Coping with menopause without HRT

Valeriana courtesy of A. Vogel

It can start in  your early 40’s (or even before) or you may be 50 or even 60. Some people sail through the menopause, particularly those women in the far east who eat a lot of soya.

While HRT is very popular it has been found to increase the likelihood of both breast cancer and ovarian cancer.

Symptoms include: hot flushes and night sweats/anxious and irritable/tiredness/vaginal dryness/bladder discomfort/muscle aches/low libido/weak pelvic floor muscles.  See also Menopause – the change, not the end

 Hot flushes          

Whether they last for a few seconds or induce sweating night and day, hot flushes are a common and debilitating symptom of menopause. If night sweats are happening regularly sleep is also interrupted.

  • Wear little or nothing at night and sleep under lightweight covers;
  • Avoid caffeine, alcohol, spicy food, hot drinks and red meat;
  • Choose foods rich in naturally occurring oestrogen: soya, golden linseeds and seeds, lentils and chick peas, as well as the supplement Red Clover.

Herbal helpers

A review of five trials found that Black Cohosh reduced hot flushes in 80 per cent of menopausal women, but it isn‘t good for women who get headaches and migraine. As an alternative you could try making a tea with a teaspoonful of chopped up fresh sage leaves and boiling water as an alternative.  It would be irresponsible not to point out that there is a question over the safety of black cohosh – that it may cause liver damage, but it has not been banned. Sometimes research leading these scares is somewhat flawed but make sure you read the label and if in doubt consult a herbalist.

Other tips

Michael Dooley suggests the yoga alternate nostril breath – breathe slowly through one nostril at a time while shutting off the other one with your thumb or finger, and retain the breath to a count of four. He claims, ‘This breathing exercise was shown in a study to enable the pituitary gland to work at its best, reducing body temperature and hot flushes.‘


Homeopath and author, Beth Maceoin, recommends Pulsatilla for drenching, exhausting sweats particularly at night.

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Aches and pains

It‘s easy to think that there‘s something else wrong – like arthritis – when aches and pains in the joints and muscles set in. It seems like old age is creeping up far too quickly, but it‘s a normal menopausal symptom.

Maryon Stewart of The Natural Health Advisory Service suggests:

  • Magnesium, potassium, and B vitamins for muscle function;
  • Glucosamine sulphate which has been shown in several clinical studies to improve pain and joint tenderness – at a dose of 400mg three times a day;
  • Evening primrose and strong fish oils with calcium to help increase the uptake of vitamins and minerals, normalise hormone function, lubricate joints and keep the heart healthy.

There are special menopause formulas which contain many of the recommended supplements, such as Menopace and Fema 45+.

Other helpers:

  • Black Cohosh for aches and pains which feel like rheumatic pain – check the label as there has been some suggestion that too much of this herb can damage the liver
  • Nettle tea to clear out uric acid.

Instead of giving up exercise because of pain weight-bearing exercise can both ease aches and pains and build up bone mass to prevent osteoporosis – walking, tennis, jogging, and skipping are all good.

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Tiredness and insomnia

Passiflora courtesy of A.Vogel Bioforce

‘Not enough sleep, stress at home and at work, lack of exercise and a poor quality diet can all reduce energy levels,’ according to Maryon Stewart of the Women‘s Nutritional Advisory Service. ‘A healthy diet with a multi-vitamin supplement containing 20 to 30mg of zinc is helpful.‘

Expert tips:

  • Ginseng for women who are tired and run down, but choose Siberian Ginseng if anxiety is also a problem;
  • Sepia homeopathic remedy ‘for mental, emotional and physical exhaustion at times of hormonal upheaval and transition’ according to Beth Maceoin.
  • A relaxing night-time tea of Chamomile  can help induce sleep but for persistently bad nights passiflora or valerian tablets and tinctures need to be taken 30 minutes before bedtime.
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Anxious and irritable

It‘s not surprising that night sweats, insomnia and a host of hormonal changes leave some women frazzled, anxious and uptight!

Some recommended herbs:

  • Motherwort for anxiety accompanied by palpitations;
  • St John‘s Wort* when women are feeling low – check with doctor if taking medication as well;
  • Chamomile and lemon balm teas for calming.

