The HRT crisis

Over a million women in the UK are on Hormone Replacement Therapy, but many are unable to access the drugs the need because of shortages and supply chain issues. We take a look at some alternative solutions…

AROUND 80% of women undergoing menopause suffer from hot flushes, night sweats, insomnia, fatigue, palpitations and discomfort during sex. Couple this with heightened anxiety and issues with memory and concentration and it’s no surprise that at least a million women have prescriptions for hormone replacement therapy. This often comes in the form of bio-identical or close mimics of the hormones that the body has reduced or stopped production. HRT treatment has also been shown to reduce the risk of dementia and also protects bone density, reducing the occurrence of osteoporosis.

The British Menopause Society (thebms. org.uk) lists a range of drug options on their website, so it’s possible to find out the nearest equivalent treatment and then what the pharmacist has in stock. You can then ask your GP to change your prescription to a treatment which is available.

CBT can help with managing some of the symptoms, particularly around recognising that hot flushes are related to stress, but NHS waiting lists tend to be in excess of six months. Stress breathing exercises may also be of some use, as may other forms of stress relief, like meditating, yoga and being in nature. Exercise, too, has been shown to reduce the severity of the symptoms.

If insomnia is a problem, there are various herbal supplements as well as sleep apps that may help. In the latter case, however, there is some evidence that sleep apps can increase anxiety around sleeping. Night sweats can be helped with the use of cooling pillows and mattress pads. Opening a window or using a cooling fan may help. Some people recommend freezing nightwear before use and a cold shower before bed may also be of assistance.

Natural supplements such as St. John’s wort, black cohosh and soy or red clover phytoestrogens can ease symptoms in the short term.

Natural supplements such as St. John’s wort, black cohosh and soy or red clover phytoestrogens can ease symptoms in the short term. NICE have published findings that St. John’s wort, which is also used for depression, can relieve hot flushes. There’s also evidence that black cohosh is as effective as HRT when it comes to dealing with hot flushes, but it’s known to cause rashes and stomach upsets in some users. It’s best to take professional advice from a medical herbalist or your GP as some of these supplements can have a detrimental effect on other medications, such as cancer drugs. As ever with supplements and herbal formulations, it’s important to buy from a reputable supplier, with properly measured doses and quality control.

Some private clinics offer an unlicensed, unregulated drug combination called compounded bioidentical hormone therapy, but, as yet, there is no evidence that these treatments are efficacious.

Diet is another useful way of getting phytoestrogens into the body. Celery, green beans, lentils, chick peas and, above all, soya products like tofu, soya milk, miso and tempeh are all useful sources. Pumpkin seeds, flax, sesame and sunflower seeds can also help. One small study found that a soy-rich, low fat plant-based diet, similar to that of many Japanese women - reduced the number of hot flushes experienced by over 80%. 15 of the 38 women involved found that their hot flushes disappeared. B vitamins, particularly vitamin B9, known as folate, and B6 can be useful in symptom reduction. The former can alleviate hot flushes and the latter lowers the risk of depression associated with the menopause.