Questions raised over HRT alternatives

By Stephen Daniells

- Last updated on GMT

Related tags Menopause Alternative medicine

The Royal College of Obstetricians and Gynaecologists (RCOG) has
issued an opinion paper on the herbal alternatives for HRT, and
concludes that not only are they less effective than the regular
treatment, but some may be harmful.

The news, despite being picked up by many national news agencies, is not all bad however, with isoflavones from soy and red clover in particular coming away with significant credit.

"On the positive side, there are early data that some of the better researched preparations, such as soy and red clover, may well have some benefits, not only on symptom relief but also on skeleton and cardiovascular system,"​ states the RCOG paper.

The major Women's Health Initiative study released in 2002 found that hormone therapy could actually increase the risk of certain conditions it was previously believed to prevent, including heart attack. A further study on combination hormone therapy also found that it increased the risk of death from breast cancer.

Following the findings, sales of soy isoflavones surged. However the RCOG Opinion Paper indicates that further research to prove the efficacy of herbal remedies for hot flushes is needed to support their availability in the marketplace.

Summaries of the opinion paper have appeared in mainstream publications in Britain, including the UK's Daily Mail (HRT alternatives 'could damage your health' warning​), the Telegraph ( Alternative cures for menopause 'may be harmful'​) and the BBC (Menopause alternative remedy fear​).

Richard Warren, honorary secretary of the RCOG said: "The current interest and enthusiasm directed towards alternative treatments for menopausal symptoms is understandable, but the full risks and benefits of these alternatives are still unknown."

A summary of the alternatives found that there insufficient science to support their claims of relieving menopausal symptoms or of being able to equal the benefits of conventional therapies, particularly for herbals such as St John's Wort, dong quai, gingko biloba, ginseng, liquorice and valerian root. Moreover, some of these herbals were associated with adverse effects and interactions with prescription medications such as the blood thinner, warfarin.

"More research with well-designed clinical trials is needed,"​ said the opinion paper.

The paper concludes that the overall effectiveness of alternative preparations indicates a 50-60 per cent reduction in symptoms, considerably lower than the efficacy of traditional HRT, which has 80-90 per cent reduction in symptoms.

For soy and red clover however the paper reports that benefits have been reported from some studies, and notes that for soy a stronger benefit was observed for postmenopausal women taking soy isoflavone supplements rather than for soy products.

Five placebo-controlled studies also reported that red clover was effective in reducing the number of hot flushes, compared to placebo, however these effects were only statistically significant in two of the five studies considered.

Meanwhile Dr Sarah Brewer, a GP specialising in a natural approach to health, said: "It's good news that isoflavones have been recognised as helpful for women experiencing the menopause. And it is important to remember, of course, that the safety risks associated with HRT are well documented and far greater than those linked with any complementary therapy used to help menopausal women."

No mention of the side effects of the traditional HRT are mentioned in the opinion paper, only comments on the efficacy of the products in relation to HRT.

Indeed, this same point was picked up by Dame Dr Shirley Bond, medical advisor to the Natural Menopause Advice Service (NMAS): "I find it interesting that the report does not mention any of the potential side effects of HRT but only possible side effects from the alternative therapies.

"If, as the RCOG report says, the alternatives relieve 50-60 per cent of symptoms, whereas HRT relieves 80-90 per cent, surely that is better. I would rather have a 60 per cent response than a response with the risk of breast and other cancers."

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