NMAS Dear Doctor

If you have a problem you would like advice on, please send your letter to the NMAS “Dear Doctor” page. Dr Bond will answer as many letters as possible on the website. As we usually receive several letters on the same subject, they are often dealt with in one reply. So don’t be disappointed if it is not your name on the letter as it may well answer your questions. We hope so. In the interests of an accurate reply, please include as many details as possible such as age, how long on/off HRT and other medical conditions.

January 2005

Dear Dr. Bond,
Having recently come off HRT, I suffer terribly from hot flushes. My doctor recommends that I increase Estroven to 2 tablets per day (one morning + one evening). How long can I continue with 2 tablets per day? Is there anything else I can do to help?

Dr Bond's reply:
There is no reason at all why you should not take 2 Estroven tablets per day for up to 3 months, and then reduce the dose to 1 tablet a day again. In order to maximize utilization of isoflavones you could consider taking a probiotic product for a while, which should be available from your local health food store. If you did not wean off your HRT you will have problems. If these are very bad you could go back on your HRT to settle the flushes and then wean off the HRT slowly taking Estroven as you do. There is a fact sheet on our web site about coming off HRT.


Dear Dr. Bond,
I am 40 years of age and my periods have stopped about 5 years ago for no apparent reason. Does this mean I am menopausal? I don’t seem to have any of the symptoms?

Dr Bond's reply:
35 is very young for your periods to stop. You do not say whether you had any other problems at the time or whether you had been on the contraceptive pill. If you are having an early menopause then you have to consider your increased risk of osteoporosis and have a bone mineral density scan.


Dear Dr. Bond,
I recently read an article in a newspaper to say that sunbed users have stronger bones. I am worried about skin cancer? Can you recommend something else instead to help keep my bones strong?

Dr Bond's reply:
There should certainly be a benefit for your bones by exposure to sun and sun beds because sun acts on the skin which then makes active vitamin D that is needed by the bones. I would not recommend sun beds as a way of avoiding osteoporosis. The first thing you should do is to have a bone mineral density scan to see if you are at risk of osteoporosis. If your bones are OK then just maintain a good diet or supplement. If your bones are not as strong as they should be then you must take a good bone supplement, exercise and maybe consider using progesterone cream. Consult our fact sheet on osteoporosis.


Dear Dr. Bond,
I am going through the menopause and am concerned that I have not exercised most of my life. What kind of exercise would you recommend for me, at this stage in my life to help me optimise my bone strength?

Dr Bond's reply:
There is considerable evidence that the best form of exercise for strengthening bones is yoga. Skipping, dance and playing tennis are all excellent. However you must also ensure that you are obtaining all the nutrients your bones need by taking a good bone supplement.


November 2004

Dear Dr. Bond,
I am in my early forties and my periods are still regular so I do not think I am approaching the menopause but I have noticed that my PTM is becoming much worse especially if my period is a bit delayed. Is there anything I can take to help avoid this?

Dr Bond's reply:
This is a common problem as women reach their forties and it relates to the natural hormone changes that occur at this time. Although you still have regular periods the chances are that you do not ovulate every month. This is why it becomes more difficult to become pregnant, as you become older. If you do not ovulate then the hormone progesterone, which is normally secreted by the ovary to prepare your body for a pregnancy, is not produced. This means that your oestrogen is not balanced and you experience the symptoms associated with PMT. If you take a supplement containing vitamin b and magnesium such as Magnesium OK you will find that your symptoms will be greatly alleviated. A good healthy diet and general life style are also important.


Dear Dr. Bond,
I am in my early fifties and am experiencing symptoms that my reading tells me are associated with the menopause. My periods are also erratic but my doctor has done a test to measure my FSH and he tells me that it is normal and that I am not starting the menopause. This does not make sense to me.

Dr Bond's reply:
The problem with the single blood test for FSH (Follicular Stimulating Hormone) is that it varies from cycle to cycle. If your doctor measured it during a cycle when you had ovulated, it would be normal. However if it had been measured during another cycle when you had not ovulated it would have been raised and he would have told you that you were entering the menopause. This test can sometimes be helpful but more often than not too much reliability is placed on it. It is forgotten that it is only telling you what is happening that cycle. If you have symptoms suggestive of the menopause at your age, then the odds are that you are entering your menopause. You should ensure that you are leading a healthy lifestyle and eating a good diet. In addition you should take a supplement designed to help at this stage of your life. It should contain specific vitamins and minerals combined with isoflavones. A good supplement that supplies these is Estroven.


Dear Dr. Bond,
I am in my late thirties and having been taking the contraceptive pill since I was nineteen. I stopped taking the pill six months ago because I wanted to have a baby but I have not yet had a period and my doctor has done a blood test and told me that I have had an early menopause and need to take HRT. What can I do?

Dr Bond's reply:
The first thing is not to panic. It is not uncommon for periods to be delayed for many months when you stop taking the pill if you have previously been on it for a very long time.This is because the ovaries have been suppressed and they need time to recover. The test your doctor has done will have shown that you have not yet started to ovulate. This does not mean that you will never ovulate again. What you have to do is to rebalance your body and hormones. To do this you must make sure that your lifestyle is healthy, do not smoke or drink alcohol, eat a healthy whole food diet, do some exercise and take some natural remedies to help balance your hormones. Mexican Wild Yam is particularly useful at this time. It can also be helpful to see a homeopath or acupuncturist who can help to balance your system. What ever you do, you should not take HRT as this will suppress your ovaries even more.


Dear Dr. Bond,
I am in my late thirties and my periods stopped about a year ago. My doctor says that I have had an early menopause. He has checked my blood on several occasions because he says that just doing it once is not enough. He says I am not ovulating and that my oestrogen levels are also low. I am not surprised at this as the same thing happened to my mother, an aunt and my older sister. My doctor has said that I should take HRT but I am anxious about this as well as being anxious as to what might happen if I do not.

Dr Bond's reply:
Your doctor is probably correct in his diagnosis because he has tested your blood levels on several occasions and you have a family history of early menopause. One of the main problems of an early menopause is the increased risk of osteoporosis. However traditional HRT will not do a great deal to prevent this and there are now recognised side effects to taking HRT long term. In addition, a woman as young as you are, will probably want to remain sexually active and the low oestrogen levels can lead to vaginal dryness and shrinkage. To maintain a normal hormone balance for your age you should consider taking bio-identical hormone replacement therapy. This involves taking hormones that are identical to those that your body makes as well as taking them in a dose specific for you. Traditional HRT only contains one of our three oestrogens and it does not include progesterone but a synthetic form called progestogen. You should also have an osteoporosis screening test to see how strong your bones are now and to keep an eye on them for the future.


Dear Dr. Bond,
I am very confused. A year ago my doctor told me to stop HRT because of the reports of certain trials which had been stopped because of the increased risks of breast cancer. She also told me that these trials also suggested that HRT did not have the benefits that had been thought in relation to prevention of heart disease and dementia. I stopped HRT and I have to admit that I do not feel as well as I did and my sweats and flushes have returned. The doctor now tells me that I can go back on to HRT because the results of the trials were not interpreted correctly and it is now thought to be relatively safe for 5 years. What do you think?

Dr Bond's reply:
I am not surprised that you are confused, many doctors are as well. I personally believe that HRT should be avoided if possible but let me set out for you the situation as it is considered to be at the moment. The advantages of HRT are:

1. It is effective in reducing hot flushes, sweats and vaginal dryness. It can also help relieve insomnia and depression if these are hormonally related.
2. It can reduce bone loss in osteoporosis but this benefit only last while the HRT is being taken. When the HRT is stopped, bone loss increases and the osteoporosis can revert to being as severe as it would have been, had the HRT not been taken.
3. There is some evidence that suggests that HRT may reduce the risk of colon cancer.

On the other hand, the disadvantages of HRT are:
1. There is a significant increase in the risk of breast cancer. This is greater with the combined HRT than with oestrogen alone.
2. There is an increased risk of strokes
3. There is an increased risk of coronary heart disease in the first year of taking HRT and no benefit is seen in later years.
4. There was no evidence to show any protection from dementia or mental deterioration
5. There was an increased risk of venous thrombosis
6. There was an increased risk of uterine cancer is oestrogen was taken on its own but no increased risk with the combined HRT
7. There was an increased risk of ovarian cancer in women who took oestrogen only following a hysterectomy where the ovaries were retained.

