NICE guidance on menopause: cognitive behavioural therapy is an effective non-hormonal intervention for managing vasomotor symptoms

Biochemical tests needed

Hunter and colleagues report the effectiveness of cognitive behaviour therapy (CBT) in women with breast cancer or severe menopausal symptoms. CBT is much safer than taking more HRT which may just suppress warning symptoms. Progestogens and oestrogens are powerfully carcinogenic , vasoactive, thrombogenic and psychotropic hormones, and such use is the main causes of breast cancer in young and menopausal women.

Hemminki and McPherson found few women in Finland had never used OCs by 2002 with control non-users “possibly overestimated to be 10%”. OC use doubled the risk of breast cancer: adjusted Odds Ratio 2.1 (95% confidence interval 1.1 – 4.2).1 In the USA, the incidence of invasive breast cancer doubled from 1.53 to 2.90 per 100,000/year in women aged 20 to 34 years from 1997 to 2009. The 5-year survival rate for distant disease was 31% for women aged 25-39 years.2 Genetic testing by Evans and colleagues revealed that women born after 1940 with BRCA1 and BRCA2 had a cumulative risk of 22% for breast cancer by 40 years of age compared to 8% in women born before 1930 (p = 0.0005).3 This is a large increase. The average duration of use by breast cancer cases in the Collaborative Group re-analyses of 54 studies and 51 studies was 3 years of OCs and 2 years of HRT .4,5

In my experience most women with severe menopausal symptoms have already used hormonal contraception or HRT and have a legacy of underlying biochemical abnormalities, allergies and/or infections which need specific treatments including repletion of essential minerals, vitamins, and, polyunsaturated fatty acids deficiencies. 6

Vasomotor symptoms such as flushing have many causes including toxic metal sensitivities and increased bacterial or fungal gut fermentation. This can be diagnosed by i blood ethanol levels increases in response to a glucose drink after fasting.7 Adverse reactions to alcoholic drinks, tobacco smoking, coffee, food and chemicals, and verifiable nutritional deficiencies, are increased by use of OCs and HT. 8,9

Progestins, cyproterone acetate, medroxyprogesterone acetate and megestrol acetate, form DNA adducts in primary cultures of human hepatocytes signifying genotoxic risk.10 DNA adducts involve cadmium from tobacco smoke, chlorine from tap water, nickel from stainless steel, disinfectants, pesticides and malondialdehyde from endogenous oxidation.11 The risks of cancers are increased if DNA adducts block the multiple tumour suppressor gene.12

Talking can help but it is not enough. Stopping smoking and drinking tea, coffee and alcohol, along with high protein, low allergy diets, and supplementation of common nutritional deficiencies are also important.

1 Hemminki E, McPherson K. BMC Womens Health. 2002; 2: 9. Published online 2002 Aug 5.

2 Johnson RH, Chein FL, Bleyer A. Incidence of breast Cancer with distant involvement among women in the United States, 1976 to 2009. JAMA 2013;309(8):800-805.

3 Evans DG. Shenton A, Woodward E, Lalloo F, Howell A, Mather ER. Penetrance estimates for BRCA1 and BRCA2 based on genetic testing in a Clinical Cancer Genetics service setting: Risks of breast/ovarian cancer quoted should reflect the cancer burden in the family. BMC Cancer 2008, 8:155.

4 Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies. Lancet. 1996 22;347(9017):1713-27.

5 Collaborative Group on Hormonal factors in Breast Cancer. Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52 705 women with breast cancer and 108 411 women without breast cancer. Lancet. 1997;350 (9084):1047-1058.

6 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity and mineral imbalance. J Nutr Environ Med 1998:8:789-91.

7 Hunnisett A, Howard J, Davies S. Gut fermentation (or the auto-brewery syndrome): a new clinical test with observations and discussion of clinical and biochemical implications. J Nutr Med 1990:1:33-38.

8 Grant ECG. Food allergies and migraine. Lancet 1979 May 5;1(8123):966-9.

9 McLaren-Howard J, Grant ECG, Davies, S. Hormone replacement therapy and osteoporosis: bone enzymes and nutrient imbalances. J Nutr Environ Med. 1998;8:129–138.

10 Werner S1, Kunz S, Beckurts T, Heidecke CD, Wolff T, Schwarz LR. Formation of DNA adducts by cyproterone acetate and some structural analogues in primary cultures of human hepatocytes. Mutat Res 1997 Dec 12;395(2-3):179-87.

11 Howard JM. The detection of DNA adducts (risk factors for DNA damage. A method for genomic DNA, the results and some effects of nutritional intervention. J Nutr Environ Med 2002;12:19-31

12 Hemminki, K. DNA adducts, mutations and cancer. Carcinogenesis 1993 14,2007–2012.