Menopause Month: Dr Zoe Williams answers our final question from a reader on menopause in week four of our series during October’s Menopause Awareness Month.
Our partnership with Issviva, who support women going through menopause and their medical ambassador, Dr Zoe Williams, has come to an end. We hope you found our weekly series answering your questions on menopause-themed questions useful.
Read on for our final question and answer.
Last year I was diagnosed with estrogen-based breast cancer and I’ve been told by my GP that I’m not eligible for Hormone Replacement Therapy (HRT). I’ve been researching more natural and herbal routes to see if they can help with my symptoms. Which vitamins and supplements would you recommend to help with menopause symptoms and is there anything else that I can do?
Dr Zoe: Let’s talk a little bit about why it is that women who’ve had certain types of breast cancer usually can’t access HRT as I think that’s quite common. So, whenever a doctor is prescribing any drug, we always carry out a ‘risk versus benefit’ assessment. And usually, if the benefit massively outweighs the risk, then we’re likely to go ahead and prescribe.
As with any drug, even paracetamol, there’s always some risk. With HRT, there are some small risks, and the one people talk about the most is a very small increased risk of breast cancer. For most women that small risk is tiny compared to the benefit that they’re going to get from taking HRT. For example, many women gain a lot of weight during menopause and it’s really difficult to control that. And if that weight-gain tips them into the obesity bracket, then we know that increases the risk of breast cancer more than the HRT.
Sometimes drinking more than a few glasses of wine a week can increase your risk more than HRT. So, it is a small risk, but if a woman has previous breast cancer, and it’s an oestrogen receptor positive breast cancer, then currently that is deemed to be riskier for them to take HRT. It switches the balance.
“When we’re talking about things that people can do for themselves, we need to take a holistic look at lifestyle.”
And it’s debatable, depending on who you speak to, where it increases that risk, too. So, at the moment, it’s usually not advised that people who’ve had receptor positive breast cancer take HRT. But that’s not all forms of HRT, that’s systemic HRT, that includes tablets, patches and gels. But it might be that your symptoms are related to vaginal atrophy, for example, so vaginal dryness, soreness and urinary tract infections. If that’s the case, then those symptoms can actually be treated with topical estrogen and you would be fine to use that.
However, as a GP, in this particular case, I wouldn’t feel comfortable or confident prescribing HRT to this lady. I’d want to get her in front of a menopause specialist, ideally, or an Endocrinologist or someone who can really help make sure she’s getting the best and safest type of HRT and also get some psychological support.
When we’re talking about things that people can do for themselves, we need to take a holistic look at lifestyle. Calcium is a really important supplement because we know that people lose bone density when they lose oestrogen.
It’s really important to talk about diet and nutrients, the best diet tends to be the Mediterranean diet. That’s a diet rich in healthy oils, olive oil, avocados, nuts and oily fish etc. Try to introduce things like berries that are really dense in nutrients as much as possible and embrace as many different coloured fruits and veggies as possible. Different colours tend to have different nutrients. For example, green leafy vegetables tend to have different nutrients to your bright orange and red vegetables.
Research a good quality menopause supplement. Ideally, it’s better to get the nutrition from a healthy diet if you can but a supplement won’t do you any harm. Hydration is also really important as well as exercise and keeping your body moving is also key.