The medical consensus of opinion is that HRT is not without risks but that if menopausal symptoms are severe and nothing else will help, then taking HRT for up to 5 years is all right provided all the risk factors are considered especially in relation to the individual. It may also be considered in severe osteoporosis if non of the other medications are acceptable.

What is not considered here is the possibility of using bio-identical HRT which does not seem to carry the same risk factors, although extensive trials have not been carried out as for traditional HRT.

The best option for menopausal symptoms first of all is to try the complimentary route using food supplements, herbal preparations, acupuncture, etc. and to only consider any form of HRT if these do not make life bearable.


October 2004

Dear Dr. Bond,
I am 45, 5'4” tall and I now weigh 75kg. I am currently being prescribed Cetririzine Hydrochloride and Beclomethasone Dipropionate Aqueous Nasal Spray. I have also been taking red clover for almost three months and ever since I have felt some form of pressure on the part of my throat where I believe to be the thyroid gland. I have also noticed that even though I am physically active, I have been gaining too much weight and haven't been able to shed it off. I have healthy eating habits and take supplements alongside Novogen, red clover, Menopace, flaxseed oil, primrose oil, garlic pills and turmeric. Can red clover affect the thyroid gland? Is it linked to weight gain? Can it be classified as a natural HRT? Can I take all these supplements alongside my prescribed medication without affecting my health or gaining anymore weight? Please advise.

Dr Bond's reply:
You do not say why you are taking the medication that you list but I suspect that you have some allergy. You should consult your own doctor as to what supplements you can take with your medication and also ask him or her to check your thyroid. Red Clover is a phyto-oestrogen and is not classified as HRT. Natural HRT strictly speaking refers to bio-identical hormones.


Dear Dr. Bond,
I am 60 and came off Climess HRT tablets in August 2003 after 10 years. I was not told by my doctor about coming off gradually and just stopped. I am worried that I may have caused some harm by doing so. Could you advise me please? I am taking Tofu pill which has greatly reduced the hot flushes that returned, and omega 3 fatty acids. My main worry now is total loss of libido and great tightness and dryness of the vagina making sex painful. I do take a vitamin and mineral supplement, also alpha lipoic acid and L-Carnitine, Co-enzyme Q10, vitamin B complex, medeen and zinc, do you think I am over doing it? I suffer from peripheral neuropathy. I am not diabetic. Should I take calcium supplements?

Dr Bond's reply:
You will not have done yourself any harm by coming off HRT cold turkey. You have done the correct thing by taking supplements to help your symptoms. Calcium supplements on their own are a waste of time. If you are concerned about your bones then you should ask your doctor to arrange for you to be screened for osteoporosis. If this shows a problem then you need to take a specifically designed bone supplement that contains all the vitamins and minerals you need. Regarding your vaginal problems, I would suggest that you try a phyto-soya vaginal gel and increase your vitamin E intake.


September 2004

Dear Dr. Bond,
I am 39 years old and am experiencing some symptoms of menopause - inability to control my body temperature before and during a period, incredibly painful breasts, dry vagina, mood swings and hugely irrational irritability and my periods happen when they like! I wonder if I should I see my GP but I really don;t want to take up a valuable medical slot if this is simply my next stage in life. I am otherwise well if rather overweight and would appreciate any help you might be able to offer

Dr Bond's reply:
Dear Cheryl, The symptoms you describe are typically of those caused by the hormonal changes that take place prior to the menopause. Even though these changes are part of a normal process, there is no need for you to suffer and not have any help. Going to your doctor might help but the chances are they will suggest HRT or similar. I would suggest that you take a look at your whole life style because diet, stress and exercise, or lack of it, can all play important roles at this time. Make sure that you eat a good balanced diet that includes as much organic food as possible. Also reduce you intake of coffee and alcohol. It can also be useful to take a general vitamin and mineral supplement. Stress can always throw your hormones out of balance. If this is a problem for you then try to handle your stress better. Take up some form of relaxation or meditation and possibly take an adrenal support formula. Exercise is important for the general metabolism and to help your bones stay strong. In addition to the general vitamin and mineral supplement and the adrenal support formula I would suggest an isoflavone supplement such as Estroven together with some Magnesium combined with vitamin B6 for the moods and the stress. Confiance is a particularly good combination.


Dear Dr. Bond,
I am 48 years old, with no obvious menopausal symptoms to date. My periods are still regular although becoming light. I have suffered for many years from chronic cystic breast disease. Despite a strict and consistent regime of a careful vegetarian/fish, no dairy diet, regular exercise, use of fish oil/evening primrose oil and more recently soya products and isoflavones supplements, there has been no significant improvement. If anything the pain and discomfort is worse. Regular breast screening shows only multiple cyst formation. I have read extensively about breast problems, particularly cancer, and therefore I am aware of the significant role oestrogen can play in its development. Presently my hormone profile reveals a drop in progesterone levels and although my oestrogen level is considered within the normal range, obviously this imbalance has made me oestrogen dominant. If this profile status remains for any length of time, I am concerned about the consequences. John Lee's work on the use of natural progesterone sounds like an exciting solution although Marilyn Glenville, 'Natural Alternatives to HRT' is not supportive of his recommendations. I find this all very confusing and would appreciate some advice on how to ease my way through the menopause whilst also making an informed decision in order to protect myself, as much as possible, from the development of breast cancer.

Dr Bond's reply:
Dear Brenda, You are absolutely correct in saying that you think your problems relate to oestrogen dominance. So many people find this concept difficult to understand, especially when they know that their oestrogen levels are falling. However as you know, the importance lies in the ratio of oestrogen to progesterone. I think it would be well worth your while to try some natural progesterone cream. I know some people are not completely happy with the use of progesterone in the form of cream but this is often because they do not understand that the progesterone is bio-identical. Even though it is made from Wild Yams or Soya, the molecule of progesterone that results cannot be differentiated by a chemist from a molecule made in your own body. Because of this, the body treats it just as it would if it had made it itself and it doesn’t accumulate in the body. The progesterone creams has been used for about 30 years without any reported side effects and I really believe that, if it was a problem, we would have seen them by now. It is best if you can have the cream prescribed by a doctor who is familiar with its use rather than self medicating.


Dear Dr. Bond,
There was recently a TV programme that seemed to suggest that taking extra vitamins and minerals was dangerous. Did you see this program and what did you think of it?

Dr Bond's reply:
Yes I did see the programme and found it interesting. The main assumption they made, which I consider to be untrue, was that you could obtain all the vitamins and minerals you need from your food. This might be true if you grew all your food yourself in a pollution free environment and mineral rich soil but that cannot be said of modern food. Some of the side effects of vitamins that were referred to in the programme were worrying and what struck me was that the evidence they presented was not very conclusive and it was not absolutely clear that taking those specific vitamins was what cause of the problem. Other factors that often contribute to the problem, were not mentioned. They also seemed to be discussing instances where high doses of individual vitamins had been taken. This is never a good way to take your vitamins. Vitamins and minerals are always best taken in specifically designed supplements for specific conditions. For example, if taking antioxidants, a combination of Selenium with vitamins A, C and E is better than taking a high dose of vitamin E because the combination found in these specific supplements are low dosage and designed to work together.


Dear Dr. Bond,
I am 38 years old and am beginning to experience occasionally irregular periods. Am I starting the menopause?

Dr Bond's reply:
I think it is unlikely that you are starting the menopause at 38. The average age for periods to stop is 50 with any time between 45 and 55 being considered normal. It is not uncommon for periods to become erratic in the late thirties and this is not a cause for concern. It relates to the fact that when you reach that age you may not ovulate every cycle, and even if you do, the hormone balance particularly in the second half of the cycle is sometimes our of balance. These changes are aggravated by stress. I would suggest that you take a supplement product containing some magnesium and vitamin B6, such as Magnesium OK, to help balance your hormones.


Dear Dr. Bond,
Can a blood, urine or saliva hormone test tell me whether or not I am menopausal?

Often, if you go to your doctor complaining of problems that suggest you might be menopausal, he will do one of these tests and tell you whether you are or not menopausal. Unfortunately, these tests can only measure the hormones in the month in which you have the test done. As you approach the menopause it is not uncommon to have one month when your hormones reflect a menopausal picture followed by one in which the hormones are as normal as they were when you were in your twenties. These tests cannot give you a definite answer. All these test can do is, together with the information on how you feel and what your periods are doing, give you an indication as to whether or not you are approaching the menopause.


