All Change

1 September 2004

Publication: Harpers and Queen

Whether you are 30, 40 or 50, your health can benefit from the right choice of nutritional supplements. Not simply alternatives to HRT – still the only medically approved treatment for early menopause – herbal remedies and selected vitamins can help to slow down the decline of fertility and keep you feeling younger longer

HRT: THE UPDATEFor most women, the decline in oestrogen production, which begins in the early thirties, is barely noticeable - apart from decreasing fertility – until the early forties. Consultant gynaecologist Elizabeth Owen of the West Middlesex Hospital believes it is vital for women to feel in control and to make their own decisions about taking Hormone Replacement Therapy (HRT).

'Don’t forget if you’re feeling depressed, it may have nothing to do with the menopause. HRT is not going to treat clinical depression or increase self-esteem, but if you’re feeling low and tired because you’re struggling with debilitating symptoms, then it probably will.’

Women have been scared and confused by recent research linking HRT with breast cancer. Karen Winterhalter, executive director of the charity Women’s Health Concern, says: 'Some turn to alternative therapies, but the only truly effective medical treatment for menopausal symptoms is HRT. Women have been put off by alarmist reports; this could turn back the clock to a time when they just had to put up with symptoms.’

Two years ago, US Women’s Health Initiative research concluded that long term use of HRT increased risk of breast cancer – a finding also made by the much criticised UK Million Women Study. Women in this trial were not typical HRT users (some started taking it in the seventies) and were more likely to get ill. Put in absolute terms, the results show four extra cases of breast cancer fir every 1,000 women in their fifties taking combined HRT for five years. It sounds frightening, but probably carries less risk than being obese, and around the same as drinking more than two glasses of wine a day. Once HRT is stopped, the risk returns to its original level within a year. There were also slightly more heart attacks, strokes and blood clots; but more protection from thinning bones and colon cancer. Oestrogen-only HRT, suitable for women who have has a hysterectomy, does not raise the risk, and may even protect against the disease. Looking to the future, consultant gynaecologist Colin Davis of the London Clinic says an alternative 'designer oestrogen’, raloxifene, has some of the benefits without unwanted side affects. It increases bone density and may inhibit breast cancers. 'But we really need a new range of treatments,’ he says.

Jenny Hope is medical correspondent for 'The Daily Mail’.

SUPPLEMENTS THE LOWDOWNFortunately, there is plenty we can do to help minimise menopausal symptoms, and the earlier we begin, the better: even your thirties is not too soon. Here’s our guide to the best supplements to support you before, during and after the menopause.

THIRTIES TO MID-FOURTIESMULTIVITIMIN AND MINERAL SUPPLEMENTSBone density begins to decline in our thirties. Slowing down the process is the aim, and one way to help is to ensure a good general intake of micronutrients. Look for a supplement that contains 100 per cent RDA of all the vitamins and minerals because, although calcium is well known for being vital for strong bones, research reveals the importance of many other micronutrients.

HIGHER VITAMIN B12In research from the Netherlands, B12 intakes have been linked to higher bone mass.

And scientists from Tufts University in Boston have shown that vitamin K is necessary for creating a strong bone superstructure onto which minerals such as calcium are then deposited; studies from Columbia University reveal that intakes of 18mg of iron a day are linked to stronger bones by promoting the production of collagen, a main component of bone. Few of us get sufficient selenium from our diets, and this trace mineral is needed to neutralise free radicals, which, when left to wreck havoc in the body, release collagen and elastin, the natural production of which declines from our thirties. Try Multibionta (£8.19 for 60 days’ supply).

ST JOHN’S WORTDepression is a common symptom of PMS and can be exacerbated as we near and enter menopause. In spite of criticism from pharmaceutical companies in the UK, St John’s Wort remains an excellent choice for reversing the blues. In fact, Germany, where it is available on prescription, doctors are confident enough in both its efficacy and safety to use this herb for dealing with mild depression, prescribing it five times as frequently as antidepressant drugs. Helping to raise levels of the feelgood brain chemical serotonin, St John’s Wort also reduces stress, helps improve sleep problems associated with 'the change’, and has been shown in clinical trials to enhance the libido of menopausal women. Try Kira St John’s Wort (£14.95 for 30 days’ supply).

EVENING PRIMROSE OILThere is a connection between the severity of premenstrual symptoms and those of the menopause in terms of irritability and cramps. Getting them under control as early as possible in life may reduce the problems they cause later on. The most convincing research on evening primrose oil relates to an its ability to tame irritability by helping to smooth out changing hormone levels during the menstrual cycle, and reduce cramps by blocking the prostaglandins that trigger discomfort. A 1,000mg supplement three times a day is recommended. Try Efamol (£7.49 for 30 days’ supply) ...

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