Natural alternative causes fewer complications

PUBLISHED : Wednesday, 18 May, 2005, 12:00am
UPDATED : Wednesday, 18 May, 2005, 12:00am

HORMONE REPLACEMENT Treatment (HRT) is often prescribed by doctors to treat menopausal symptoms caused by the decline of female hormone levels.

But studies show that HRT increases the risk of breast cancer, endometrial cancer, strokes and heart disease, and may induce anomalous mammary growth.

A study in 2002 of the effects of HRT on the heart, 'The Heart and Oestrogen/Progestin Replacement Study' found the risk of cardiovascular problems rose significantly in the first year of HRT among women with a history of coronary heart disease and remained high nearly seven years later. The risk of venous thromboembolism was also greater.

The results suggest that post-menopausal hormone therapy should not be used for the secondary prevention of coronary heart disease in women with established histories of the problem.

The Women's Health Initiative, another large-scale study in 2002 on the overall health benefits and risks of HRT in primary prevention of coronary diseases in healthy postmenopausal women, used oestrogen and progestin in one group and oestrogen alone in another.

The group taking oestrogen and progestin was prematurely stopped five years and two months into the study because of concerns about breast cancer and cardiovascular risks.

Both studies showed that HRT alleviated menopausal symptoms and reduced the risk of hip fractures, but it did not reduce cardiovascular risks in women with or without coronary heart disease.

Both studies also showed HRT increased the risk of venous thromboembolism.

Other studies have shown that HRT does not lead to a significant increase in the risk of breast cancer if it is taken for less than five years. However, the risk then increases the longer the treatment is continued.

Japanese women experience much milder symptoms of menopause than women in the west, according to Kenneth Lee Kwing-chin, a professor in the School of Pharmacy at the Chinese University of Hong Kong.

He said only 25 percent of Japanese women reported menopausal symptoms, compared with 65 per cent of American women.

Scientists broadly attributed this to the prominence of soya beans in traditional Japanese diets, Dr Lee said. Soya bean products were rich in phytoestrogen, with a traditional Japanese diet containing about 300mg of phytoestrogen a day.

Dr Lee said phytoestrogen had similar effects to oestrogen, thus modulating the risk of osteoporosis, cardiovascular dysfunction and memory loss. Precursors and sources of phytoestrogen include beans, clover, alfalfa, whole grains, seeds, fruit, vegetables, rye, and legumes.

Recent studies indicate that phytoestrogen has no effect on breast tissue density in premenopausal women and may increase bone density in postmenopausal women.

A number of studies have shown that it reduces the frequency of hot flushes. The data also suggested that it may be beneficial in the treatment of cardiovascular problems, menopausal symptoms and osteoporosis. It also has favourable effects on lipid profiles.

Dr Lee said some research even suggested that phytoestrogen might be as effective as HRT in preventing loss of bone density. Cheung Lai-ping, an associate professor in the department of obstetrics and gynaecology at Chinese University, believes patients should use conventional HRT to control the symptoms of menopause, but she suggests patients change to natural alternatives after three or four years.

'HRT remains the most effective treatment for menopausal symptoms,' said Dr Cheung. 'We should aim for short-term treatments with the lowest effective dosages. HRT should preferably not exceed five years as complications start mostly after five years.'