has demonstrated that most cases of osteoporosis are not caused by calcium deficiency and "cannot be prevented by calcium megadosing." . . . Instead he found that magnesium deficiency plays a key role. Grant cites a study of osteoporosis, which showed that none of the osteoporotic women participating had low blood calcium levels. In his own study (J Nutr Medic 1991; 2, 165-78), Dr Abraham gave magnesium to 19 women taking HRT. "After eight months, the bone mineral density in the women taking the supplements had increased by 11 per cent, while there was no increase in the women taking HRT alone," writes Grant. "Bone minerals were still improving after two years." Grant provides copious evidence that some of the biggest causes of osteoporosis are hormones like the Pill and HRT.
Besides avoiding calcium supplements (which interfere with the absorption of zinc and iron, Dr Grant suggests that menopausal women take the following supplements: magnesium (500 mg), zinc (at least 30 mg), boron (3 mg), which helps the body make its own estrogen, at least 10 mg manganese, 1 gm vitamin C per day. You also need vitamin K if accelerated bone formation is desirable, vitamin D, folic acid, B6, essential fatty acids and "first class protein".
John Mansfield: "In my view, a lot of menopausal symptoms are related to food sensitivity. Once we put women on an elimination diet, the severe symptoms stop. In some cases, we find the women have a candida albicans overgrowth.
Mansfield endorsed the studies of Guy Abraham and Grant's supplement regime. "Other important nutrients are chromium, selenium and manganese, plus essential fatty acids."
Patrick Kingsley: "I rarely ever use calcium supplements, for the reasons mentioned above. Although I always design vitamin programmes individually, as a rule of thumb I would recommend: 300 mg of magnesium, 15-30 mg of zinc, 50-100 mg of B6 (or 50 mg pyridoxal-5-phosphate, the first metabolite of B6).
"If all menopausal symptoms aren't relieved by this method, I've also had success with the homeopathic preparation Lachesis (30c potency), used four times a day for the few days, reducing gradually to one just before bedtime. It will immediately abort a hot flush if taken at the first sign. An alternative homeopathic remedy is silver nitrate (30c).
"Without question, zinc, magnesium and B6 improves the physical cause of low libido. Some women assume that the onset of menopause means that they will become old and haggard. This is absolute rubbish; although there is slightly more estrogen diminution after menopause, the body is still producing it from the adrenal glands. Leading a pleasurable and exciting life also helps maintain sexual energy, and continuous weight bearing exercise helps guard against osteoporosis."
Leo Galland: "Controlled scientific studies have showed that hesperiden derived bioflavonoids work in treating hot flushes. The relief isn't as dramatic as with HRT, but 1000-2000 mg/a day can be helpful. Bioflavonoids work best on an empty stomach.
"Besides soy products, a good dietary source of natural estrogen is wild yam (which also includes progesterone). If estrogen is really depleted, this will only cause mild estrogenic activity. I find vitamin E 400 units per day and evening primrose oil six capsules of 500 mg per day will help ovaries maximize output of estrogen during the early stages of menopause.
"A French physician, Dr Kathy Bonan in Paris, has written to me about a preparation of an amino acid, beta alanine, available in France, which is very useful in relieving hot flushes.
"Vitamins B6 and magnesium will help some of the other symptoms, such as anxiety. Evening primrose oil and vitamin E will help maintain libido, but the most effective method of maintaining interest in sex and keeping the vaginal canal lubricated is to have regular sex.
"Chinese herbal remedies containing angelica and ginseng also tend to promote estrogenic activity."
Stephen Davies: Since the adrenal gland is the major organ involved in adaptive changes in the body and has the highest concentration of vitamin C and pantothenic acid of any organ, it's wise to ensure an abundance of these two essential nutrients. Besides many of the above recommendations it's also good practice for your practitioner to make sure that the thyroid is functioning normally."