Dear Dr. Bond,
I have finished my periods and no longer have any menopausal problems except that I have noticed that my skin is more wrinkled and I seem to be more sensitive to the sun. My doctor has suggested a low dose of HRT but I do not want to take any hormones. Can I do anything about this?

Dr Bond's reply:
I do not think that taking HRT is the answer to this problem. The skin changes that you are experiencing are due to an increase in substances called free radicals. These are substances that are responsible for most of the changes we associate with ageing. They are dealt with in our bodies by substances known as antioxidants. You can increase your intake of these by taking a supplement containing Selenium, vitamins A, C and E.


August 2004

Dear Dr. Bond,
I am, I think, a very fit woman in my late forties. I have never had any problems with my periods and am anxious to avoid any problems at the menopause. I certainly do not want to take any hormones. Is there anything I should be doing now?

Dr Bond's reply:
You have obviously led a fit healthy life style and should continue to do so. If you are not taking a nutritional supplement product, you could consider Confiance which is designed to maintain good hormonal balance. It is also sensible to have a screening test for osteoporosis to make sure that your bones are strong as now is the time to deal with them if they are not.


Dear Dr. Bond,
I am 49 and I think my periods have stopped. I have some sweats and flushes but not too bad. My doctor says I should consider HRT as my mother had osteoporosis but I am not happy about this.

Dr Bond's reply:
If your doctor is concerned about you developing osteoporosis, rather than just dish out some medication that will not do very much good in the long run he should send you for an osteoporosis screening. If your bones are alright now then the screen can be repeated in a few years time. If you are worried about developing osteoporosis in later years, this is a good time to start taking mineral supplements for bone and exercise.


Dear Dr. Bond,
I have reached my mid thirties and am, I believe, fit and well. However I have noticed that my skin is not as elastic as it should be and my nails are dry. What can I do about this?

Dr Bond's reply:
The changes you mention are due to what are known as free radicals. These are reactive particles that form in our tissues as a result of toxins and internal processes in the body and can cause what is known as oxidation in our tissues. These changes are responsible for many of the changes we notice as we age- they can be described as similar to metal going rusty. The effects of these free radicals can be countered by taking antioxidants nutrients. Selenium is a very powerful antioxidant and it is a good idea to supplement it because our diets are very low in it. I suggest you combine Selenium with the vitamins A, C and E.


Dear Dr. Bond,
I have read many articles that explain the advantages of eating soya foods to prevent menopausal problems. While this is probably true I find that I cannot eat these foods as they upset my digestion. Can I obtain the advantages of these foods any other way?

Dr Bond's reply:
The reason soya food have the effects they do in preventing menopausal symptoms is because it contains iso-flavones. Generally, soya foods are easy to digest but it you are having digestion problems, it might be a good idea to try different forms of it. For instance, you can buy silken tofu, which is plain, but you can also buy it marinated. (Read the label to ensure the product is not made with isolated soya). You can also eat it in prepared foods like burgers and sausages. Go for organic ones if you can, to avoid food chemicals. Other type of soya foods are miso and tempeh. These are all available from health food shops and some supermarkets. If you still experience digestion problems after doing this, you can obtain isoflavones in specially prepared supplements. Estroven is one example. The advantage of obtaining you isoflavones this way is that you know how much you are getting each day.


Dear Dr. Bond,
I know it sounds vain but I hate the fact that since I had my menopause I have developed brown age spots. I have been told that taking oestrogen will improve my skin but would prefer something with less side effects.

Dr Bond's reply:
Recent research has found that these spots as well as skin cancer occur most commonly in women who are low on Selenium. In the UK most people are low on Selenium because our diets are low in this essential nutrient. I would suggest therefore that you supplement your diet with Selenium. Incidentally, selenium works best if combined with vitamins A, C and E.


Dear Dr. Bond,
I am in my late forties and am sure that I am approaching my menopause. My periods are irregular and fairly heavy but nothing that bothers me. I went recently for my cervical smear and the doctor said that I had a fibroid. I went to the hospital where they recommended a Hysterectomy and removal of my ovaries. This seems rather drastic to me.

Dr Bond's reply:
I would agree with you. If you are not aware of the fibroid it is probably not all that large so it should not cause any pressure problems. Your periods are heavy but do not bother you and will probably stop in a few years time. When that happens your fibroid will begin to shrink naturally. I would suggest that you postpone the surgery and make sure that you take a good supplement product which includes iron, to prevent anaemia, and await your menopause.


Dear Dr. Bond,
Hi. I have just come off HRT patches which I weaned myself off and I am now suffering bad night sweats, also during the day. I have a family history of osteoporosis and would like to know which supplements to take to get me past this.

Dr Bond's reply:
Well done for weaning off the HRT. To help with the sweats and flushes I suggest that you take a supplement containing isoflavones. One of the highest dosage is Estroven on which trials done last year showed an effect better than placebo in dealing with flushes and night sweats. You could also try some Red Clover and Tincture of Sage. The isoflavones will help your bones as will taking a supplement specifically designed for bone nutrition together with some Omega 3 Fatty Acids. It would be sensible to obtain a bone density screening to check the density of your bones now and to repeat it in a year to eighteen months. The reason for this is that oestrogen in HRT retains old bone and when you stop the HRT this bone may come away. If you do start to lose bone you could consider using progesterone cream as this can build up new bone.


June 2004

Dear Dr. Bond,
I have recently had glandular fever and I am very keen to improve my immune system. I am taking Echinacea Root Extract but wondered if there was anything else I should be taking?

Dr Bond's reply:
You are very sensible to want to improve your immune system after glandular fever and of course it is useful for everyone to consider this. There has very recently been a report from the University of Liverpool which shows that increasing your intake of selenium can improve your immune system. This is a mineral many people are lacking because of a switch in imports from selenium rich cereal grain grown in North America to selenium poor varieties from Europe. Selenium is also known to fight free radicals and thus protect against signs of ageing and cancer. Selenium is absorbed best if you take it in combination with vitamins A, C and E for better immune support and antioxidant protection. There are specialist products available in pharmacies that contain this combination.


May 2004

Dear Dr. Bond,
I was diagnosed with breast cancer a month ago and I am currently having radiotherapy for it. Because it is a hormonal cancer, I cannot carry on taking HRT. Are the phytoestrogens contained in Estroven safe to use in these circumstances?

Dr Bond's reply:
There is still considerable debate as to whether or not it is safe for women with, or who have had breast cancer, to take any form of phyto-oestrogen. It is advisable to discuss your particular case with your oncologist.


Dear Dr. Bond,
My doctor has recommended carrying on taking HRT because I have been diagnosed with osteopenia. I am so concerned about it I have agreed to do it. Is it ok for me to take supplements to help with the menopause symptoms and to support bones even though I am taking HRT?

Dr Bond's reply:
The current recommendation is that the taking of HRT for osteoporosis or osteopenia in not valid. The official reason for this is that the risks of breast cancer outweigh the possible benefits of taking the HRT. The oestrogen in HRT does not build up new bone. It only, possibly, slows the break down. This so called benefit will only last while you take the oestrogen. The best approach to osteopenia is to build up new bone. This can be done with weight bearing exercise (see our fact on Osteoporosis fact sheet on this) a good bone mineral supplement to build up bone and Omega 3 Fatty acid to slow breakdown. It may also be beneficial to use progesterone cream. Consult our fact sheets on What is Osteoporosis?, Osteoporosis Screening and The Role of Natural Progesterone.


Dear Dr. Bond,
I have always tried to manage the menopause in a natural way because I don’t agree with taking HRT and try to avoid taking any kind of medication whenever I can. I have been supplementing my diet with different products; one of them is Confiance, the one you recommend on your fact sheets. I have been doing quite well until recently. For some reason the effectiveness has stated to wane. What could be the reason for it?

Dr Bond's reply:
It may be that your own hormonal balance is changing as you go through the menopause. I would suggest that you continue with Confiance but take it on alternate days with Estroven and gradually transfer to Estroven.


Dear Dr. Bond,
After taking HRT to help me with my hot flushes for 10 years, I came off it 6 months ago and the hot flushes came back worse than they were before. I have been taken products containing isoflavones, not Estroven, for about 2 months now and they haven’t made any difference. What else can I do?

