What is Natural HRT?
What is menopause?
Menopause is so many things! It’s a transition into a new phase of life, where your body undergoes big changes and your periods eventually stop. Traditionally it was called ‘climacteric’ which means ‘ripening’ and post-menopausal women were highly respected for their wisdom and life experience.
Physiologically, the ovaries stop making the most potent form of oestrogen, and your adrenal glands start making less potent forms which will help support your health, but without the risk of pregnancy in your 70’s or 80’s! The lead up to menopause is known as peri-menopause, and we all experience it differently. Some women have no menopause symptoms at all, others have very debilitating symptoms, and the rest of us sit somewhere in between. We all know about the hot flushes, weight gain, mood swings and fatigue, but other symptoms include:
- Brain fog or memory problems
- Aches & pains
- Vaginal dryness
- Loss of libido
- Feeling lost, disconnected or apathetic
I encourage you to take a positive attitude towards your menopause and seek help if you are suffering. There are a lot of very disempowering scare stories out there, but menopause is a natural transition which your body can manage smoothly if it has everything it needs to do so.
What is HRT?
HRT stands for Hormone Replacement Therapy, although nowadays it’s also becoming known as MHT (Menopause Hormone Therapy). It’s used to directly replace hormones which would naturally decline during perimenopause and menopause and alleviate the symptoms that can happen.
There have been concerns over the years that HRT could increase the risk of certain oestrogen receptive cancers, and many women choose not to take it for this reason. The older forms of HRT contained higher levels of oestrogen than the newer forms, and were often prescribed without progesterone to counterbalance the effects. Since then the guidelines have changed, and women who still have a uterus are always prescribed progesterone alongside their oestrogen. However, HRT is still being prescribed when a woman’s symptoms suggest high fluctuating oestrogen as we see in early perimenopause. Most are not offered hormone testing over a period of time, so it’s impossible to know exactly what their hormones are doing. We don’t know what the long term effects of prescribing HRT in this way are until the studies are published, but there are still safety concerns amongst some Doctors in the meantime. Our modern lifestyles tend to leave a large number of women in a state of oestrogen excess and some question the wisdom of adding in yet more oestrogen, especially whilst levels are still high.
Much of both the oestrogen and progesterone preparations are derived from the herb ‘Mexican Wild Yam’. It’s interesting that one plant can be used to manufacture two hormones with opposing effects, but the human body is unable to convert the progesterone precursors in Mexican Wild Yam into useable progesterone. When I use it as a whole herb to treat my patients, it has an oestrogenic effect, and contrary to popular belief, you don’t need very high doses of it.
What happens to your hormones in perimenopause and menopause?
My blog about the stages of perimenopause explains in more detail, but to summarise:
- In early perimenopause you have high levels of fluctuating oestrogen, with comparatively low levels of progesterone to counterbalance. Topping up levels further with oestrogen HRT at this stage could potentially cause side effects relating to oestrogen excess.
- As you head towards menopause, your oestrogen levels drop more sharply, resulting in more classic symptoms like hot flushes and mood swings.
- Eventually the levels of the most potent form of oestrogen decline to the point where your periods stop altogether. If all has gone well, you are still producing enough of the less potent forms to sustain your overall health for the rest of your life.
What is natural HRT?
Going back to the Mexican Wild Yam, we know that it’s a really useful part of any herbal menopause toolkit, but there’s some confusion over how it works. It’s good to be aware that although they may claim to offer a form of progesterone replacement, unless they’ve been highly processed in a pharmaceutical facility, Mexican Wild Yam creams don’t contain any useable progesterone. They might still relieve your symptoms, but it’ll be due to the other constituents within the herb or the overall phyto-oestrogenic effect.
It also helps to remember that there are varying degrees of natural. If you pick a leaf off a plant and eat it, it’s completely natural. If you add it to a cup of boiling water and drink the tea, still quite natural. If I made it into a herbal cream, there would be some processing involved that takes it away from its natural state. Eventually, if it’s highly processed to transform it from a plant to a pharmaceutical drug, it’s no longer natural.
It’s not necessarily the case that natural is good and synthetic is bad. There are herbs like Monkshood or Belladonna which can be deadly. Likewise there are drugs like general anaesthetics which are man-made but lifesaving. When it comes to peri-menopause, it’s really a question of personal choice. Doctors are on the whole now much more aware of how to prescribe HRT safely, and the newer forms deliver much lower doses of hormone into the body. As I said though, some Doctors are still hesitant about prescribing HRT due to safety concerns. It’s a matter of weighing up the risks and benefits for yourself, and going with what feels best for you.
In the true sense, there’s no such thing as natural HRT. The only medication that will directly replace declining hormones is prescribed HRT, or to a lesser extent, hormonal contraception. In my practice we trust that given the right resources, the body can navigate the menopause transition easily. If the process isn’t going smoothly and there are debilitating symptoms, it’s a sign that one or more systems are struggling and need support. I take menopause symptoms in the context of a woman’s overall health, and use the herbal remedies to address the underlying causes, giving the body back the resources it needs.
What are phyto-oestrogens?
There’s a lot of confusion around phyto-oestrogens and how they work, and it they are quite complex! In a nutshell though, phyto-oestrogens bind to the body’s oestrogen receptors, and help to regulate the effects of our own home made oestrogen on various body processes. There are two types of oestrogen receptor: alpha and beta, and four main classes of phyto-oestrogens, which are:
- Phenolic phyto-oestrogens
- Steroidal saponins
- Triterpenoid saponins
- Resorcylic acid lactones
Only the first three on this list are used to support women through menopause, and they’re found in all kinds of foods and medicinal herbs. We know that including these in the diet throughout life is really important both for menstrual and overall health, but particularly in early childhood.
