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Nutritional alternatives to hormone replacement therapy

Marilyn Glenville
(specialising in natural approach to female hormone problems)
Women's Healthcare
St John's Wood
T:0870 5329244

According to the Massachusetts Women's Health Survey of 1991, 20-30% of women did not collect their hormone replacement therapy (HRT) prescription, 20% stopped within nine months and 10% took therapy intermittently.(2) If we add these statistics to the number of women in whom HRT is contraindicated because of a history of breast cancer or thrombosis, plus the proportion of women who view the menopause as a natural event and who want to manage it without drugs, it is obvious that there is a large population of women who need another way to manage their symptoms.

The role of the diet in menopause
One of the questions that most perplexes scientists is why and how the menopause is experienced so differently around the world. Up to 85% of Western women will experience hot flushes,(3) compared with only 14% in some Asian countries.(4)
In some parts of the world, notably the Far East, breast cancer is not the major killer it is in the West. The UK has a breast cancer death rate that is about six times higher than in Japan. However, studies conducted in the USA have shown that when Japanese women move to the West, their level of breast cancer rises to that seen in the West.(5) Many experts think the main factor is diet, and this is borne out by the fact that as the traditional Japanese diet becomes more Westernised, cases of breast cancer are starting to increase among Japanese women in Japan.
There are a number of differences between the Japanese diet and the British diet. The Japanese eat large quantities of unsaturated fats in oils and fish, whereas the Western diet is high in saturated fat from meat and dairy foods. Traditionally the Japanese do not eat much dairy food, but they do consume large amounts of soya bean products, including tofu, miso (soya bean paste), tamari (wheat-free soya sauce), tempeh and soya milk. As a result, scientists have begun to study the benefits of a group of plant hormones known as phytoestrogens found in soya bean products. In clinical trials, phytoestrogens have been shown to reduce both hot flushes and night sweats,(6) and one study showed that women taking soya capsules versus a placebo had a significant reduction in hot flushes in only four weeks.(7) Phytoestrogens have also been shown to reduce vaginal dryness(8) and to play a part in osteoporosis.(9)
Almost all fruit, vegetables and cereals contain phyto­estrogens in varying strengths, but it is the isoflavones (a specific class of phytoestrogens) that are the most beneficial. These are found in legumes such as soya, lentils and chickpeas. In the human gut, bacteria convert isoflavones into substances that have an oestrogenic action, although they are not themselves hormones. The average Japanese woman's daily intake of isoflavones is between 20mg and 80mg per day; the average Asian woman's diet contains about 45mg per day, while American and British women generally consume between 1mg and 3mg per day.(10)
However, the phytoestrogens have also received some negative press claiming that soya can accelerate brain aging, lead to thyroid problems and cause reproductive problems. The research citing these negative effects has not been substantiated. In September 2000, the British Nutrition Foundation issued a press statement saying:
"Recent media coverage has raised a number of concerns about possible effects of soya products on health, including thyroid abnormalities, mineral deficiencies, Alzheimer's disease and effects in women consuming soy products during pregnancy on the unborn child.(11) In reality, for most of these there have been few published studies and much of the work cited to support many of these claims has been conducted in experimental animals, rather than humans. So, at the present time, these concerns remain speculative and unproven."
Coronary heart disease is the major cause of death in postmenopausal women in the UK, and it was believed that HRT reduced this risk. But there is now doubt as to whether women without pre-existing cardiovascular disease will benefit from HRT.(12) However, it is important to remember that there is a vast amount of medical literature on the benefits of nutrition on cardiovascular disease. In October 1999, the US Food and Drug Administration allowed the marketing claim that 25g per day of soy protein as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease.(13) Soya isoflavones have been shown to lower serum cholesterol levels by as much as 20%.(14)
Vitamin E has been the subject of extensive research over the last 50 years. Human studies have found that vitamin E (100-400iu daily) significantly reduces the risk of coronary heart disease and heart attacks.(15)
As well as including phytoestrogens, a well-balanced diet is essential during the menopause to help the body to adjust automatically to hormone changes, naturally maintaining oestrogen from the adrenal glands and fat deposits. A number of key points with regard to diet should be recommended to menopausal women:

  • Stabilise blood sugar levels by reducing sugar and refined foods in the diet and eating little and often to reduce the toll on the adrenal glands.
  • Reduce or eliminate caffeinated drinks such as tea and coffee as these contribute to the blood sugar problem and also act as diuretics, depriving the body of vital nutrients and trace elements.
  • Ensure a good intake of essential fatty acids from oily fish, nuts and seeds, which help lubricate the joints, skin and vagina.
  • Avoid soft fizzy drinks which contain high levels of phosphorous and increase the risk of osteoporosis by increasing urinary calcium excretion.
  • Include a good intake of phytoestrogens in the diet from many sources and not just soya.