Dr Bond's reply:
The flushes are due to the fact that you came off your HRT suddenly. You should always wean off and as you do so introduce a supplement such as Estroven. I suggest that you try Estroven, as trials have shown it to be effective in dealing with hot flushes. You need to take it for at least 6 weeks. You should also include a supplement to support the adrenals to help the body deal with stress. See our fact sheet on coming off HRT.


Dear Dr. Bond,
I am 58 and I had both ovaries removed when I was 35 after being diagnosed with endometriosis. I was told by the consultant to come off HRT immediately because of chronic groin pain. I came off immediately about 6 months ago. Everything was ok but I am now getting chronic bone ache all over my body especially in my groin, hips and arms. My GP doesn’t understand and I’m not getting much help from the consultant. Can this be caused by stopping HRT? Can the supplements you recommend help with this problem? v

Dr Bond's reply:
I doubt that your aches and pains are due to coming off HRT although that may aggravate the problem. I suggest you take Omega3 Fatty acids to help to lubricate the joints. Some Selenium ACE to help the immune system which is sometimes involved. You could also take some Glucosamine together with a supplement containing Boswellia, Curcumin and ginger as these are natural anti-inflammatories.


April 2004

Dear Dr. Bond,
Could you please advise which natural menopausal treatments are suitable for use with Thyroxin. I am 43 years of age and following several years of perimenopausal symptoms (erratic and absent cycle, hot flushes, severe fatigue, insomnia and mood swings) I was diagnosed as being hypothyroid in April last year. At the time, blood tests showed T4 levels at 5.7, LH at 31.6 and FSH at 62.2. A test this month showed levels of T4 at 14.5 (taking 75mcg of Thyroxin), LH at 37.1 and FSH at 80.5 leading my GP to confirm me as menopausal since the gaps in my cycle have extended with the most recent being over 6 months, following only four light periods in the previous year. I should also add that I have not had children and so there is an emotional loss connected to this diagnosis. I eat a very healthy diet, drink only water, no alcohol and am a non-smoker. Over the past few months the signs have intensified with mood swings, depression, hot flushes, chest pains and sleeplessness increasing to the point where my daily activities have been compromised. These have been checked out with my GP who is being helpful with offers of HRT, a bone scan and counselling. However, I would prefer to avoid HRT and use natural and holistic remedies, but am aware that some may be contraindicated due to my hypothyroid state. Any advice you can give me would be very much appreciated.

Dr Bond's reply:
You are very sensible to resist taking HRT. Although your blood test indicated that you were possibly menopausal you should not take this as absolute truth. You should remember that this was a single blood test and will reflect what your hormone levels were at the time. I suggest that you read our fact sheet on premature menopause and you will see that a number of women are diagnosed as menopausal when they are not. Any women who is not ovulating, for what ever reason, is very likely to have a high FSH. This does not mean that you will never ovulate again. It is interesting that you have also recently been diagnosed as being hypothyroid. It could be that you have an oestrogen progesterone imbalance making you what is known as oestrogen dominant. We also have a fact sheet on this. My suggestion would be that you do a saliva hormone test via Harley Place Screening (see contact details on the NMAS website site) It may be that natural progesterone is actually what you need.


Dear Dr. Bond,
I am 55 years of age and had a hysterectomy nearly five years ago but still have my ovaries. I was put on Oestrodol tablets but have weaned myself off gradually, taking my last tablet a month ago. Since then I have started the hot flushes and night sweats which are getting worse and I generally feel awful especially not sleeping properly and also having a sinus infection does not help. My query is that I had suspected gall stones last year but the hospital finally decided I have IBS assisted by nerve ending pain (from a back operation 15 years ago). Do you think Black cohosh could help with flushes and sweats? I appreciate it takes a while to get into the system. Can you suggest a better option please?

Dr Bond's reply:
You do not say whether you had started your menopause or not when you had your hysterectomy but I suspect that you had not. I can never understand why women are given oestrogen following a hysterectomy when the ovaries have been left. After all, it is the ovaries that make oestrogen, not the uterus, and there is no reason to assume they will work any differently just because the uterus has been removed. Weaning off oestrogen as you have done is always better than stopping it suddenly. The weaning process can take several months. During the weaning process it is helpful to take an isoflavone supplement, such as Estroven. In fact, I would suggest you start doing that now. Estroven has been shown in trials to help sweats and flushes but it can take up to four or six weeks. Red clover can also help.


Dear Dr. Bond,
I am 31 years old. I have been having symptoms over the last year that I've just pushed to the back of my mind. These include 12 periods in the last six months, loss of libido, vaginal dryness, tender breasts, hot flushes, memory problems, tiredness and acne. I was under a lot of stress in 2003 and experienced a bereavement. To start with I put it down to that, but I can’t understand why I'm still having problems. Someone suggested early menopause, I have to say I laughed. Medical History, I haven't taken the contraceptive pill in 8 years due to them making me bleed for 3 weeks in 4. I have 3 children, 9 years, 7 years and nearly 6 years old. I have suffered with depression/post-natal depression on and off for the last 13 years, this started with insomnia. Even now I still have the odd night, not something I really worry about. Whenever I've been to my Doctor with any of my symptoms, I just keep being told to come back in 6 months if I'm still having problems. Could this just be a hormone imbalance or could last years stress be the cause. I've put the premature menopause idea at the back of my mind due to my age. Should I insist on some tests from my Doctor? Any suggestions or ideas would be wonderful. Thank you.

Dr Bond's reply:
You are certainly experiencing a time of hormonal imbalance. It could be an early menopause but is more likely to be due to the stress you have been going through recently. The symptoms are classically those of oestrogen dominance (see our fact sheet on this). I would suggest that you ask your doctor for some tests. It would be useful to check your blood generally to make sure that your are not anaemic and that you do not have a thyroid problem. You should also ask him to check your hormone balance. In particular, he needs to check your FSH (this indicates how well you are ovulating in the particular cycle). This should be done in the first half of your cycle. In the second half of the cycle he should check your oestrogen and your progesterone. This will indicate whether or not you actually ovulated and can also be used to check whether or not you are oestrogen dominant. If your doctor is not happy to check the hormones in this way they can be checked using saliva. See sheet on Harley Street Screening on www.nmas.org.uk


Dear Dr. Bond,
I am concerned about coming off HRT because I am afraid it might make my hair thinner (I have a lot of hair at the moment), make my breasts sag (I have always had good breasts) and I might lose the “get up and go” factor. Even though I have a disability, I still want to be active to keep on with my interests. Thank you for your help

Dr Bond's reply:
There is no need why any of these should happen providing you come off HRT very slowly and ensuring that you take the appropriate vitamin and mineral supplements. I would suggest taking Estroven, which with its isoflavones can help balance your oestrogen levels. Also, Silica-OK may help maintain healthy hair and nails and Bodymax, a multivitamin and mineral with ginseng, can help maintain your get up and go. Don’t forget a positive attitude is also important.


February 2004

Dear Dr. Bond,
I had a total hysterectomy when i was 35 yrs old, i am now 44, for endometriosis. Since then i have tried all sorts of HRT, at present i am on Tibolone. i still feel like i am a 44 yr old in an 84 yr olds body, tired, aching, moody, depressed and continue to put on weight although I exercise far more than i ever used to. i wondered if i may be suffering from a lack of progesterone and if it would be worth me getting some cream ? Please can you help? Regards, Tina.

Dr Bond's reply:
You do not say whether you had or not your ovaries removed but I suspect that you did. A total hysterectomy is actually only the total removal of the womb although the term is often used to include, incorrectly, removal of ovaries as well. [The correct term is hysterectomy combined with ovarectomy]. If your ovaries were removed you are probably suffering from a lack of both oestrogen and progesterone. Tibolone does not contain any oestrogen or progesterone. I would suggest that you ask to be prescribed oestrogen, in the form of Hormonin and half a tablet a day would probably be enough. Have it balanced with progesterone, either as a 3% cream or in the form of tablets (Uterogestan). The Hormonin would be taken daily and the progesterone for two or three weeks out of every four. You might like to try a good food supplement such a Confiance too, which contains five useful minerals and six vitamins to help the body adjust naturally to changes at this time.


