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Practice Clinical updates

Non-hormonal treatments for menopausal symptoms

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5101 (Published 23 November 2017) Cite this as: BMJ 2017;359:j5101

Hot flushes are part of an allergic reaction Re: Non-hormonal treatments for menopausal symptoms

The epidemiological studies of Issacs, Britton and McPherson found that women doctors had a high incidence of HRT use.1,2 In their 10-year follow-up of women doctors aged 50-64 years current use remained at 38.1% but ever-use increased from 53.4% in 1993 to 66.2% in 2003 (p<0.001). There was a marked reduction in uptake by women doctors under age 50 years with their discontinuation rate increased from 27.8% to 42.4% (p<0.001). However, over 20% of women doctors aged 65-74 years were still using HRT. The median duration of HRT use was 8.1 years by current users and 5 years by past users.

However, use of HRT and the breast cancer rates and mortality sharply declined in hormone taking countries after the results of the Women’s Health Initiative randomised double-blind controlled study in 1992 which found increases in breast cancer and vascular diseases with no overall health benefits.3 It is a shame that women doctors seem more likely to believe the widespread promotional propaganda that HRT is needed for symptom relief and osteoporosis prevention. Neither of these claims stand up to detailed biochemical investigation in my experience.4,5

Hot flushes are part of an allergic reaction

Women suffering from hot flushes can easily prove that hot flushes are part of an allergic reaction to common foods or chemicals. In 1979 I published the results of a study entitled “Food allergies and Migraine” (Lancet 1979;1:966-69). 60 migraine patients stopped all medications, including contraceptive and menopausal hormones, and also stopped smoking and drinking alcohol. The patients followed the “lamb and pears diet” of Dr John Mansfield. The aim of the diet is to avoid common foods for 5 days, when withdrawal symptoms can occur but then hidden or masked food allergens can be unmasked. Common foods causing vascular reactions like flushing, headaches, pulse or blood pressure rises, or other symptoms, were wheat (78%), orange (65%), eggs (45%), tea and coffee (40% each), and corn, cane sugar and yeast (33% each). No patients needed medication when avoiding their main food and chemical allergens and 85% of patients became headache-free. Those with hypertension became normotensive. The commonest chemical allergens were cigarette smoke and domestic gas. Women who have been taking progesterones and/or oestrogens or antibiotics often have positive gut fermentation tests and also need anti-fungal medication, probiotics and a strict low yeast diet.6

Reactions to foods and chemicals increase if zinc, copper and magnesium, and B vitamins and essential fatty acids are deficient and supplementation is usually needed to replete these deficiencies. Deficiencies of zinc and copper can severely disturb immune system homeostasis including lymphocyte and antibody production (Nutrition and Immunology 2000, Humana Press).

It is indeed a real problem that the best tests to see what is going on, especially when women take hormonal contraception or HRT, have not become generally available. I wonder why? Has too much time and money has been spent on psychology and flawed epidemiological studies? Important investigations include estimating levels of white cell zinc, red cell magnesium, superoxide dismutase activities, functional B vitamin tests, metallothionein, DNA adducts, ATP profile, lymphocyte sensitivity tests, and red cell essential fatty acid profiles.

1 Isaacs AJ1, Britton AR, McPherson K. Utilisation of hormone replacement therapy by women doctors. BMJ. 1995 Nov 25;311(7017):1399-401.

2 Isaacs AJ, Britton AR, McPherson K. Why do women doctors in the UK take hormone replacement therapy. Epidemiol Community Health. 1997 Aug;51(4):373-7.

3 Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Writing Group for the Women’s Health Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomised controlled trial. JAMA 2002;288:321-33.

4 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity and mineral imbalance. J Nutr Environ Med 1998:8:789-91. DOI:10.1080/13590849862131

5 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.

6 Grant ECG. Food allergies and migraine. Lancet 1979;1:966-69

Competing interests: No competing interests

13 December 2017
Ellen C G Grant
Physician and medical gynaecologist
Retired
KT2 7JU, UK