Dr Jeni Worden answers your questions about Medical Homeopathy

After HRT -how homeopathy can help

It may seem strange to be mentioning a form of treatment, Hormone Replacement Therapy (HRT) that is firmly planted in the field of conventional medicine on a website for those interested in complementary therapies. However, although HRT has its detractors, it does still have a part to play in restoring wellbeing to women suffering from menopausal symptoms. The menopause is that stage of a woman's life when her reproductive system starts to wind down, causing a wide range of symptoms, some of which can be very distressing and debilitating. The vast majority of women will start to experience the so-called 'change of life' in their late forties but symptoms may persist after a woman has passed her sixtieth birthday.

The main symptoms experienced are hot flushes, night sweats, bladder problems such as cystitis and infections, depressed mood, reduced sex drive, forgetfulness and reduced concentration. For most women, symptoms will last two to three years, starting with an irregularity of periods and ending with the periods completely stopping. After twelve months, a woman who has not experienced any periods is commonly said to have gone through the menopause and to be 'post-menopausal'. Any vaginal bleeding after this time should always be reported to a doctor or practice nurse as it could be an early sign of endometrial cancer ('cancer of the womb').

As a GP I am often asked by worried women to carry out blood tests to see whether or not they are going through the menopause but such tests do have drawbacks. They only give a 'snapshot' of the hormone levels a woman is experiencing at a certain point in time and are notorious for being returned from the testing laboratory as being within the normal range when the patient is quite clearly experiencing some or all of the symptoms of the menopause. Patients often feel let down by the results, which is why GP's tend to advise against these tests in general. The exception to the rule is where a woman has a congenital lack of a womb or has had a hysterectomy with preservation of her ovaries. Changes to the menstrual cycle are not apparent in these women and early subtle changes of the menopause can be confused with a mild depression, perhaps leading to incorrect treatment of the underlying problem. In the end, the best way to judge whether a woman is going through the menopause is to listen to her and to look at her as a whole which is the holistic approach.

Often all a woman will need at this point in her life is reassurance that her symptoms are normal and that she is not suffering from a mental illness. The ups and downs of teenage girls at puberty are echoed in women at the menopause but without the ability to scream and shout and to flounce out of the house, slamming the door. Instead, most women will either be looking after a family or working, which can lead them to feeling trapped emotionally and physically by their symptoms. Why some women sail through the menopause with the minimum of symptoms and others regard it as the worst time of their lives is not understood by the scientific community and exactly what causes hot flushes is also some what of a mystery. Although we know that it is the reduction of levels of oestrogen (the principle female hormone) that seems to be responsible for hot flushes and night sweats, the exact means by which this happens is not clear. What is clear is that for women with debilitating symptoms and a markedly reduced quality of life, HRT can literally be a life saver, increasing the hormone levels back up to normal and often having a dramatic effect, reducing symptoms to a more manageable state within a week or so of starting treatment.

So if HRT is so wonderful, why has it fallen from grace so recently? The main reason is research showing that HRT could increase the risks of having a heart attack or stroke. The Women's Health Initiative study (2002) was carried out in the United States on a population of women ten years older than would commonly be prescribed HRT in the UK and who also had existing risk factors for heart disease. Although the older and less fit women in the research could have biased the results against HRT as they were inherently more likely to suffer from heart disease, the medical profession were concerned enough by the results to significantly reduce their prescribing of HRT. This course of action was backed up by the Million Women Study, funded by Cancer Research UK, which looked at an increased risk of cancers linked to taking HRT, principally cancer of the womb. It is estimated that at least 340 000 women stopped taking HRT after the WHI research was published and that of the 300 000 women estimated each year to enter the menopause, many will now look at alternatives to conventional treatment. The National Institute for Clinical Excellence (NICE) currently recommends HRT for the relief of debilitating vasomotor and urogenital symptoms (hot flushes, night sweats, cystitis, recurrent urinary infections, vaginal dryness) in women over fifty and for two to three years only, with an annual review of symptoms. Women under fifty (the most common age for the menopause), particularly those having hysterectomy with removal of the ovaries or undergoing an early ('premature') menopause can still be prescribed HRT as they are only receiving hormones that they would normally have.

All this has meant that a reasonable proportion of women over fifty in the UK have either stopped their HRT suddenly or have been persuaded by their GP's to do so, and in so doing, have landed right back into the menopausal symptoms that they were trying to escape from. Some women would have been started on HRT for treatment or prevention of osteoporosis ('brittle bones') and may not have had any symptoms when they started treatment but certainly have now. HRT is no longer a recommended treatment in the UK for prevention of this disease and other non-hormonal treatments are widely available on prescription, in addition to the lifestyle advice of not smoking, maintaining a sensible body weight, regular weight bearing exercise, e.g. walking and a dietary intake rich in calcium and vitamin D.

So if you are one of the unfortunate women who have to wear sleeveless t shirts on the coldness of days and who sleep on a beach towel to save continually changing the bed sheets, what can you do to make life more comfortable for you and those around you? In my experience, there is no single complementary therapy or medication that works for all women and this is borne out by conversations with other doctors and therapists. There are, however, several homeopathic medicines which can be effective at relieving menopausal symptoms. It is especially important, however, to try to see a Faculty of Homeopathy recommended practitioner as a prescription will work better if holistic and tailored to the individual. Also, there are other problems that can affect a woman in her fifties, such as an under active thyroid gland, which can mimic menopausal symptoms; thyroid problems can respond well to treatment so it is important to have this particular problem excluded professionally by blood tests and medical examination.