Dear Dr. Bond,
I am a 50 year old women. Having discovered I was suffering with severe endemetrosis for several years I had a total hysterectomy in July 2003. For two months post-op I was great. No continual bleeding, no anemia - wonderful.. Then "zap" I felt I was being gradually brought to a closure! These changes in my body, like an imbalance, felt it wasn't me any more. I started the "talked about" hot flushes, every 15 mins this surge of heat through my body (day & night), vaginal dryness, headaches and feelings of low self esteem. Added to which, I feel I am driving my partner further and further away because of no libido! Just this feeling of emptiness. What are your thoughts generally? My consultant has suggested to go on Oestrogen patches, do I give it a go? Would welcome any information. Thank you. Wendy

Dr Bond's reply:
A total hysterectomy usually means that they also remove your ovaries. This is why you have the onset of menopausal problems. While using an oestrogen patch would of course deal with the hot flushes and other menopausal problems, it could start up your endometriosis again if you had any lesions in the abdominal cavity and you would be back experiencing pain etc. I would suggest that you first of all try some Estroven, which contains isoflavones and is known to help with the problems you describe but will not reactivate your endometriosis.


Dear Dr. Bond,
I am 52 and have been taking Trisequens (HRT) for 10 years. In view of current medical advice, I have decided that I would like to come off it. I have consulted my doctor who has suggested I just stop taking the tablets. However, the advice I have read is to reduce the dosage gradually but, as there are 3 different tablets to be taken during the month, my doctor is unable to advise me how to do this . Can you help me, please? Linda Lindsay

Dr Bond's reply:
The way to wean off is to work your way through the pack taking tablets in the same order as before but take them on alternate days, thus a months supply will last for two months. Then take them every third day spreading the pack over nearly three months. This should work especially if you take a supplement called Estroven at the same time.


Dear Dr. Bond,
I am 52 andI have been on HRT for 4 years, Evoril Sequi patches, and for about the last year the continuous type Evoril Conti. I am not happy to continue with it as throughout I have had bleading and the doctor I see said I had to stop it because of the unexplained bleeding. I was advised to stop immediately which I did but now I have terrible night and day sweats continuallty. I have been off it now since Dec 12 and not had an uninterrupted night's sleep since.
I have been taking red clover for about a month but it has not helped. I have just gone on to Black Cohosh (1 week in) and so far no improvement. I also take Vit C, Calcium/magnesium,Star Flower Oil and cod liver oil. I would be grateful for any advice as I am suffering quite a bit. I know you say HRT should be stopped gradually but it is too late now as I don't want to go back on even if only on a smaller dose (as recommended). I am surprised the doctors don't advise that it should be stopped gradually as I would have gone that route. Other than this I am in good health and try to exercise regularly. I look forward to your reply and thank you in advance. Jo Churchill

Dr Bond's reply:
Dear Jo, as you say the problem is that you stopped your HRT too quickly, I would suggest that you ask your doctor to put you back on a very low dosage of HRT and then wean off using Estroven as you do so. See our fact sheet on comning off HRT for giudance as to which hormones to ask your doctor to prescribe.


Dear Dr. Bond,
I am 51 years old and had a hysterectomy in 1996 due to constant bleeding. The surgeon removed my left ovary and as the right one was okay, he said I wouldn't be needing HRT for a few years. I began to take HRT prescribed by my Doctor in 1998 and noticed that I put weight on rather quickly and eventually began to 'forget' things. I decided to come off the HRT in 2000 which the Well Woman Nurse agreed and started to take alternative tablets bought from my local health shop. It was suggested I tried Black Cohosh, Sage and Red Clover but only take one type at a time for 3 months. I didn't feel any different whilst taking Black Cohosh and the hot flushes I was having stayed the same. I then tried Sage with a multivitamin for 6 months and still experienced hot flushes to the extent that I had to get up in the night and couldn't concentrate in the day. I became tired easily and irritable due to the sleep disturbances. I then tried Red Clover, still took the multivitamins, started taking Evening Primrose with Cod Liver Oil tablets and went on a High Fibre diet as I started to have digestive problems. I continued the course of the tablets bought and have upgraded my intake of Soya and probiotic yoghurts alongside wholegrain products and organic fruit & vegetables. I do not smoke, drink a 14% aperitif with water once or twice a week and keep myself occupied with walking, reading, meeting people. I am now on Soya Isoflavones and multivitamins for the over 50's as I still had the flushes. I have the hot flushes day and night, sometimes more than others, have lost weight due to the change in diet, have better digestion and generally feel okay. I have had some stress this last year due to family but have got that under control. I wonder if you could suggest something I could take to reduce the hot flushes as I feel they are making me depressed as well as tired and am I doing right by being on a better diet plan and taking in Soya on a regular basis? Thank you for your help, I appreciate it. Regards, Margaret - Grimsby, England.

Dr Bond's reply:
Dear Margaret, you do not say how you came off your HRT. I suspect that you just stopped it rather than weaned off. I would suggest that you consider going back on to your HRT and as soon as your problems have resolved you should start reducing your HRT dose very slowly. At the same time as you reduce your HRT, you should start taking Estroven. For help with this, consult our fact sheet on how to come off HRT. I hope this time will work for you.


January 2004

Dear Dr. Bond,
In 1997 I had a total hysterectomy and since then have been on Oestrogen patches in varying amounts - currently down to about 25mg. Due to bereavement and long term sick leave due to a back problem, stress levels in my life have been considerable for the last 18months and so I imagine my cortisol levels are quite low. I questioned my GP about coming off HRT in view of recent research findings and he advised me to go "cold turkey" and refused to prescribe any more patches. I have to say I feel he is completely out of touch with the implications of doing it this way, and as I still have a few patches left I intend to reduce them even further by cutting them in half before stopping completely. In view of my situation as described, do you advise the use of a progesterone cream to help deal with the return of menopausal symptoms - and if so, how long would you advise me to use it for?
Many thanks for your advice, Lyn Read.

Dr Bond's reply:
Unfortunately , you do not tell me how old you are or why you had to have your historectomy. Also I do not have other medical details relating to you. If you are younger than what it is considered to be the normal menopausal age, then you should probably continue on oestrogen but on as low dose as possible to avoid flushes and sweats. If you are past the age of, or near the age of your natural menopause, then I would suggest that you wean off the oestrogen. Details of how to do this are in our fact sheet on the subject. If you decide that it is appropriate for you to stay on oestrogen for a while, then you should consider seriously the importance of taking natural progesterone as well. This is very important to balance the unwanted side effects of oestrogen such as heart problems and breast cancer. Again there is a fact sheet on the subject of natural hormones and one on progesterone you can read to find out more about these products.


Dear Dr Bond
I went on HRT about 10 years ago as I approached the menopause. I did not have any problems but I was terrified of growing old and looking old and my doctor assured me that taking HRT was a good idea. I am still worried about looking old but am also worried about the recent reports that HRT increases the risk of breast cancer. What should I do?

Dr Bond's reply:
It was wrong of your doctor to give you the impression that HRT was an elixir of youth. A youthful appearance is more likely to relate to a woman’s general health and nutrition than to her hormone balance and to the life style that she has led. There is indeed a lot of media hype regarding HRT keeping a woman youthful but most of this is produced by the drug companies and is part of their marketing strategy. There is no clinical evidence that taking HRT keeps a woman looking younger. While I understand your concerns, you should seriously consider coming off HRT. Do not do this suddenly but wean off (advice re this is on our fact sheet). At the same time, you should look at your life style and make sure that you are doing all you can to maintain good health and nutrition. This would include a good diet as well as taking a good general vitamin and mineral supplement and supporting your hormone balance with a product such as Estroven which contains isoflavones as well as providing a combination of vitamins and minerals.


Dear Dr Bond
I have a family history of osteoporosis and my doctor has suggested that I take HRT to prevent having it myself. I am 49 and seem to be starting the menopause.

