The most troublesome symptom of menopause has to be hot flushes. They cause an amazing amount of personal discomfort, embarrassment and loss of sleep, not to mention the effect on our libido and sex lives!  Women complain to me all the time of having to fan their face, change their clothes, and even bedclothes, and they also find that they are subject to prejudice at work and socially  as a result of the ” ageism” that those women experience while suffering menopause.

Hot flushes are also the single most powerful reason that ordinary GPs reach for the usual synthetic HRT, which is mainly estrogen.  We know that in most cases the hot flushes will respond to the estrogen and will go away. One happy patient and one relieved GP? When a GP has a pill that he or she knows will help this tearful, anxious woman in front of you who is so distressed she is almost suicidal, it requires a great deal of self confidence on the part of the doctor not to reach for the easiest pill. And especially if the doctor has never had any information about hormones generally, or natural hormones in particular.

I say all this so you can understand why a normal GP, exposed only to pharmaceutical company propaganda, might think there is nothing else available other than synthetic HRT. And why a normal GP reaches for the estrogen to help this poor woman in front of him/her.

The answer is to dig deeper and use the most natural hormones possible to correct her symptoms.

Trouble follows if there is no further investigation! What is the true hormone picture here? Just how high or low is the FSH? How do we know whether there has been any other hormones active at the same time eg progesterone? Is the balance correct? Have the testosterone and its precursor (DHEA) been measured? As you can see the assumption of a low estrogen alone does not complete the diagnosis, just as the finding of a high blood sugar just once does not justify a diagnosis of diabetes. Much more investigation is required.

Also, the relief of the hot flushes, while wonderful, will soon throw up the other symptoms of menopause, for which estrogen is no help whatever!

So why do women stay on HRT for so many years? Partly it is because when estrogen was discovered it was thought to be a sort of ‘youth serum’ and women flocked to their doctors, not only to get relief of their hot flushes, but to get access to the hormone that exists in abundance in young women. Trying to tell those women that they are at risk is hard when they have convinced themselves over ten years or more that they are staying young!

The best practice guidelines say that five years of oestrogen after menopause starts is the limit. This is because the evidence of stroke, dementia and cancer starts to really build up after five years. But will the hot flushes come back? No, not if you have been balancing the estrogen with progesterone, because by five years, two things will have happened: the progesterone will have taken over that role and the estrogen receptor sites will have ‘calmed down’ so to speak, so that women in their 60s are not flushing for hormonal reasons, but usually for other reasons.

How do you manage a woman of, say, 68 who is still having hot flushes?

Well, the first thing is to take a careful and detailed history of when the flushes arise, what food or drink she has had, what exercise she has had that day. Then she needs to come off all hormones for two weeks and then have a full profile of her sex hormones done, together with a 3-hour glucose tolerance test. If that test shows that she has a drop at the third hour below her fasting level, she will also need her insulin levels done. In most cases there will be found a problem unrelated to her sex hormones, but being masked by the estrogen she has been taking.

What about young women and estrogen? The estrogen level in young women varies enormously during her menstrual cycle, but young women do not suffer hot flushes because the drop in estrogen is only temporary. Young women in our community are actually exposed to fairly significant amounts of oestrogen from preservatives, pesticides and plastics, not to mention hormones found in meat and chicken! All of these xeno- estrogen’s cause a build upon estrogen and if she has a shortage of progesterone to balance it, she will quickly complain of headaches, fatigue, bloating and a host of other general non-specific symptoms. Most of these symptoms resolve once the proper balance of estrogen and progesterone is achieved.

Young women on the contraceptive pill will complain also of headaches and other more vague symptoms. The contraceptive pill has been a gift to womankind by freeing them from the prison of unwanted and recurrent motherhood. But the hormones involved are not the same as our own hormones and when pregnancy is definitely finished with, a young woman would be well advised to get his or her tubes ‘done’ and get off the synthetic hormones that are in the Pill, rather than spending 10-15-20 years on a drug like the Pill waiting for menopause!

The Pill is often prescribed by GPs for women at menopause. The rationale seems to be: she is short of estrogen now, she has had years of the Pill without I’ll effects, and the contraceptive function is an added benefit. But to those women I say, do not agree to take another 5-10-15 years of the Pill when you can take natural hormones and feel better without the risks of the synthetics.