Aromatherapy oils can also be relaxing – put a few drops in a bath or preferably in a massage!

  • Lavender, rose and geranium oils
  • Ylang ylang on a tissue to ease depression;
  • Lavender oil can be rubbed into the skin – test it first – on the throat either side of the thyroid where it gets absorbed by the carotid artery and carried to the brain.

Other calming tips:

  • Valerian or passiflora herbs for calming;
  • Nux vom homeopathic remedy which according to Beth Maceoin, ‘Is good for anyone who sleeps badly, has headaches and craves tea, coffee, alcohol or cigarettes to keep them going.‘
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Loss of libido

There‘s so many reasons for loss of libido at this stage of life – for men and women. Young children, relationship problems, depression, overuse of prescription drugs, plenty of stress at work and home, and hormonal changes all contribute.

Now we have so many herbs at our disposal you can find some to boost sex drive (forget the Viagra!):

  • Damiana used by the Maya of Central America
  • The Chinese Horny Goat Weed;
  • The Inca‘s Maca from Peru and Korean Ginseng, which should not be used by anyone with high blood pressure.
  • Bush Flower Remedies‘ Sexuality

Aromatherapy‘s great for sensual mood building with oil burners or massage. Some oils have an aphrodisiac quality:

  • Neroli
  • Sandalwood
  • Ylang ylang
  • Patchouli
  • Jasmine
  • Rose

The Romans used to scatter rose petals over the beds of newly weds and orange blossom was used to crown brides and calm and relax them before wedding nights.

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Pelvic floor muscles

Having children,  intercourse and just getting old all serve to make the pelvic floor muscles weaker. This can result in incontinence, dribbling or discomfort if the walls of the vagina are collapsing on to the bladder or bowel – prolapse.

There are conventional ways of dealing with weak pelvic floor muscles, but even doctors aren’t particularly keen on surgery and it’s such a delicate part of the body that the consequences aren’t always great and the problem isn’t necessarily solved. There are various gadgets that appear that you can put inside the vagina, but quite frankly the best solution is pelvic floor exercises.

They are so easy to do and so discreet that you can practise them while you’re driving, sitting on a train, in the bath, lying in bed or anywhere! Pilates and Yoga are both good for strengthening these muscles, and it is often worth asking the teacher for specific exercises.

Vaginal dryness

A dry vagina is due to the thinning of the mucous membrane and the fact that lubricating fluid is no longer produced. It can lead to painful intercourse and a general feeling of discomfort and the problem may be worse in very hot weather.

Doctors offer pessaries and creams that contain oestrogen, but they do ask if you have breast cancer in the family. If you prefer to avoid taking oestrogen a natural plant-based moisturiser can be just as effective.  A phytoestrogen diet as highlighted above definitely helps as well.

Author of Natural Medicine, a Practical Guide to Family Health, homeopath, Beth Maceoin recommends:

  • Avoid tight jeans and nylon underwear
  • Don‘t use scented soaps or bath foams
  • Do have regular sexual activity! ‘It maintains lubrication and suppleness of the genital area and orgasm with the associated rush of blood and muscular contraction plays an essential part in maintaining moisture and flexibility of the vagina!’

Helpful products

There are some very helpful products on the market at long last to help women with this problem. Some of them are lubricants to use when anticipating making love, while others are pessaries and vaginal gel which are inserted into the vagina overnight to make it more moist generally.  There are also some supplements taken as oral capsules which may prevent the area from drying up.

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Bladder discomfort

Vaginal dryness and prolapse or weak pelvic floor muscles can contribute to bladder discomfort and sometimes it’s really hard to know what is the cause. Another possibility is that the lack of oestrogen in the body can also cause cystitis – eating soya which contains phytoestrogens could help.If the bladder is being squashed by the walls of the vagina it may produce a dragging pain rather like period pain and can lead to considerable discomfort. Without having surgery there isn’t much that can be done except Pelvic Floor Muscle exercises (see above).Vaginal dryness needs to be addressed as well because it can mean that the vagina tissues tear during intercourse, causing infection which spreads to the bladder.If infection in the bladder is a regular problem there are many things that can be tried including:

Uva ursi, a herbal remedy which soothes bladder infections

Compounds in cranberries (proanthocyanidins – PACs) attach themselves to bacteria (which are mainly E-coli) preventing them from adhering to cells in the bladder – try supplements or Ocean Spray’s Cranberry Plus Grape, Apple and Cranberry Juice which contains no artificial sweeteners or sugar.