Dr Bond's reply:
Certainly a family history of osteoporosis puts you at increased risk of having it yourself. However, it is not certain that you will develop it. First of all you should ask your doctor to arrange an osteoporosis screening to see what level of bone mineral density (BMD) you have. If your BMD is normal or above, then your risk of developing osteoporosis is low. The sensible thing to do would be to ensure that you have a good diet providing bone building vitamins and minerals and take reasonable weight bearing exercise. You can then repeat your osteoporosis screening after your menopause. If your BMD is low, then your doctor needs to look more closely into the problem. I normally suggest that my patients have a urine test known as a Dpd test. This measures the amount of a chemical in the urine that in its term indicates bone metabolism. If the Dpd is high, it suggests that you are currently losing bone but if it is low it shows you are building up bone. In between, it shows steady metabolism. The importance of this test is that it tells you whether the problem is one existing now or whether it relates to problems in the past. If you BMD is low and your Dpd is low or normal then all you need to do is build up new bone. If your BMD is low and the Dpd is high then you must stop the breakdown of bone. Bone can be built up using a combination of a bone building nutrients such as calcium, magnesium, boron, silica vitamins C and D. A supplement product such as Calci-Chew containing just calcium and vitamin D is not sufficient. Exercise and natural progesterone can also be very helpful. Taking oestrogen can slow bone break down as can a bi-phosonate but these only work while you take them. A supplement containing Omega 3 fatty acids, like in fish oils, can also slow bone break down.


Dear Dr Bond
I am in my early 40’s how can I ensure that I do not have problems when I reach my menopause?

Dr Bond's reply:
You are very sensible to be thinking about your menopause before you get there. First of all the menopause is not a disease nor is it a hormone deficient condition, it is natural stage in woman’s life. You may have no problems but unfortunately many women do which is why you ask this question. In my experience working with women over more than 20 years, it is so clear to me that women who look after their general nutritional and hormonal health throughout their lives have far fewer menopausal problems than others. It is never too late to start and I suggest that you read our various fact sheets so that you know what can happen and what you can do about it other than taking HRT. Also look at your life style and try to reduce the effect that any stress has on you. Look at your diet, in particular keep your alcohol and coffee intakes low. Ensure that you eat a good balanced whole food diet and possibly take supplements to help your hormone balance such as Confiance.


December 2003

Dear Dr Bond
I have been taking medroxyprogesterone orally for 18 months - this was originally given to bring under control a prolonged heavy bleeding which has been going on for 3 months. I take 50 mg daily. The reason for the heavy bleed I now know is that I have a fibroid. My current medication largely keeps the bleeding under control but periodically, especially if I over-exert myself I can bleed for 3 weeks and lose large clots. My GP has suggested that I think about the Mirena coil. I have talked with the doctor who would fit it and basically he frightened the life out of me. He told me I would need a day off work, that I am likely to feel sick and in pain afterwards and may not be able to drive myself home. Add to that the mixed reports I have read on the Internet and my own mixed feelings. I feel torn. Would it really be better to have locally delivered progesterone? Will it have an effect given that my original bleeding was due to a fibroid and not thickening of the uterine lining? Are there any major drawbacks to continuing my current medication until after menopause when I am told that fibroids are likely to shrink anyway? Can you offer any recommendations?
Thanks. Jeanette

Dr Bond's reply:
I would consider a Mirena coil that delivers the progestogen locally to be a better option than taking the progestogen for such a long time by mouth. You do not say how old you are but if you have a number of years to go to the menopause it could be sensible to consider having the fibroid removed or even a hysterectomy with retention of your ovaries. The problem with long term heavy bleeding is that it can affect your general health as well as being a nuisance.


November 2003

Dear Dr,
I have a very confused partner. My partner has just had a hysterectomy(the removal of both ovaries and the womb due to an ovarian cyst. The cause of this was suspected to be emnientosis which she has had for a number of years. she is 39 years of age and has had cysts on the breasts. her farther has had cancer for a number of about 30 years and died from this. She has been given 2mg elleste solos tablets. one to be taken each day until she is 51 (12 years time). shew is very concerned by taking these and at present looking at taking Menoplace and Black Cohosh and taking Calcium tablets. but she is unsure if this is going to be enough to stop osteoporosis in later life can you give her any suggestions as to if the 2mg elleste solos tablets are safe for her to use? What side effects she might have if she does take them? Will the combination of Menoplace, Black Cohosh and taking Calcium tablets be enough and what side effects will she have from taking this combination. Her hysterectomy was 45 weeks ago and she is suffering from flushes and mood swings, dry skin and dry hair already. Can you give some advice as the doctors and surgeons just say take the HRT and dont offer any alternatives. Many thanks for your time.

Dr Bond's reply:
I am not surprised that both you and your partner are confused as to what is the best for her to do. First of all I sugest that she consults the fact sheets on our web site where there is a great deal of information that will help. Then I suggest that she consults a practitioner who deals with hormonal problems in a natural way as I suspect that she will continue to need oestrogen for some time but she should also be taking natural progesterone


Dear Dr,
I am anxious to avoid taking HRT because of the increased risk of breast cancer and other side effects. I am at present suffering from hot sweats day and night and I am not sleeping well. I have read that taking certain supplements can help alleviate these symptoms but my doctor says that there is no evidence of this and that I am wasting my time and money.

Dr Bond's reply:
What a pity your doctor is not aware of the recent study carried out under the auspices of NMAS with a supplement called Estroven. Estroven contains 55mg of isoflavones combined with specific vitamins and minerals that are known to help balance hormones. The study was a double blind study using a placebo. It was carried out independently and the results were analysed statistically. The study showed that there was a significant decrease in the incidence and severity of sweats, flushes and insomnia in the women who took Estroven compared to those taking a placebo over a period of two to three months. I would suggest that you try Estroven.


Dear Dr,
I want to wean off my HRT. Are there any supplements that can help me as I do this and how should I do it?

Dr Bond's reply:
The most important thing when coming off HRT is to do it slowly otherwise you may have more severe symptoms that you had before you went on it. This is because when you are on HRT, you are on high levels of oestrogen and if you stop suddenly, the levels drop immediately.

There is a fact sheet on the NMAS website telling you how to wean off HRT and supplements that you can take as you do so. One of the very best for this which has recently been proven by a study is Estroven.


Dear Dr,
I am well past my menopause and no longer have any problems. However, when I was going through the menopause, I had a terrible time. I have heard that the tendency to have menopausal problems often runs in families and I wondered if there is any advice that I can give my daughter to perhaps make that time easier for them. They are only in their 30’s at present.

Dr Bond's reply:
You are absolutely correct in saying that the menopausal pattern often runs in families. However, there are many things that our daughters can do to help prevent these problems. In my practice, I have noticed over the years how women who take care of their general health and well being throughout their lives have generally less problems at the menopause than those who do not. One of the biggest problems today is that of stress and again I have noticed that women who have led stressful times during the years from the 30’s leading up to the menopause have many more problems than those who have either had less stress or learnt how to manage stress. Stress is any extra demand made on the body and is a natural reaction unless we have too much of it. If one is aware that ones life is stressful then it is very important to learn how to handle it. This involves relaxation, exercise, diet and supplements. If a body is stressed then it needs extra B vitamins and antioxidants. Supplements such as Selenium-ACE, Magnesium-OK or Magnesium-B can be combined with a good B complex product. Attention to general and in particular hormonal health form the mid-thirties onwards is a valuable investment for any woman particularly those whose mothers had difficult menopause.


Dear Dr,
I am 53 years old woman suffering from fibroids and as a result I have extremely heavy periods. I know the fibroid will eventually shrink and therefore I am reluctant to have an operation to remove it. My doctor has suggested I try an IUD called “Mirena” which releases progesterone over 5 years into the womb. In your fact sheet on progesterone, you mention three forms, but there is not mention of progesterone being released by an IUD. I would really welcome your advice as to whether there could be any adverse side effects, as apparently the “Mirena” is relatively new to the market.

Dr Bond's reply:
A Mirena coil does not release progesterone. It contains and releases a progestogen which is a chemical hormone. This hormone can inhibit the build up of the lining of the uterus and can be useful to control heavy bleeding, if this is due to a hormonal imbalance where excess oestrogen is causing a thick lining in the uterus. If the bleeding is due to a fibroid, a Mirena coil is unlikely to be helpful. I would suggest that you consider using a progesterone product, either as a cream, suppositiories or in tablet form.

A Mirena coild can also have side effects such as pain and cramps and sometimes the progestogen can lead to moods and depression.


August 2003

Dear Dr,
Should I be worried by the onset of the menopause?

Dr Bond's reply:
Of course you should not be worried by the onset of the menopause. The menopause is a natural process in a woman’s life. While some women may have problems at this time, many women go through this stage of their lives with few or no problems at all. If women do have problems, there are many ways in which they can be dealt with. In my view, any form of HRT should be considered an absolute last resort because of its potential side effects. If natural remedies do not work then hormones may be needed but traditional HRT is not the answer. Natural hormones such as a tri-oestrogen combined with progesterone (not a progestogen) should be used and the dose should be specifically worked out for each individual woman and only taken for as long as needed.