One of the commonest homeopathic medications that I prescribe is Sepia. This important gynaecological medicine is based on cuttlefish ink and can be really helpful where the feelings of worthlessness and lack of self confidence can damage a woman emotionally. These symptoms are all too common for some women in the menopause and may not be helped by a slightly dominant partner who may not understand or have patience with their symptoms. There is often marked depression and tearfulness which the partner can be irritated by and the whole relationship becomes strained. The woman often feels isolated and cuts herself off socially, withdrawing psychologically. Her family can find her distant and taking less interest in her appearance which are typical symptoms of clinical depression. She feels worn out and sex is no longer of interest to her. She may no longer find her partner attractive, a situation she may find difficult to come to terms with, and the partner also. Tears are common in the GP surgery when telling of her problems and a feeling of desperation with the situation is apparent, sometimes leading to irritability. Frequent attacks of sweating which lead her to feel clammy on waking at night predominate and often an unpleasant vaginal discharge, brought on by the hormonal changes she is undergoing. For severe symptoms, I recommend either a daily dose of Sepia 30C but occasionally, I find a weekly dose of 200C strength necessary for symptom relief. As well as using homeopathy in this situation, I also feel it is very important to encourage my patients to undertake an activity that makes them feel good about themselves, even if it is simple as having a manicure or taking the dog for a walk. One must always treat the patient as a whole and helping the patient to feel better in a very general way will, in my experience, help the homeopathic medication act more efficiently.

The time that a woman takes to go through the menopause varies but is usually said to be between 2-3 years. I find that most menopausal symptoms peak about 3-6 months after stopping HRT, and will often be manageable about 12-18 months HRT was last taken. One of the most difficult symptoms to relieve are the profuse sweats at night and it is in this situation that I use Lachesis. This is a remedy often associated with sexual jealousy and a passionate nature but even the mildest woman can be helped by this medicine, particularly if her remaining menopausal symptoms have settled. Typically, a patient who can be helped by Lachesis wakes to her symptoms or suffers from them in her sleep. There may also be an element of irritability. A dosage regime similar to that of Sepia can be used.

Black cohosh has been recommended by herbalists for the relief of menopausal hot flushes but worries about possible toxic effects on the liver have led to some health concerns about this remedy, particularly when combined with conventional medication. However, taken in the homeopathic form of Cimicifuga, this can be a useful remedy and without side effects. Women may tend to feel the cold rather than being hot all the time and have a tendency to depressive symptoms.

There are numerous medications for bladder problems, including Causticum, Staphisagria, Berberis and Sarsparilla but a recently discovered homeopathic medication called Adamas, based on diamond dust, can be used for frequency of urinating, associated with vaginal dryness. Reduced elasticity of the vaginal wall and a change in the acidity of the vagina are both symptoms due to low oestrogen levels. This is the reason for recurrent urine infections and difficulties with sexual intercourse at the menopause. Conventionally, these symptoms can be treated with oestrogen creams or pessaries used vaginally without many of the risks of HRT per se, but not every woman wishes to do this. The Adamas can be used alone, or in combination with Sepia.

Many of the best known homeopathic medications can be used during the menopause such as Pulsatilla and Nat Mur but Graphites is often over looked. I have found it helpful where a woman perhaps has gained a few unwanted pounds over the period of the menopause, having previously been perhaps slightly overweight.  She is generally mild in temperament but puts a brave face on things, a little like the Nat Mur person. She has the weepiness of Pulsatilla but tends to be chilly where Pulsatilla is hot. Typically, Graphites like sweet foods, but occasionally dislike such foodstuffs which can seem to be at variance with their body shape. They may, or may not, have skin problems, such as a weeping eczema or psoriasis. A woman who does well with Graphites may well be very sensitive to music, weeping at her favourite piece.

One thing that I would like to emphasise is the menopause is just a normal stage in every woman's life, as difficult or as easy as it might be for an individual. As well as homeopathy, regular exercise can help maintain brain function in older women, according to recent research and can also help with the physical symptoms of the menopause. The role of Soya (isoflavones) in the diet is not fully recognised but in countries such as Japan, where soy is a staple food, less than 25% of women get hot flushes. It may be necessary to consume at least 25mg of isoflavones a day compared to the 1mg most UK women obtain through their diet. Some women do experience allergy type symptoms, such as swollen joints, with high levels of dietary soya so some caution is needed if making a drastic difference to one's intake. 800IU of vitamin D and 1500mg of calcium is the recommended daily dietary allowance to prevent osteoporosis. This can be obtained either through eating oily fish 2-3 times a week and drinking at least half a pint of milk a day or through nutritional supplements. Alcohol and caffeinated drinks can worsen flushing and irritate bladder function so a reduced intake is advised.

Although some women do undergo a fairly permanent change in their underlying body temperature ('thermostatic dysfunction'), most women will experience only temporary changes with the menopause. There IS help available for this time of upheaval and the fact that it often co-incides with children 'flying the nest' or other life events does not always make it easier to manage. If you feel that your symptoms are adversely affecting your life and wellbeing, please do not hesitate to contact your GP or homeopathic doctor. Conventional websites such as www.menopausematters.co.uk or www.the-bms.org have more information about this inevitable, but not always welcome, change in our lives.

Dr J Worden  copyright 10.07



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