Daily Mail, Tuesday, August 13, 2019 Page 43

T

housands of women

who rely on hormone

replacement therapy (hRT)

to cope with the menopause

are finding it hard to get

their prescription filled in uK

pharmacies, as the Mail first

reported on saturday.

There is a nationwide shortage of hRT,

the most common treatment for

menopausal symptoms including night

sweats, hot flushes and mood swings.

used by about 200,000 women in the

uK, hRT can be given as patches, pills or

gels, providing the female hormones the

body stops producing at the end of a

woman’s fertile life.

Boots and LloydsPharmacy are among

those said to be experiencing the

shortage, which started in december

2018 and has worsened in recent weeks.

The department of health and social

Care is aware of the supply issue, which it

says has been caused by manufacturing

delays. But helen stokes-Lampard, chair

of the Royal College of General

Practitioners, has said that the underlying

reason remains unclear because it is

commercially sensitive. ‘nobody will be

honest with the public and the nhs,’ she

said. ‘It’s frustrating.’

LloydsPharmacy supplier aah

Pharmaceuticals has run out of 15 of the

24 hRT brands it usually stocks, while

pharmaceutical retailer alliance, which is

owned by the same group as Boots, has

run out of nine of 27 hRT products.

now, women are panic-buying, which

adds to the problem. sid dajani, of the

Royal Pharmaceutical society, says

women are coming to his pharmacy in

hampshire asking for a six-month supply

of hRT, instead of their usual three

months, having persuaded their doctors

to write extra prescriptions.

so if you can’t get hold of hRT, what are

the alternatives — and do they work?

here, we assess the options. always ask a

doctor before trying a new treatment.

By THEA

JOURDAN

ARE PLANT-BASED HORMONES THE ANSWER?

Revealed: Yesterday’s Mail

... with alternative remedies that

could keep those hot flushes at bay

How to

beat the

shortage

HRT

BIOIDENTICAL hormones are plant-based

and promoted as a more natural, gentler

form of HRT. Derived from plants such as

Mexican yams, they have the same structure

as the hormones made naturally in the body

and, like conventional HRT, combat the

menopause by raising levels of oestrogen.

They are available only privately, costing

around £350 for a year’s supply, and

preparations are custom-mixed for

individual patients, based on the results of

a blood or saliva test. They can be given as

a lozenge, patch, cream or vaginal gel.

Advocates say the fact they are chemically

identical to human hormones means they

are safer than conventional HRT and have

fewer side-effects. However, doctors warn

they are unregulated and so do not have to

undergo the same level of testing.

The NHS does not recommend bioidentical

hormones, saying it is unclear how safe or

effective they are, and the British Menopause

Society has warned they are prescribed by

‘clinicians who usually do not have any

recognised menopause training’.

Meanwhile, critics query how natural

these hormones really are, since they are

processed in laboratories so they match

human ones. Exempt from NHS supply

chain pressures, which are affecting its

stocks of HRT, bioidentical hormones are

still available — but Dr Heather Currie, an

obstetrician, advises against switching.

‘The HRT we prescribe has been fully tested

and we know the doses of the hormones it

contains — people don’t necessarily know

what they are getting with [custom-mixed

bioidentical] preparations,’ she says.

FIONA MACRAE

HERBAL HELP

Black cohosh

WHAT IS IT? Made from the root and

rhizomes of a plant native to north

america, it is sold as a powder, pill

or capsule taken two to three times

a day. different preparations

contain different strengths and

doses may vary.

IS IT EFFECTIVE? ‘some studies

show that black cohosh may ease

menopausal symptoms including

mood swings and hot flushes.

however, other studies have found

it has no significant benefit,’ says

dr heather Currie, an obstetrician

and former chair of the British

Menopause society. side-effects

can include headaches, tummy

upset and dizziness.

Red clover

WHAT IS IT? native to Europe, red

clover contains phytoestrogen, a

plant hormone that acts in a

similar way to oestrogen, and is

taken as capsules or powder.

IS IT EFFECTIVE? ‘Research shows it

may have a beneficial effect on

menopausal symptoms,’ says dr

Currie. a study published in the

journal PLos one in 2017 found

that fermented red clover extract

may help to reduce the severity of

night sweats and hot flushes and

prevent menopausal bone loss,

which affects one woman in three

over the age of 50.

however, the researchers were

cautious about saying red clover

works — it could be the fermenta-

tion process that makes the

difference, they said, as it allows

the body easily to access the

oestrogen-like compounds in red

clover. side-effects may include a

rash, muscle ache and nausea.