Dear Dr,
I’m currently taking combined HRT and am concerned about the recent health scares and would like to come off it. What’s my best course of action?

Dr Bond's reply:
It is my view that you should be concerned about the risks of taking combined HRT. The first thing, however, is not to panic and not to stop your HRT suddenly. You should consult you doctor and discuss the best course of action for you. My recommendation would be to come off your HRT slowly by reducing your daily dose over a period of several weeks or months. There are details of how do do this on the fact sheet “How to come off HRT”.


Dear Dr,
What can I do to alleviate some of the symptoms such as night sweats and hot flushes?

Dr Bond's reply:
Night sweats and flushes can be very distressing. They are due to the balance of the oestrogen and progesterone hormones changing and swinging about. Once these hormones have settled at their new natural low levels the problem will stop. In the mean time, there are many things one can do to alleviate the problem. Bearing in mind that stress aggravates these problems, try to lead a less stressful life style. Find time to relax and exercise. Make sure that you eat a good balanced diet and avoid any thing that you find aggravates the problems. Coffee, spicy foods and alcohol are the main culprits. In addition you could take a supplement containing isoflavones or other phyto-oestrogens such as sage or red clover. At night it often helps to have a fan in the bedroom blowing gently on your face and during the day time wear light clothing in layers.


Dear Dr,
I find I’m suffering from a loss of libido due to the menopause. Is this normal?

Dr Bond's reply:
Regrettably a loss of libido is very common at the time of the menopause. The main reason for this probably relates to the fact that as far as nature is concerned we have intercourse to produce babies and once that is not a possibility there is no need!! However, we do not feel like this and often as the menopause passes, libido returns. Make sure that there are not other problems causing the lack of libido such as vaginal dryness or tightness which can be dealt with. Also make sure that you are not over tired and stressed. Most women find that once they can overcome the lack of interest the actual act can be as satisfying as ever—so sometimes it is a case of making a mental effort.

There is a lot of talk about the increase in susceptibility to osteoporosis during the menopause. Should I start taking calcium supplements? Osteoporosis is not a condition that suddenly appears at the menopause. It is a condition that relates to our bone health throughout life. Through life bone is being built up and broken down. From childhood until about the age of 25, bone density should be increasing. This will only happen if diet and life style are healthy. After about 25 the bone density remains about the same because the build up and break down of bone balances itself. After about the mid thirties bone density starts to decrease by about 1% per annum and this continues until the menopause when it increases to 3% per annum for a few years and then reverts to 1% per annum. This is normal and does not produce osteoporosis. Osteoporosis occurs if during life there have been factors likely to induce it. These include, family history of osteoporosis, poor diet or eating problems, times when periods have been very erratic or stopped, early menopause, either natural or surgical. The most important thing to do as you approach the menopause with regard to osteoporosis is to have a bone mineral density scan done either with X-ray or ultra-sound. You may be able to arrange this via you GP or contact a service such as Harley Place Screening (0207 3232383) If your bone density is low then you should have a urine test done to see whether the problem relates to past bone loss which has now stabilised or whether you are actively losing bone at this time. The result of this test will indicate whether or not you need to concentrate solely on building up new bone or whether you need to consider slowing breakdown. Bone can be built up using diet, supplements, exercise and natural progesterone.


Dear Dr,
Are there any foods I can incorporate into my diet to alleviate menopausal symptoms, and any foods I should eliminate?

Dr Bond's reply:
A good healthy diet with balanced whole foods will certainly help to avoid the problems of the menopause. It is sensible to avoid coffee, fizzy drinks, alcohol and too much red meat. Probably the simplest advice is to follow what I describe as a Mediterranean type diet.


Dear Dr,
Can you recommend any supplements, herbs or vitamins that might be helpful?

Dr Bond's reply:
It is often very useful to take specifically designed supplement prior to the menopause to ensure that your body is a well balanced hormonally as is possible. The value of these supplements lies in the fact that they are specifically designed and contain substances such as isoflavones, vitamins and minerals that work together. Good examples of these are Estroven and Confiance.

Herbs can also be helpful for menopausal problems and it is a good idea to consult a herbalist on this matter. Commonly used ones include red-clover, agnus castus, black cohosh and sage.


Dear Dr,
How long do the natural alternatives - such as agnus castus and black cohosh - take to start having an effect?

Dr Bond's reply:
Natural alternatives tend to take longer to work than hormones but some response should be seen within a week to ten days. Often though, the full effects are not seen until the remedy has been taken for a month. The other thing that happens sometimes is that a remedy that seemed to work suddenly no longer seems to be as effective. Often ringing the changes with the remedies if this happens will result in a solution to the problem.


Dear Dr,
Are there any herbs that might be contra-indicated for certain people?

Dr Bond's reply:
Regarding herbs that are recommended for menopausal problems these should always be treated with respect. Just because they are herbs, does not mean that they are completely harmless. If you have any other medical condition or take any prescribed medication you should always consult your doctor before taking any herbal remedy.


Dear Dr,
Can you suggest any further reading on the subject?

Dr Bond's reply:
There are many books available including “What your doctor may not tell you about the menopause” by Dr. John R. Lee, “Passage to Power” by Leslie Kenton, “The New Natural Alternatives to HRT” by Marilyn Glanville


June 2003

Dear Dr,
I wonder if you could advise me, I had a total hysterectomy 12yrs ago and was put on estrogen-only patches soon afterwards (50mgms twice weekly) which have kept menopausal symptoms at bay. In Jan' this year I visited one of the practise GPs and asked about coming off HRT before travelling on 4 longhaul flights, she suggested that this would be advisable. I then asked if it would be a good idea to stay off rather than reduce the patches gradually and she replied that I could if I wanted to. I came away feeling poorly informed and unclear about the best course of action and I made a decision based on what she said to come off my patches altogether.

Since mid January I have experienced about 15+ hot flushes a day and a very dry scalp but no other symptoms that I'm aware of. I started taking a food supplement Black Cohesh and Licorice and recently Evening Primrose Oil but with no noticable improvements. I also use soya milk on my cereal each morning.

On reading your fact sheets I realise I would have been better advised to wean myself off my patches gradually as I had originally planned. Now I don't know whether to stay off HRT or go back on reduced amounts, could you offer me any help in coming to a decision?

Dr Bond's reply:
Having read the fact sheets you now know that it would have been easier for you to have come off your HRT slowly. It sound as if you are having a terrible time now and I suggest that you go back on the patches for a while to get rid of the flushes and then reduce them slowly. Ask you GP for a lower dosage patch, such as Estraderm Matrix 25. Use this until the flushes go then reduce your dosage by cutting pieces off your patch until you feel that you can manage without them. You would manage this more easily if you balanced it with Progesterone in the form of a cream. As you reduce the oestrogen dose, you can also supplement your diet with products such as Estroven or Confiance.

Dame Dr. Shirley Bond


Dear Dr,
I am 61 years of age and suffer from vaginal dryness. My doctor has given me an oestriol vaginal cream named Ortho-Gynest. I have been using this for a month and it has helped, but I am becoming increasingly worried using it as my doctor has not mentioned to me using natural progesterone cream to balance the oestriol. Should I ask my doctor to prescribe natural progesterone cream and if so how should I use it in combination with the oestriol cream? I use the oestriol cream twice a week every week.

Dr Bond's reply:

If you are using a cream containing any form of oestrogen for vaginal dryness it should be balanced preferably with natural progesterone to prevent any build up of the lining of the uterus or more generalised problems. The vaginal cream should not be used daily either but just a few times a week. There is also a very good producvt called Phyto-soya vaginal gel made by Arkopharma that can often produce results as good as using oestrogen.

Dame Dr. Shirley Bond


February 2003

The Fact Sheets and Dear Doctor page provided by The Natural Menopause Advice Service have been written with the assistance of Dame Dr. Shirley Bond, a practising GP specialising in women's health, who is medical adviser to NMAS.