These tend to prefer the beta receptors which are the main ones involved in alleviating menopause symptoms. They also help to protect brain, bone and cardiovascular health after menopause. Good food sources of phenolic phyto-oestrogens include:
- Flax, pumpkin, sesame and sunflower seeds.
- Vegetables such as broccoli, onions, leeks, celery and celeriac.
- Pinto or lima beans, split peas and soya
- Fruits like oranges, apples, grapes or citrus
- Herbs like chamomile, red clover, thyme and parsley
Steroidal saponins come from medicinal herbs and I can tell which ones they’re in because they’ll froth when I shake the bottle! The word ‘saponin’ comes from ‘soapy’ and these constituents make them foam up when I agitate the liquid. They have a closer resemblance to our own home-made hormones and help to modulate their effects. The steroidal saponins in Mexican Wild Yam are used to manufacture HRT, and other herbs which I use would include Tribulus and Shatavari.
Triterpenoid saponins come from a different group of medicinal herbs with a much lesser phyto-oestrogenic effect. They work more broadly, encouraging the body to create its own hormones in the correct amounts at the correct times. Most focus on supporting adrenal function, and double up as adaptogens which help the body out of its stress response. Examples would include Liquorice, Black Cohosh and Siberian Ginseng.
What are PhytoSERMs?
This is the new name being given to phyto-oestrogens to better explain what they do, because they increase or decrease the effects of oestrogen according to need. Phyto SERM stands for Selective Estrogen (American spelling!) Reuptake Modulators, which is a fancy way of saying they modulate the effects of oestrogen, rather than simply increasing them.
Are Phyto-oestrogens safe to use after cancer?
Research done over the past 30 years has concluded that certain phyto-oestrogens have a protective effect against oestrogen receptive cancers returning. Soya has been studied particularly thoroughly, and you can search for more information on the PubMed website. Despite this many women are still warned off using phyto-oestrogens by their healthcare team, and/or are nervous about taking herbs which contain them. Where this is the case I avoid using these herbs, which can lead to treatment taking a little longer, but is much better than having a patient constantly worrying about the herbs they’re taking.
Natural ways to increase progesterone
Low progesterone whilst problematic during perimenopause, isn’t seen as being as big a problem as low oestrogen, so there’s far less research available. What we do know is that there are some herbs which will encourage the body to convert and use its own progesterone more effectively. These would include Vitex agnus castus, Liquorice and White Paeony but they all need to be used with care and at the correct dosages.
Natural ways to increase testosterone
Doctors are often criticised for not routinely offering testosterone replacement as part of standard HRT. It’s true that low testosterone levels can contribute to symptoms in women as well as men, but men generally need higher levels, and the difficulty is getting the dosage right for the female body with preparations we currently have available. Symptoms of low testosterone can include fatigue, low libido, and bladder problems, but there are more serious health risks associated with high testosterone, hence the reluctance amongst many Doctors to prescribe it without ongoing monitoring.
Again, there’s been less research into herbs and foods which raise testosterone levels, but there are some we can use if needed. Maca powder raises testosterone levels in men, but not women, although it does help us to produce other hormones more effectively. Herbs like Korean Ginseng and Tribulus will raise testosterone levels in women to some extent, but they’re best taken as part of a broader herbal prescription.
Advantages of natural HRT
There are lots of advantages when it comes to using natural HRT alternatives. Particularly working with a medical herbalist gives you more than just medicine. I also offer moral support, advocacy, an explanation of any medical tests you may need help with, and dietary/lifestyle coaching. It allows you to be cared for, which might make a nice change when you’re the one who does all the caring!
Herbal remedies offer a safe, effective, and usually fast acting way of treating your peri-menopause symptoms. All of the medicine is tailored to your exact needs, according to your priorities. As well as using herbs containing phyto-oestrogens, I can add in others which influence your body’s hormone balance, help you to cope with chronic stress, support your gut health, and work on specific symptoms. It’s a very rounded and holistic approach which treats all of you at the same time.
Because we have plenty of herbs to choose from, we don’t have the same supply issues that we’re seeing with HRT. Even if it’s difficult to source herbs from our usual suppliers, we can make medicines from plants growing in our gardens or surrounding area. We never run out of options!
Herbal remedies also support your long term health as well as helping you get on top of your menopause symptoms. We can also work on other health issues alongside your peri-menopause with all the herbs in one bottle.
Natural HRT for dementia, osteoporosis and heart disease
It’s important to realise that at present most governing bodies, and the Menopause Society guidelines do not recommend HRT as a preventative for dementia, osteoporosis or heart disease as there’s insufficient evidence to support it.
There is some evidence supporting the use of certain herbs in protecting against these conditions, and currently there’s a large study taking place looking at how phyto-oestrogens might help protect against dementia. There’s already some interesting research for Sage in particular, and you can find this on the PubMed website.
Mexican Wild Yam when taken as a whole herb has been shown to stimulate the cells which grow new bone, which is useful where osteoporosis is a risk, or already present. It’s not clear whether HRT made from this herb has the same effect, but it would be interesting to find out!
There’s a lot of research backing dietary and lifestyle changes when it comes to staying healthy after menopause, but unfortunately it’s not very well publicised. Simple changes like 30 minutes exercise a day, or changing to a more anti-inflammatory diet can make a huge difference. You can find out more about the proven ways to help yourself in my Rejuven8 programme.
Where to get help
If your symptoms are having an impact on your life, look at my 90 Day Rescue programme, and if you’ve only got mild symptoms or would like to learn more about self care, you’d like my Rejuven8 home learning programme.
If you’re not sure, you’re welcome to book a free call and we can explore your best options together.