Is natural HRT making you sick?

By Susan Arentz  BHSc(Hons), Adv Dip Nat, Dip Bot Med, Dip Nut, Dip Hom, Adv Cert NFM

Many women prefer natural treatments over chemical hormone replacement and there are studies showing that some plant based treatments may improve menopausal symptoms^1-4.  So which natural supplements are they, which are a waste of time and money, and are they safe?

The best way to know if natural treatments may be helpful or harmful is to make an informed decision based on expert advice and independent and transparent information.  This type of information comes from research investigating the effectiveness and safety of treatments.  Specially trained experts with clinical experience involving exposure to large numbers of people wanting treatments for similar conditions are the experts to consult regarding this information.

In the area of supplement use for HRT, evidence based practice is imperative since a recent survey of 2020 women aged between 40-65 years found that over 39% of survey participants were regular users of natural treatments for menopausal symptoms including hot flushes and night sweats⁵.  In this review, concern was raised where there was no effect of particular treatments backed by scientific evidence.  From this survey, naturopathic practitioners showed a greater concern when the supplement with the second highest use as a ‘natural HRT’ was not only unhelpful for the condition but also has potentially harmful effects.

So how can women make informed decisions about their use of natural treatments?  The best way is to have a consultation with a degree qualified naturopath or herbalist trained to assess evidence and with clinical expertise.  This consultation may steer you towards evidence informed treatment choices, and save time, money and grief!

And just in case you are wondering, the naturopathic remedy of choice for symptoms associated with menopause is often Cimicifuga racemosa (black cohosh)^{7, 8}.  This has the best evidence for improving symptoms associated with menopause and having the least risk to women.  Another specific compound that has been demonstrated to have an effect is the soy ingredient genestein – although this has some limitations (see below)⁹.

Other natural treatments commonly used for menopausal symptoms have found no effect on these symptoms including Trifolium pratense (red clover) and diets high in soy products and soy extracts (so even a high soya bean intake will not be beneficial in the usual circumstances).

Perhaps most importantly, evening primrose oil has long been touted as a treatment for many conditions and is the second most commonly used natural therapy for HRT.  Following on from evidence effected from scientific studies, it is rarely used in clinical practice since it has been found that the omega 6 oils, abundant in evening primrose oil are already overrepresented in western diets.  Excessive consumption of evening primrose oil may exacerbate inflammation (pain, redness and soreness, etc.)¹⁰.

So, supplementation with evening primrose oil is rarely indicated and it in fact evening primrose oil may cause harm.  Since there is no scientific evidence of its effectiveness for relieving menopausal symptoms, it’s a good idea to take yourself off this supplement if you are using it for this condition!

1. Kronenberg, F. and A. Fugh-Berman, Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Annals of internal medicine, 2002. 137(10): p. 805-813.
2. Taku, K., et al., Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials. Menopause, 2012. 19(7): p. 776-790.
3. Lee, M.S., et al., Maca (Lepidium meyenii) for treatment of menopausal symptoms: A systematic review. Maturitas, 2011. 70(3): p. 227-233.
4. Bedell, S., M. Nachtigall, and F. Naftolin, The pros and cons of plant estrogens for menopause. The Journal of steroid biochemistry and molecular biology, 2014. 139: p. 225-236.
5. Gartoulla D, D.S., Worsley R, Bell RJ., Use of complementary and alternative medicine for menopausal symptoms by Australian women aged 40-65 years. Medical Journal of Australia, 2015. 203(3): p. 146.
6. Mitchell, C. Call to standardise CAM 2015 [cited 2015 4 August 2015]; Available from: https://www.mja.com.au/insight/2015/29/call-standardise-cam.
7. Laakmann, E., et al., Efficacy of Cimicifuga racemosa, Hypericum perforatum and Agnus castus in the treatment of climacteric complaints: a systematic review. Gynecological Endocrinology, 2012. 28(9): p. 703-709.
8. Beer, A.-M., et al., Efficacy of black cohosh (Cimicifuga racemosa) medicines for treatment of menopausal symptoms-comments on major statements of the Cochrane Collaboration report 2012 “black cohosh (Cimicifuga spp.) for menopausal symptoms (review)”. Gynecological Endocrinology, 2013. 29(12): p. 1022-1025.
9. Lethaby, A., J. Marjoribanks, F. Kronenberg, H. Roberts, J. Eden and J. Brown. “Phytoestrogens for menopausal vasomotor symptoms.” The Cochrane Library. 2013
10. Patterson, E., et al., Health implications of high dietary omega-6 polyunsaturated fatty acids. Journal of nutrition and metabolism, 2012. 2012.