Due to recent health scares surrounding HRT (Hormone Replacement Therapy), more women are looking for alternative and natural ways to cope with symptoms associated with the Menopause

Although many consider HRT to be a relatively new drug, its predecessor, ORT (oestrogen replacement therapy) actually made its debut in the 1930s. However, as ORT was only available in the form of an injection or implant, it proved to be neither convenient or popular with the masses, and interest dwindled until the 1960s, when gynecologist Robert Wilson extolled the apparent virtues of this 'anti-aging' drug for menopausal women in his book, Feminine Forever.

Sadly though, as more women embarked on ORT. it became clear that oestrogen on its own could increase the risk of cancer of the womb and breasts.' In the absence of progesterone - the hormone which triggers bleeding in women who have not conceived - cell mutations were starting to take place in the endometrium (lining of the womb). And so progestagen, the synthetic version of progesterone, was added to the preparation, and HRT was born.

But some 40 years later, the HRT story still lacks a happy ending. World-wide research, including the recent One Million Women Study', funded by Cancer Research UK, clearly links HRT with an increased incidence of breast cancer - with the combined osteogen-progestagen version of the drug being the biggest culprit of all. One major research program, due to run until 2005, was even abandoned 3 years early when mid-survey results showed that those participants taking HRT had a higher risk of breast cancer (26%), stroke (41%), and heart problems (29%).

So in light of this research, should women continue to take HRT? Needless to say. this is a decision that lies solely in the lap of the individual. It is for each woman to decide, perhaps in conjunction with her Doctor, whether the benefits of taking HRT outweigh the potential health risks -which, in some instances, might be the case. However, according to nutritionist and psychologist, Dr Marilyn Glenville, there are only two benefits that the majority of women can hope to attain from HRT: "The first is that it alleviates hot flushes and night sweats, the second that it maintains bone density for as long as you take it. But in her book, The New Natural Alternatives to HRT,' Glenville goes on to point out that maintaining bone density does not necessarily prevent bone fractures, and that hot flushes and night sweats may be down to diet...

Diet and the menopause

Hot flushes, night sweats, irritability, anxiety, depression and a number of other symptoms can all be attributed to fluctuations in blood sugar levels. Those who eat a lot of sweet or refined foods will probably experience sharp drops in their blood sugar levels throughout the day, and often at night too (around 3 or 4 a.m.). When blood sugar levels drop sharply, the 'stress' hormone adrenaline is released into the bloodstream, prompting the liver to produce more glucose in order to counteract the fall. When this occurs on a regular basis, the end result can be a whole range of symptoms that mimic the menopause.

It is also worth noting that whilst 85% of Western women suffer with hot flushes during the menopause, only 14% of Asian women will experience this symptom. Why? The answer seems to lie in 'phytoestrogens', which are naturally occurring substances in food that have a hormone like action in the body - of which isoflavones are perhaps the most beneficial, And while Westerners eat between 1-3mg of isoflavones a day, those in the East eat between 20-80mg. Foods particularly rich in phytoestrogens include organic and GM-free: beans (especially soya); peas; celery; garlic; seeds; grains; broccoli; cinnamon; sage and parsley.

Bear in mind that stimulant such as tea. coffee, alcohol, and spicy foods can also promote hot flushes and sweating.

Osteoporosis and exercise

One of the main reasons that women take HRT is in the hope that it will prevent osteoporosis. Although not all women will necessarily develop osteoporosis later in life, the odds of this condition occurring do increase when a woman reaches the menopause as oestrogen production starts to decline. But although research has shown that HRT can increase bone density, it is not yet known whether this actually helps to prevent fractures.

Exercise in general is good for joint mobility and overall health, and weight bearing exercise that places pressure on the bones is extremely important in the prevention of osteoporosis (e.g. racket sports, walking, jogging, etc.). Diet also plays a vital role; women are advised to avoid 'anti-calcium' foods and beverages such as sugar, alcohol, caffeine and fizzy drinks. Vitamins C, D, and K, and the minerals calcium, zinc and magnesium are also considered by nutritionists to be important in maintaining bone health.

As for the other symptoms...

In The Menopause: What You Need to Know, the authors suggest that a number of psychological symptoms associated with the menopause (e.g. depression, mood swings, tiredness, etc) may actually have more to do with stressful life events coinciding with the menopause, rather than the menopause itself. Such events include: parents becoming less independent: loss of a partner; children leaving home; and coming to terms with ageing in a culture that values youth and fertility. Obviously, HRT cannot help any symptoms that are caused by stress. But holistic therapies can...