Avoid sugar and yeast – often the problem can be linked to Candida – see Candida in this section and eat plenty of fresh vegetables, wholegrains and pulses.

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Balancing hormones

SaladHow much does stress really affect the body? We all know that it plays its part in depression, heart health and other conditions, but actually it has an enormous effect on our hormones which can affect you in many different ways. Kimberley Gridley, a homeopath, nutritionist, specialises in Natural Hormone Balance for Women, based on functional medicine.

Kimberley sees women of all ages, but not surprisingly many of them have faced high levels of stress. Too much stress exhausts the adrenal glands, which provide the adrenaline for the ‘fight and flight mechanism’. Common issues are weight gain, emotional ups and downs, periods and PMT, menopause and hot flushes, fibroids and endometriosis. Many are struggling with lack of energy and tiredness, as well as Chronic Fatigue or Fibromyalgia.

In addition to saliva and blood tests to check for hormonal imbalance, Kimberley asks patients about their diet. She also runs a diagnostic test called a heart rate variability test (HRV) which indicates how the hormones are coping, how you burn calories, whether you are struggling with stress levels, and what metabolic type you are.

Functional medicine is a personalised approach to healthcare which focuses on why we have disease and getting to the root cause of the problem. Each person is treated as an individual and their particular health issues are addressed. This is in stark contrast to conventional medicine which often treats disease with drugs in a ‘one size fits all’ approach.

Once Kimberley has all this information she prescribes homeopathic or herbal remedies, vitamins and minerals, and other supplements such as Omega 3s or probiotics. She also draws up a diet that is suited to your type, but is very likely to consist of a lot of vegetables.

Kimberley practises at the Nelson’s Pharmacy at 87 Duke Street, London W1K 5PQ, 020 7079 1282, . See Kimberley’s website  where you can get a free copy of Hormone Balancing Eating Plan: The Low GI Companion e-book.

Find out more about functional medicine by watching Dr Mark Hayman on YouTube. 

Menopause: the change – not the end

At any one time millions of British women are experiencing menopausal symptoms such as: disturbed sleep, hot flushes, night sweats, joint aches and pains, loss of libido, irritability, aching muscles and joints, confusion, poor memory and concentration, vaginal dryness, headaches, depression and anxiety.

The menopause can hit at any time around 50 but some women have it later or in their 30s or even earlier. It can also cause long-term problems making women more susceptible to brittle bones or osteoporosis and heart disease.

Sounds dreadful – but it needn‘t be!  Read: Coping with menopausal symptoms

First of all – the Perimenopause

What is less known about is the perimenopause. Women in their 40s are constantly complaining that they forget everything, that they can’t sleep well, that they feel irritable or anxious but then they say ‘It can’t be the menopause because I’m still having periods and (groan) I’m not old enough yet’.

But the perimenopause can run for at least ten years before periods gradually slow down and stop.  It is due to a drop in oestrogen and changes in ovarian function preceding the menopause.  Symptoms include:

• Poor concentration
• Menstrual irregularity
• Heavier periods
• Hot flushes
• Mood swings
• Anxiety and irritability
• Tiredness

Sounds just like the menopause.  Because the symptoms are the same doctors are likely to prescribe HRT, but similarly all the natural alternatives that work for the menopause can help to relieve perimenopause too, so read on.

Treating the menopause

Sebastian Pole of Ayurvedic specialists, Pukka Herbs, says:

Women’s health issues are often treated with Hormone Replacement Therapies (HRT),  anti-depressants or surgery. Ayurveda thinks that women’s health should be treated holistically and without synthetic hormones.

For example, the recent 2003 Lancet report of the ‘million women study’ showing that 20,000 extra cases of breast cancer had been caused by using HRT says it all. Menopause is not a disease, it is a transition, and the risks associated with invasive treatment outweigh the benefits.

The majority of women do not need invasive hormone ‘replacement’. Whatever stage of life you are in you may need some help with including some additional healthy living habits. Most of us do!

