We asked menopause experts about HRT alternatives following news of a national shortage

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  • Around a million women in the UK use HRT treatment to control their menopausal symptoms such as hot flushes, mood swings, and night sweats, according to the National Institute for Health and Care Excellence.

    Around 2.5 million HRT prescriptions are issued every year in England in the form of patches, pills or gels.

    But within the UK currently, there is a national shortage of HRT  – meaning many menopausal women have been left without their normal treatment to ease menopausal symptoms.

    MORE: National hormone replacement therapy shortage ‘incredibly’, says expert

    In fact, the shortage has not got so bad, that leading doctors have called for an investigation into the medical crisis.

    They noted the enormous effect that a lack of HRT could have on menopausal women – saying that without it, women are left with the risk of unwanted pregnancies and serious mental health issues such as depression and anxiety.

    Dr Edward Morris, the president of the Royal College of Obstetricians and Gynaecologists, said, “We understand the HRT supply situation should begin to improve from February 2020 as the range of products which supply 70% of the HRT patch market will be reintroduced to the UK market.

    “However a number of HRT medications and contraceptives remain unavailable, some until the end of this year, and some with no timeline as to when they will be back on the market,”

    HRT alternatives

    Why is there an HRT shortage?

    Women are reportedly suffering due to supply and manufacturing issues (allegedly in China), leaving many pharmacies out of stock of the most commonly prescribed HRT brands. GPs have warned that over half of HRT drug brands are out of stock.

    Which types of HRT are affected?

    The types of HRT affected by this shortage are mostly tablet forms of combination preparations containing oestrogen and a progestogen. Some hormone combination patches have also been affected.

    MORE: HRT: essential reading on the side effects, benefits and risks of hormone replacement therapy

    In response to the HRT shortages, the British Menopause Society has produced an update on the current availability of HRT products and brands in the UK.

    It’s important to speak to your GP if you are unable to get hold of you usual prescription as although you may not be able to receive the brand of HRT you normally receive, the pharmacist or GP can usually come up with a suitable alternative.

    What are the HRT alternatives?

    This Morning’s Obstetrician and Gynaecologist Dr Larisa Corda said, “While the HRT shortage is frustrating for many women, it is helping to draw attention to HRT alternatives that may be available. While we know that HRT can help ease symptoms of fluctuating hormones during the menopause, there are many HRT alternatives to consider if HRT isn’t the right – or available – choice for you.

    “I would advise anyone who is considering HRT alternatives to go and see their GP in the first instance, who can always refer to a specialist if required, to discuss your individual situation and needs.”

    If you are considering HRT alternatives Gynaecologist and BMS-accredited menopause specialist Miss Anne Henderson advises, “women should not radically change tack and stop HRT abruptly, as this can lead to rebound symptoms which can be worse than the original menopausal problems”.

    Lifestyle changes

    HRT alternatives

    During the menopause your body is changing and hormones fluctuate so it’s a crucial time to adopt a healthy lifestyle and exercise regularly. According to Dr Louise R Newson, “It’s important women have holistic approach to the menopause about their diet, exercise, and sleep.”

    Healthy diet

    When you are going through your pre-menopause you may find you that eating certain foods can trigger some symptoms such as hot flushes, poor sleep and weight gain.

    Specialist Menopause Nurse Kathy Abernethy advises, “Drink plenty of water and focus on a balanced diet – plenty of vegetables, good protein and healthy fats will help to you have the energy you need to get through the day. Avoid or reduce food and drinks that could trigger symptoms like hot flushes and insomnia such as caffeine, spicy foods, alcohol and large quantities of sugar and salt.”

    MORE: How to lose a stone in a month: an easy-to-follow, effective diet plan

     

    HRT alternatives

    Exercise

    For women, the Department of Health and Human Services recommends aerobic activity for at least 150 minutes a week – this could include swimming, biking or jogging. Exercising during the menopause has a number of health benefits including relieving anxiety, lowering depression, preventing weight gain and building muscle strength.

    Kathy Abernethy also advises, “Try relaxation and meditation techniques such as yoga, reading or simple pleasures like going for a walk or painting your nails. Explore ways to express yourself at this significant milestone in your life – whether that’s a new hobby or rekindling an old one.”

    HRT alternatives

    Herbal remedies

    Herbal or natural remedies  have frequently been used as HRT alternatives to help ease symptoms of the menopause. Though, unfortunately the evidence behind them in most cases is weak. The most common natural supplements used to reduce symptoms of the menopause include phytoestrogens, black cohosh, evening primrose oil and ginseng.