Holistic treatments and the menopause

By looking at the list of symptoms on the opposite page, you will notice that many of these can be addressed naturally, through the use of holistic therapies, (Obviously, therapists need to remember that clients' needs vary considerably, and their individual symptoms need to be taken into account, and the treatment tailored accordingly.)

Massage and aromatherapy

Massage alone can help to: relieve stress; improve sleep; eliminate waste and toxins; aid joint mobility; improve circulation; and stimulate the endocrine system. Aroma therapists can obviously take these benefits one step further by selecting essential oils that are appropriate for specific symptoms experienced by the client:

• Aching joints: lavender, camomile, bergamot, rose, juniper
• Depression: lavender, rose, camomile, clary sage, sandalwood, ylang-ylang, bergamot
• Hot flushes: Roman camomile
• Memory/concentration: rosemary
• Sleep problems: bergamot, lavender, camomile, petit grain.

Other oils that may be of benefit include geranium (a hormone balancer), and for those clients who feel they are losing their femininity, rose can be particularly helpful.

Reflexology

Reflexology is a very 'balancing' treatment, and one that can be of great benefit to women experiencing the menopause -though, again, this very much depends on the individual. Key reflex areas worth considering include: pituitary (to regulate the endocrine glands); adrenals (to balance hormones); thyroid and parathyroid (to help bone health); and ovaries/ reproductive area (to help regulate).

Other holistic therapies

For clients who feel tired, forgetful, or lack concentration, Indian head massage may prove beneficial as it is a stimulating treatment, and increases circulation in the region of the brain. Other therapies that have a balancing/ relaxing effect may also be suitable.

Skin care

Collagen is an important protein found in the skin, hair and nails, and sadly for those reaching the menopause, oestrogen levels affect its production.4 As women reach the menopause, they will generally find that their skin becomes thinner, dryer and less elastic. Obviously, Beauty Therapists and Aroma therapists will be able to provide their clients with advice, treatments, and products that will help them to address specific changes taking place in their skin.

Therapists need to remember that it is not their place to advise any client as to whether HRT, or any other medication, is appropriate for them. Whilst it is acceptable to offer generalised after-care advice, therapists should not offer dietary recommendations, nor should they attempt to make a diagnosis, unless they hold the relevant qualifications to do so. Clients who express a wish to come off HRT should be advised to consult with their Doctor before doing so.

References and further reading

1. Glenville, Dr Marilyn. The New Natural Alternatives to HRT (Published by Kyle Cathie Ltd, 2003) ISBN: I-85626-461-0. Dimensions: 175mm x 235mm; 231 pages; no pics.
2. Glenville, Dr Marilyn. Eat Your Way Through the Menopause (Published by Kyle Cathie Ltd, 2003) ISBN: I-85626-468-8. Dimensions: 210mm x 240mm: 191 pages; colour pics.
3. Million Women Study Collaborators Breast cancer and hormone-replacement therapy in the Million Women Study (The Lancet: Vol. 362; No. 9382; 09 August, 2003)

3. Rees. Dr Margaret. Purdie, Professor David. Hope. Dr Sally. The Menopause: What You Need to Know (Published by the British Menopause Society. £6.99. Available from book shops. ISBN; O-9536228-2-7). Dimensions: 147mm x 210mm; 105 pages: diagrams and tables throughout

What is the menopause?

Medically speaking, the 'menopause' is actually a woman's final period, though today it is a word commonly used to describe the transitional years leading up to this event, often signaled by hot flushes, irritability, lack of energy, irregular periods, forgetfulness, and mood swings. The menopause occurs when the ovaries literally run out of eggs. The average age at which a woman will reach the menopause is 51, but this can be earlier under certain circumstances, e.g. following a hysterectomy, sterilisation, the removal of one or both ovaries, or if she is a heavy smoker. The menopause is considered to have occurred if a woman has not had a natural period for 12 consecutive months (providing that there is no medical reason for this, and she is not pregnant).

The symptoms

• lack of energy
• mood changes, irritability
• depression, anxiety
• osteoporosis, joint pains
• changes in hair/ skin quality
• hot flushes, night sweats
• forgetfulness, poor concentration
• vaginal dryness, declining libido
• constipation, weight gain

Our thanks to International Therapist Magazine for allowing us to share past articles