Last week we looked at the history and studies relating to the good and bad sides of hormone replacement therapy (HRT).
One of the studies was the Million Women Study, which led researchers to believe that 1,300 women in the UK had developed ovarian cancer and a further 1,000 had died, as a direct result of taking HRT.
On the ground, oncologists were seeing a sudden and steep drop in cases of breast cancer. The only difference was the fall in the use of HRT. In the US, breast cancer rates fell by 12 per cent in 2003 (the year after the WHI study, mentioned last Sunday), while a smaller decrease was seen in the UK.
Researchers at the M. D. Anderson Cancer Centre in Houston, Texas, reported that 14,000 fewer women that year had been diagnosed with the cancer. Researcher Peter Ravdin said: “It is the largest single drop in breast cancer incidence within a single year I am aware of. Something went right in 2003 and it seems it was the decrease in the use of hormone therapy.” (N. Engl. M. J. Med., 2007)
The company concerned prepared to be hit with actions for compensation. The company paid out, even when it was taken over by Pfizer, who inherited 9,900 pending claims. One woman (in the US) was awarded $75 million in punitive damages after she contracted breast cancer from taking Prempro. This enormous award was partly due to the fact that the court recognised the company was continuing to promote the therapy, despite knowing it could cause cancer.
Subsequently, a new product has appeared on the market, offering a new generation of therapies, some designed only for short-term usage. The UK’s NICE (the health quality controller) has issued new guidelines to doctors, advising them to begin discussing HRT with women going through menopause. This discussion should involve risks and benefits, and length of use, of the new types of therapy available. There are still concerns with the guidelines and the efficacy of the support of these new therapies. For example, within the 18-person panel that made the new HRT recommendations, nine have financial ties to HRT manufacturers.
Every woman should ask: do the recent studies make HRT safe and counterbalance the mountain of evidence of harm that has accumulated over the past 12 years or so?
The herb Ginkgo biloba can improve your sex life within a month
There are plenty of tried and tested alternatives to HRT available to treat symptoms of menopause.
• Brittle bones/osteoporosis – supplement with vitamin D. One study from Addenbrookes’s Hospital in Cambridge found that even low-dose supplements can dramatically reduce the risk of fractures compared with a placebo (BMJ, 2003). Boron can also help prevent post-menopausal osteoporosis, as it stimulates the body to make more oestrogen.
• Hot flushes – try Omega-3 fatty acids. Taking 2g/day halves the severity of hot flushes, and had a positive effect in 70 per cent of women taking these supplements (Menopause, 2009). Vitamin E can also reduce the frequency and severity of hot flushes (Gynaecol. Obstet. Invest., 2007), as can acupuncture, which achieves a ‘marked clinical improvement’ with 12 sessions compared with the usual care (Menopause, 2010).
The herbal supplement Fernal was twice as effective as a placebo in reducing flushes in one trial of 54 menopausal women. In addition, the herb black cohosh has a long tradition of use for ‘women’s problems’ and can help with flushes and mood swings. It is so effective that Germany’s health regulator has approved its use at 40mg/day. There have been concerns that it might worsen the spread of breast cancer, so women with a family history of the disease should perhaps think twice before taking it (J.Womens Health, 2005).
• Loss of libido – the herb Ginkgo biloba can improve your sex life within a month, according to one trial of 202 pre and post-menopausal women complaining of low sex drives (Adv. Ther., 2000).
• General symptoms – aromatherapy has helped women with their general menopausal symptoms after a month of home care and two sessions with a therapist (J. Altern. Complement. Med., 2005). Yoga, tai chi and meditation-based programmes can also ease symptoms.
• Diet-based advice – a few simple changes to the diet could offset HRT’s cancer risk, several studies have found. Implausible as it may sound, adding celery and parsley to the diet might even reverse aggressive breast cancer caused by HRT. It is connected to apigenin, a compound found in those foods.
Apigenin, a flavonoid, shrinks tumours stimulated by progestin, the synthetic hormone used in HRT and birth control pills, say researchers at the University of Missouri. It kills cancer cells, stops them from spreading and interferes with genetic codes that encourage cancer growth. Curcumin, a compound in the curry spice turmeric, seems to have a similar effect on cancer cells. It appears to slow and even stop the development of cancerous tumours in the breast (Menopause, 2010).
Finally, your basic diet can also help. Wheat, dairy, caffeine, alcohol and processed food can all worsen hot flushes and various symptoms. So rehash your diet for a period of three months and assess how you feel afterwards.
kathryn@maltanet.net