Evening primrose oil

WHAT IS IT? This oil, from the seeds

of the plant, is rich in gamma-

linoleic acid, an essential

fatty acid involved in the produc-

tion of hormone-like substances

called prostaglandins. Excess

prostaglandins are thought to

counter the hormonal changes

associated with the menopause.

IS IT EFFECTIVE? Results are mixed,

but a study of 80 postmenopausal

women published in the Journal

of Education and health

Promotion in March 2018 found it

did help to reduce hot flushes and

improve quality of life.

‘some women find it helps breast

tenderness in particular,’ says dr

Currie. side-effects are normally

mild, but can include nausea,

diarrhoea and indigestion.

St John’s wort

WHAT IS IT? synthesised from a

European plant, this is used mainly

to produce a remedy for mild to

moderate depression, anxiety and

sleep problems. It can also be used

to treat mood changes due to the

menopause, with the plant

chemical hypericin said to act on

messengers in the nervous system

which regulate mood.

IS IT EFFECTIVE? ‘some studies

suggest it might help ease low

mood caused by the menopause,

but there is a lack of robust

evidence and also a lack of

regulation around production,’

says Mike Bowen, a consultant

gynaecologist in harley street.

It can also interact with other

medication, including tamoxifen,

used to treat some types of breast

cancer, so always check with a

doctor. side-effects may include

insomnia and vivid dreams.

Fennel cream

WHAT IS IT? This is a preparation

from an anise-flavoured plant used

in cooking, which can help to ease

vaginal dryness and vaginal

atrophy (thinning, drying and

inflammation of the vaginal walls

due to less oestrogen) caused by

the menopause. It is usually admin-

istered as a 5g dose once a day.

IS IT EFFECTIVE? ‘It is a lubricant so

it will help to ease dryness,’ says

sid dajani.

one clinical study, published in

the journal Maturitas in 2016,

found it was effective in managing

vaginal atrophy and had no

side-effects. It may also help

relieve sleeplessness and anxiety,

according to a u.s. study.

DRUG TREATMENTS

Gabapentin

WHAT IS IT? Typically prescribed to

treat epilepsy, it has also been used

in lower doses as a non-hormonal

way to reduce menopausal hot

flushes. The usual dose is 300mg

three times daily.

IS IT EFFECTIVE? studies show it

can reduce hot flushes for at least

12 weeks. But side-effects may

include drowsiness, lightheaded-

ness and dizziness. This has to be

prescribed by a doctor and is not

used routinely.

Clonidine

WHAT IS IT? normally used for high

blood pressure and to prevent

migraines, it is a drug some GPs

are now prescribing to treat hot

flushes. It is usually taken in a

50mg to 75mg dose twice a day.

IS IT EFFECTIVE? sid dajani says

there is no hard evidence it has

any effect. ‘If you have no benefits

after two to four weeks, treatment

should be stopped,’ he says. side-

effects may include feeling sick,

drowsiness and a dry mouth.

SSRIs

WHAT ARE THEY? These are a class

of drug known as selective

serotonin reuptake inhibitors,

which include Prozac (fluoxetine)

and Cipramil (citalopram) and are

usually used to treat depression.

Women with menopausal hot

flushes are usually prescribed low-

dose 20mg tablets once a day.

ARE THEY EFFECTIVE? ‘studies show

ssRIs are effective at treating

menopausal symptoms such as

hot flushes and mood swings, but

may take up to eight weeks to

have any effect,’ says Mike Bowen.

side-effects may include drowsi-

ness, weight gain and nausea.

ssRIs, as the Mail has highlighted,

can also, more rarely, cause sexual

dysfunction in women.

LIFESTYLE TWEAKS

RELaxaTIon techniques and

dietary changes are effective ways

to reduce anxiety associated with

the menopause.

Acupuncture

WHAT IS IT? The ‘needle therapy’

first used in China 2,000 years ago

is still a popular alternative

treatment. Fine needles are

inserted at points around the body

to ‘correct flows of energy’.

IS IT EFFECTIVE? In a small 2011

study, researchers found meno-

pausal women who had needle

therapy for ten weeks had less

severe hot flushes and mood

swings than those who had

dummy acupuncture with blunted

needles. however, the jury is still

out as to whether acupuncture

can really make a difference.

Critics of the technique attribute

any benefits to the placebo effect.

Picture: REALIMAGE/ ALAMY

RldYtd’Mil

GPS DELUGED

IN HRT CRISIS