Vitamin and mineral supplements
It is not easy for women to get all the nutrients they need from food, and a national food survey conducted in 1995 found that the average person in Britain was grossly deficient in six of the eight vitamins and minerals studied. So, as well as a healthy diet, supplementation is beneficial during the menopause not only to ensure adequate nutrients for maintaining healthy bones, but also to help with the menopausal symptoms.
It is important for menopausal women to take a multivitamin and mineral supplement that includes boron, which helps to improve the metabolism of two nutrients essential for bone health - calcium and magnesium.(16) Extra vitamin E is required for its cardiovascular benefits, and vitamin C has been shown to reduce hot flushes(17) and is important for bones as it helps to build up collagen, the "cement" that holds the bone matrix together.

Herbal remedies
Herbs have long been used to treat women's conditions, and the herb of choice for the menopause is black cohosh (cimicifuga racemosa), an indigenous plant of North America that has been used by native North Americans for centuries. A number of clinical trials have confirmed its efficacy in relieving menopausal symptoms, especially hot flushes and night sweats.(18)

Women who can't tolerate HRT or who choose not to take it should be given advice on the natural approach to the menopause. Women who are happy taking HRT can still eat well and take supplements in order to keep themselves as healthy as possible. It is important that women know what choices are available to them so that they can make an informed decision.


  1. Office for National Statistics and Government Actuary Department UK. United Kingdom population projections. London: Office for National Statistics; 2001. Available from URL:
  2. National Opinion Poll Survey. The menopause revolution. How far have we come? Horsham: Ciba Pharmaceuticals; 1991.
  3. Kessel B. Alternatives to oestrogen for menopausal women. Proc Soc Exp Biol Med 1996;217:38-44.
  4. Boulet M. Climacteric and menopause in seven south-east Asian countries. Maturitas 1994;19:157-76.
  5. Coleman MP, Esteve J, Damiecki P, et al. Trends in cancer incidence and mortality. Lyon, France: IARC Publications; 1993.
  6. Upmalis DH, Lobo R, Bradley L, et al. Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicentre, double-blind, randomised, placebo-controlled study. Menopause 2000;7(4):2236-42.
  7. Albertazzi P, Pansini F, Bonaccorsi G, Zanotti L, Forini E, De Aloysio D. The effect of dietary soy supplementation on hot flushes. Obstet Gynecol 1998;91(1):6-11.
  8. Brzezinski A, Adlercreutz H, Shaoul R, et al. Short term effects of phyto­estrogen-rich diet on postmenopausal women. Menopause 1997;4:89-94.
  9. Tham DM. Potential health benefits of dietary phytoestrogens: a review of the clinical, epidemiological and ­mechanistic evidence. J Clin Endocrinol Metab 1998;83:2223-35.
  10. Barnes S, et al. Rationale for the use of genistein-containing soy matrices in chemoprevention trials for breast and prostate cancer. J Cell Biochem 1995;22:181-7.
  11. Phillimore J. Soya bean crisis. The Observer Magazine 27 August 2000.
  12. Herrington DM, Espeland MA, Crouse JR 3rd, et al. Estrogen replacement and brachial artery flow-mediated vasodilation in older women. Arterioscler Thromb Vasc Biol 2001;12:1955-61.
  13. The role of isoflavones in menopausal health: consensus opinion of The North American Menopause Society. Menopause 2000;7(4):215-9.
  14. Adlercreutz H, Mazzur W. Phytoestrogens and Western disease. Ann Med 1997;29:95-120.
  15. Pryor A. Vitamin E and heart disease: basic science to clinical ­intervention trial. Free Radic Biol Med 2000;28:141-64.
  16. Abraham G. J Nutr Environ Med 1991;2:165-78
  17. Smith C. Non-hormonal control of vaso-motor flushing in menopausal patients. Chicago Med 1964;67:193-5.
  18. Stolze H. An alternative to treat menopausal symptoms. Gynaecology 1982;3:14-6.

Further reading
Glenville M. Natural ­alternatives to HRT. London: Kyle Cathie; 2001.
Glenville M. The nutritional health handbook for women. London: Piatkus; 2001.

Forthcoming event
25 Sept 2002
The nutritional approach to the menopause and prevention of osteoporosis - a seminar by Dr Glenville
For more information or to book:
T:0870 5329244