Getting to the heart of the problem

Ayurveda offers the potential for true healing to occur. And this is because it addresses the ‘heart’ of health, which is spiritual, mental and physical well-being. Ayurveda will treat every person on a multi-dimensional level and, generally speaking, I would recommend that for women to attain the best health you should:
• Take a daily multi-vitamin (from a wholefood source)
• Eat at least 50g of phyto-oestrogens a day – linseeds, lentils and soya products.
• Eat an array of multi-coloured vegetables and lots of whole grains. These contain cellular protective, heart and bone strengthening nutrients.
• Eat cold-pressed organic oils; hemp seed is my favourite as it contains a blueprint of the body’s essential fatty needs. These omega oils protect your heart, brain, joints and nervous system.
• Stop eating salads. They may contain more nutrients but they are poorly assimilated, weaken digestion and can cause weight gain!
• Eat cooked food. The cooker has ‘pre-digested’ the food making it more available for you.
• Take Aloe Vera juice with Shatavari capsules – it is well renowned for rejuvenating women’s health. Shatavari is one of those miraculous plants that really helps boost women’s health; it balances hormones, improves the flow of breast milk, improves fertility, improves libido and stops hot flushes.
• Take Ashwagandha. This is another wonderful herb that helps to settle your nervous system, give a good sleep and give you more energy. Herbs work in these multi-faceted ways because many of them help the body to respond. They are not a ‘replacement’ they are ‘food’.
• Perhaps most importantly, have a regular oil massage. You can give this to yourself, or receive it from your partner or see an expert. It is fantastic for your immunity, skin quality and for removing excess fluids. And it’s a treat.

Sebastian Pole is an Ayurvedic practitioner and Herbal Director of Pukka Herbs which offers 100% organic Ayurvedic remedies and teas, produced to high ethical standards, from herbs grown by farmers who are paid a fair wage. For more information, see or ring 0117 9640944 . Sebastian’s clinic is on 01225 466944,

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Why not  take HRT?

You only have to follow the headlines to know that there have been a lot of scares for the 2 million or so women who take HRT in Britain:

  • In recent years many women who swore by HRT and its miracle cures have come off it because of a host of scares particularly concerning increased risk of breast cancer, strokes, blood clots and Alzheimers.
  • There has been definitive research that showed that the incidence of breast cancer was increased with users of HRT, and now it has been found that 1,300 women in Britain died from ovarian cancer in the 14 years between 1991 and 2005 because they were using the drug.
  • Recent research has questioned the claim that HRT protects against heart disease and osteoporosis – studies have shown that any increase in bone mass is lost when women come off HRT.
  • Two-thirds of women stop taking it in the first year because of the side-effects.

One of the worst disadvantages of HRT is that if you come off it suddenly you may see a robust return to hot flushes, night sweats and other symptoms. It is important to seek help from your doctor or other professional in women’s health to structure the cessation of HRT.

The Natural Health Advisory Service  (NHAS) advises:

  • A diet high in phytoestrogens: soy, pumpkin, sesame and sunflower seeds, linseeds, and Red Clover supplements, to ease hot flushes, create new bone, provide protection from heart disease and improve memory and brain function;
  • Cutting out caffeine, spicy foods, hot drinks and alcohol which all aggravate hot flushes;
  • Avoiding tea, wheat and bran which contain tannin and prevent nutrients being absorbed.

Maryon Stewart, author and founder of the NHAS,  says:

‘Our research indicates that many women of childbearing age are low in levels of magnesium, B vitamins, essential fatty acids and chromium. By the time they get to the menopause, if they haven‘t learnt to meet their body‘s nutritional needs it is impossible for the brain chemicals and hormones to cope.‘

Michael Dooley, Consultant Gynaecologist, Dorset County Hospital, Dorchester and Lister Hospital, Chelsea, London, says, ‘What works for women best are simple natural methods, positive attitude, feeling good and hopeful about themselves, a support network of family and friends, a phytoestrogen rich diet, physical activity, reducing stress and anxiety and relaxing’.

Maryon Stewart warns, ‘It is important that women shouldn‘t read bad publicity and come off HRT suddenly without finding a non-drug alternative before they do’.