HEALTH BULLETIN .CO: Ask the doctor: Are herbal remedies for menopause safe?

Tuesday, August 27, 2013

Ask the doctor: Are herbal remedies for menopause safe?

Dr Martin Scurr gives advice on herbal help for menopause

Three years ago I underwent the menopause at the age of 50, shortly after losing my dear sister to breast cancer (she was just 50).

I started to experience hot flushes, night sweats and high anxiety but was reluctant to take HRT because of the family history of cancer — my mother also died from the disease aged 64.

As an alternative, my chemist recommended red clover with isoflavones and green tea. Since my first tablets a few months ago my periods have returned and I am starting to feel myself again. But could a herbal remedy have such a profound effect — or have my periods come back due to me overcoming my grief?

J. Lipman, Surrey.

Herbal way to happy: There are several supplements on the market which mimics the effect of the body';s natural oestrogen

The symptoms of the menopause can be extremely debilitating — and I’m sorry to hear of your distress and bereavement.

The symptoms — such as hot flushes — occur because of lack of production of the female hormone oestrogen by the ovaries, which have reached the end of their reproductive life and are gradually shutting down.

The changing hormone levels may affect the hypothalamus, the part of the brain that acts as the body’s thermostat, and send it out of kilter.

Your decision to avoid hormone replacement therapy, which is very effective at easing these symptoms, was wise given your strong family history of breast cancer. There is much evidence that some, if not most, breast cancers are stimulated by the presence of oestrogen, and HRT consists mainly of this.

Popping pills: Taking herbal supplements could have a positive effect

You ask whether the restoration of your monthly cycle and the dramatic resolution of your unpleasant menopausal symptoms are down to the herbal remedy and the easing of your grief.

Given that it’s three years since your menopausal symptoms started, I suspect it’s the remedy rather than the psychological change that has been at work.

The remedy has had an instant and powerful oestrogen-like effect, stopping the hot flushes and restoring your cycle, as well as having a magical reaction on your mood.

There are several such natural substances available, and we refer to them as gonadomimetic — meaning that they mimic the effects of your own natural oestrogen. My concern is that in terms of cancer risk, we do not know for certain that such preparations are any safer than taking HRT.

There is a view that if these products are natural, or herbal, then they must be safer.

But there have been no large-scale trials to address that specific issue.

I have real concerns over the safety of this compound. If the oestrogen-like substances in the red clover are strong enough to relieve the symptoms of the menopause so effectively, then there is a possibility that these compounds may also raise your risk of cancer.

You must consider this matter very carefully given your family history, despite the great benefit you have obtained.

There are non-oestrogen alternatives to HRT, including lifestyle measures (some evidence suggests that regular, gentle exercise such as swimming can reduce the hot flushes) and medication options.

Some antidepressants may also decrease hot flushes and improve mood, and the drugs gabapentin (an anti-epilepsy drug) and clonidine may also ease the episodes.

Perhaps now is the time for an appointment with your GP to discuss your concerns and treatment options.

I was diagnosed years ago with a slow heart rate, but have recently found that I feel very tired in the mornings — it takes me around an hour or so to get going. Is my heart condition to blame for my dreadful fatigue?

Alan Cockayne, by email.

You are describing, I believe, a condition called sick sinus syndrome or sinus node dysfunction. The sinus node is the natural pacemaker of the heart: it sets the rate.

You have not stated how old you are, but ageing of the cells of that area of the heart muscle may result in this timer becoming unreliable (this condition is more common in the over-70s), and the heart rate can become slower.

The condition, which is fairly uncommon, results in not enough blood being pumped around the body, triggering symptoms of light-headedness, breathlessness, fatigue or palpitations. In your case, these episodes seem to particularly strike at night, which is why you are feeling so tired in the morning.

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Diagnosis involves a 24-hour or even a seven-day ECG (an electrocardiogram, which measures the electrical activity of the heart).

It’s also important to look for any easily treatable causes — for instance, certain medications can affect heart rhythm.

You tell me in your longer letter that you are taking a small dose of amlodipine for high blood pressure.

This is one of a group of medicines called calcium channel-blockers, which may affect heart rate and, therefore, be exacerbating your symptoms.

(There are alternative medications for your blood pressure that won’t adversely affect the sinus node and it’s important to discuss this point with your GP.)

One option for a slow heart rate is to have a pacemaker implanted.

While this helps reverse any fainting or light-headedness in most patients — important for preventing falls — it may not have such a beneficial effect when the main symptom is fatigue, as in your case.

And as there are potential complications from such surgery, including infection or bleeding, the decision to have a pacemaker fitted is more complicated and involves carefully weighing up the risks and benefits.

Once the sinus node starts to deteriorate, it tends to continue doing so.

For that reason I believe you should be having periodic reviews by a cardiologist — and every time you are seen, the correlation between your symptoms and the ECG recordings should be re-evaluated.

BY THE WAY... WE ALL NEED LESS MEAT ON OUR PLATES

Fork off: Modern westerners eat too much meat

When my children went to school, the headmaster insisted they had swimming lessons from the first day.

‘No one ever died from not learning French,’ he would say.

But there was another important message schools could have been passing on: the importance of healthy living, or rather, healthy eating.

However, this just wasn’t given any thought in those days.

The decades have passed and I am now a grandparent and I think about this a lot.

My patients, as a group, have aged with me, and many are suffering the ravages of coronary heart disease, hypertension, diabetes and stroke.

And I find myself constantly wishing that 30 years ago I’d been as enlightened about healthy eating as I am now.

Medical men like me spend a lot of time seeking out the nooks and crannies of science to see what can be applied to the quest for the better health of our patients, as well as those close to us.

But sometimes the answer is closer to home — in the kitchen. I recently attended a fascinating evening at Kew Gardens in London to learn more about the health benefits of eating less meat.

They were not advocating ditching meat altogether — this was not a push towards vegetarianism — but a careful, balanced look at why it can be a good thing to eat less meat and more plant-based foods.

Since the days when I was at school the world population has doubled, and now 70 per cent of land throughout the world is given over to agricultural use to grow crops to feed animals.

The result is we are over-eating the foods — meat and dairy products — that are least good for our health and the environment.

In my childhood, the biggest treat at the end of the school holidays was to have chicken for dinner: it was special and we called it ‘The Last Supper’. Yet, thanks to mass production, by the time I was at university even we impoverished medical students bought chicken by the bucketload.

The experts at Kew argued there could be much benefit to be gained from tweaking the balance of what we eat, little by little, to ensure that at least two-thirds of the food at each meal comes from plants — wholegrain carbohydrates, nuts, beans, lentils, fruit, vegetables and plant-based alternatives to dairy foods, including soya.

Meat, fish, eggs, and dairy foods can be a third — or less — but of better quality. In this way we reduce the intake of bad types of fat, have a lower incidence of heart disease, diabetes and even cancer, and place less burden on the resources of the world.

But how can we achieve this change? It has to begin with education, and this means teaching human biology and nutrition, instructing children about food, the relationship to future health and how to develop good eating habits. Let’s do it.

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Tuesday, August 27, 2013

Ask the doctor: Are herbal remedies for menopause safe?

More from Martin Scurr...

BY THE WAY... WE ALL NEED LESS MEAT ON OUR PLATES