I’m a 51-year-old woman suffering from severe menopausal symptoms and my GP will not prescribe HRT because there is a history of breast cancer in my family. Could you suggest any alternative treatments?
Mr Martin Griffith-Jones, Consultant Gynaecologist, Spire Leeds Hospital
Managing severe menopausal symptoms without HRT can be challenging. Wearing loose cotton clothing, taking regular exercise, stopping smoking, avoiding excessive caffeine and alcohol may help.
A blood pressure treatment may benefit daytime flushes. Night-time sweats may respond to a small dose of an antidepressant, promoting sleep and reducing night-time sweating. The hormone progesterone, in its artificial tablet form or natural progesterone cream has been used, however this is no longer considered entirely safe where there is a strong risk of breast cancer.
Alternative preparations are available across the counter at the chemist such as Menopace, Black Cohosh, Red Clover, Sage, Soya products and Agnus Castus. Observational reports suggest all may have benefit, but no large randomised studies have confirmed this.
A patient’s risk may increase if there is a first degree relative suffering from breast cancer, or if there are multiple members within the family that have had breast cancer. For those without those additional risk factors, HRT would increase risk by 4 to 6 per 1,000 women over five years’ usage. Whether or not HRT would be considered would depend on family history, the severity of the menopausal symptoms and the patient’s wishes.
Referral to a Menopause Specialist may be helpful.