    MORE: 8 causes of tension headaches – and how to beat them

    Dr Larisa Corda said, “Some herbal remedies can be enough to help with milder symptoms of the menopause but they may have side effects and can also interact with other medications you are on, so it’s really important to discuss with your doctor if you are drawn towards using these.”

    Miss Anne Henderson said, “Most women may find herbal treatments ineffective only because they tend to buy ‘over the counter’ products. I would recommend seeking advice from a fully accredited National Institute of Medical Herbalist (NIMH)  who will prescribe organic freeze-dried herbal tinctures which are extremely potent and can be very effective.”

    Tibolone

    Tibolone is an HRT alternative which similarly mimics the activity of the female sex hormones, oestrogen and progesterone. It is usually prescribed 12 months after a woman’s last natural period. Tibolone has proven effective in some women as an HRT alternative to combat hot flushes, insomnia, headaches, low libido and vaginal dryness.

    Though, Miss Anne Henderson advises, “I never prescribe Tibolone and I cannot see that it has any place in modern HRT practice. It is entirely synthetic and does not meet the current “gold standard” prescribing requirements which focus on natural body-identical hormones instead of synthetics.”

    She continued, “Tibolone is associated with a higher risk of irregular and unscheduled bleeding, endometrial abnormalities and also breast cancer than many other alternatives.”

    Similarly, GP and menopause specialist Dr Louise R Newson said, “I tend not to prescribe Tibolone, but a number of doctors do use it. Some women like it because it is a single tablet but there is a small risk of a clot.”

    Possible side effects

    • Potential increased risk of breast cancer and ovarian cancer
    • Irregular bleeding or spotting during the first 3-6 months
    • Headache, dizziness, nausea, abdominal pain, vaginal discharge, swollen feet

    Menopause magnets

    Menopause magnets are a natural HRT alternative and are billed as a hormone-free way to treat symptoms of the menopause – particularly hot flushes. They work by balancing activity within the autonomic nervous system.

    MORE: Menopause Magnets: what actually are they and do they really help ease menopause symptoms?

    A menopause magnet is places at the front of your underwear and are said to eliminate menopausal symptoms like hot flushes, water retention and bloating in perimenopausal and postmenopausal women. Though, these claims have not been medically proven.

    Possible side effects

    • Some magnets can interfere with pacemakers and insulin pumps
    • Small red mark appearing on skin under magnet
    • Can affect small children and pets

    HRT alternatives

    Clonidine

    Clonidine is a non-hormonal therapy frequently considered as an HRT alternative for the management of menopausal hot flushes in some women.  Clonidine can be used both in tablet form and patches.

    Dr Louise R Newson said, “Clonidine is a really old-fashioned drug. There is not much evidence that it really works  for women going through the menopause.”

    Dr Larisa Corda said, “Clonidine is a blood pressure medication that may be effective in reducing hot flushes and night sweats. However, it generally only has a small effect on most menopausal symptoms. It can require up to a month to notice the benefits.”

    Possible side effects

    • Nervousness, agitation, shaking, and migraines
    • Constipation, dry mouth, and trouble sleeping
    • In more serious cases: abnormal heart rate, slowed breathing or trouble breathing

    Bioidentical or ‘natural’ hormones

    Bioidentical hormones or natural hormones are man-made from natural sources such as plant estrogens and are identical or very similar to human hormones. Bioidentical Hormone Replacement Therapy (BHRT) comes in different forms including pills, patches, gels and injections.

    Some practitioners claim that  BHRT is a safer HRT alternative, though Dr Larisa Corda said, “Bioidenetical hormones are relatively new and made out of plant sourced chemicals. However, they are not yet regulated and we need more clinical trials to tests their efficacy and safety profile before they can be endorsed in the same way as HRT.”

    Similarly, Dr Louise R Newson said, “They are neither regulated or licensed, and none of the menopause societies worldwide recommend them. There is no evidence that they are better or safer than conventional HRT. They are only found in the private sector and are very expensive.”

    Possible side effects

    • Increase risk of blood clots, stroke, and gallbladder disease.
    • Increase risk of heart disease and breast cancer
    • Weight gain, fatigue, acne, headaches, spotting, mood swings

    Surgical procedure to delay menopause

    Dr Larisa Corda said, “One of the most recent developments is the potential to surgically remove ovaries from women. The ovaries can be frozen, so that they are captured in that point in time and can be implanted back into the reproductive system several years later.

    “The benefits of this are that the onset of the menopause could be delayed for up to 2 decades and the woman produces her own hormones instead of having to take HRT.

    “It’s a fascinating field and at the moment, it is only being used on patients who are likely to undergo an earlier menopause due to medical or surgical reasons. However, the bigger question will be whether it should and could be offered to healthy women who do not have these risks but wish to postpone the menopause for their own personal reasons.”

     

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