Dear Doctor
I am 37 and have been on HRT for a year. At the moment I am feeling very depressed and feel as though I've lost something. I feel frightened and alone. My doctor tested me for early menopause and confirmed that is what I had and then just said I had to go on HRT because of osteoporosis. He did not have time to discuss the medication I would be on nor did he asked me how I felt because I was a bit young to have it. I left the surgery feeling very depressed. My Doctor now wants to put me on anti-depressants but I don't want more chemicals in my body. What can I take that is natural? Please help, I feel so alone with this problem.
Jean

Dear Jean,

37 is very young to have been diagnosed as menopausal. You should consult our fact sheet on the early menopause but I will summarise for you here.

If you had come of the contraceptive pill within six months of the diagnosis being made it could be incorrect. It can take the ovaries several months after stopping the pill before they start ovulating again. If blood test for hormones are taken when you are not ovulating it will show a picture that can be mis-interpreted as menopausal. If this is the case natural progesterone and homeopathic remedies can sometimes help. However you have already been on HRT for year. You say your doctor said this was to prevent osteoporosis but the problem with traditional HRT is that it can only prevent bone breakdown and the effect stops if you stop taking the HRT. As you are only 37 you will need to protect your bones for many more years than it is considered advisable to take HRT. You need therefore to consider building up your bones.

You ask if a more natural method is available. Yes, there are several possibilities. You could wean off your HRT and see whether or not you have any symptoms that suggest you need it. These could be severe hot flushes, night sweats, breast tenderness etc. If you feel well without the HRT then I would recommend that you do not take it. You should supplement with products such as Confiance or Menopace to supply the nutrients you body needs to build hormones. You should have a bone mineral density screening done to see what your bones are like now. If they are healthy then a good bone supplement and exercise would keep them healthy. You should then have them checked again in two years. If your bones are not as good as they should be then you should add some natural progesterone cream to your regime. Progesterone is the hormone that can build up new bone.

If you find that you do need to take some HRT then you could consider taking Hormonin that has the three oestrogens the body makes combined with progesterone in tablet form.

You should consult the fact sheets on early menopause, natural hormones and one on exercise that we shall be adding soon.

Dame Dr. Shirley Bond


January 2003

Dear Doctor
I have just started my menopause. My doctor tells me that I have very low levels of oestrogen but my alternative practitioner says that my problems of bloating, breast tenderness and depression are due to oestrogen dominance. Who is correct and what should I do?
Mary

Dr. Bond replies:

Dear Mary,

They are probably both correct. The term oestrogen dominance relates to the ratio of your oestrogen to your progesterone. Because it relates to a ratio there can be a dominance of oestrogen even when the oestrogen is low because the progesterone is even lower. This is a common situation at or approaching the menopause. The reason for this is that you are no longer ovulating. As a result your ovaries do not make any progesterone and the only progesterone that you have comes from your adrenals. Your ovaries and your fatty tissue both make oestrogen after the menopause and this may be at a higher level than your levels of progesterone can balance.

Certainly the symptoms you describe are usually due to oestrogen dominance. If you wish to confirm this you can always have a saliva test (see fact sheet on Harley Place Screening)

To alleviate your symptoms I suggest that you take some Confiance that contains vitamins and minerals that help the body balance your hormones and will help with the depression. You could also take a supplement containing isoflavones such as Estroven or Phyto-soya. If these do not help it might be necessary to consider using some Natural Progesterone cream (see appropriate fact sheet).

Dame Dr. Shirley Bond


Dear Doctor,
I am approaching the menopause and many of my friends and my doctor tell me I should take HRT to prevent ageing, heart disease and osteoporosis. I feel fit and well and would prefer not to take hormones if I do not need them.
Peggy

Dr. Bond replies:

Dear Peggy,

How fortunate that you are approaching the menopause feeling fit and well. This is how it should be; the menopause is not a disease.

If you do not want to take HRT then there is no need to do so. In fact it is better to avoid HRT if possible although it is sometimes necessary for some people for a time. It is important to remember that HRT does not prevent ageing. Ageing cannot yet be prevented but what can be prevented are many of the problems associated with old age. This is best done by having a good life style, eating wholesome food and a balanced diet, taking supplements if appropriate and exercising. For women wanting an energetic life at this time, a useful supplement is either Pharmaton or Gerimax.

It now seems the claim that HRT prevents heart disease cannot be substantiated and may in fact have the opposite effect. Again the best prevention is diet, life style and regular exercise.

Not everyone gets osteoporosis at the time of the menopause. It can actually occur much younger. To check your personal risk, the best thing to do is to have an osteoporosis bone mineral density screening test either with X-ray or ultra-sound (see fact sheet on osteoporosis). If you are not at risk then you do not need to do anything. If you are at risk then you need advice regarding the correct diet, supplements and exercise.

Dame Dr. Shirley Bond


Dear Doctor,
I am only forty but have been on HRT for over five years. I was started on HRT by my doctor who diagnosed an early menopause when my period did not start three months after I stopped taking the contraceptive pill.
Margaret.

Dr. Bond replies:

Dear Margaret,

What a pity your doctor did not wait a bit longer before making a diagnosis of early menopause. The situation in which you found yourself is not at all uncommon. If one has been on the contraceptive pill for several years the ovaries have been suppressed all that time and it can take them several months to recover. If a blood test is taken at the time when you are waiting for your periods to start, the picture is often that seen in the menopause. This does not necessarily mean that you have started the menopause, it is just that that’s the picture you see when ovulation has not taken place. I find that by being patient, using supplements and, sometimes, natural hormones, the cycle can be restarted. You have now been on HRT for five years so it is unlikely, though not impossible, that your own cycle could be restarted. You would need to find a practitioner who could help you to transfer on to a more natural form of HRT and to then wean off it.

Dame Dr. Shirley Bond


Dear Doctor,
I have a very stressful life much of which I cannot alter. I have been reading that stress in the thirties can affect my hormones and lead to an early or difficult menopause. My doctor does not believe this and says I do not need to worry about it but I do. What do you suggest?
Joan

Dr. Bond replies:

Dear Joan,

In my practice I have come to realise over the years that stress can affect the hormone balance of the body. This can cause problems at the time and in later years. There are several ways in which stress does this.

Stress itself can affect the hormone balance via the hypothalamus. The hypothalamus is an area of the brain that regulates nearly every body function. Emotional response, appetite, hormone balance are among these functions. When one of them is disrupted it affects the others. This is often why when one is under stress, the monthly cycle becomes erratic.

Stress also leads to increased smoking and alcohol consumption and there has been research that shows that both of these lead to a woman having an earlier menopause. Stress is dealt with in the body via the adrenals. When the adrenals are called upon to work overtime, and make more cortisol, they often do this by using up another hormone called progesterone. Progesterone is the hormone secreted by the ovary at ovulation to prepare the body for a pregnancy and to balance oestrogen. The using up of progesterone by the adrenals is one of the causes of infertility when women are stressed.

The best way to deal with stress is obviously to try to reduce it if you can. If you cannot then you should try to find ways to help you body deal with the stress. Often relaxation, yoga or exercise can help. Lead as healthy a life style as you can; avoid smoking, too much alcohol and eat the best you can. Supplements, such as Gerimax or Pharmaton combined with a good, multi-supplement like Confiance to help the hormone balance can also be helpful.

Dame Dr. Shirley Bond


Dear Doctor,
When will I have my menopause and what problems will I have?
Irene.

Dr. Bond replies:

Dear Irene,

It is never possible to tell anyone in advance when they will have their menopause. Strictly speaking the menopause is the date of your last period but we use the term to cover a number of years before during and after that date. The average age for periods to stop is 50 but any time between the age of 45 and 55 is considered normal. The age at which this occurs is often family related. If your mother had a late menopause you are more likely to have a late one.

As to what problems you will have - again this is impossible to predict. Many women go through the menopause without any problems at all. The menopause is not a disease and nature intended us to pass through this stage of our lives without problems.

The best way to ensure that you have a trouble free menopause is to prepare for it in advance. One of the most important things is to have a positive approach and not to consider it as the beginning of the end and the rot setting in. It can be a very positive time for women who are freed from the monthly reproductive cycle and can move on into their wiser years! If you start ensuring that you have a healthy life style, pay attention to your diet, make sure that you take moderate amounts of exercise and learn to deal with stress in such a way that it does not upset your balance you stand a good chance of having an easy menopause. If problems do arise then try to deal with them naturally, do not rush to take hormones or antidepressants unless there is no other way. For many women the menopause can be a very difficult time but equally for others it can be a very fulfilling time with few, if any, problems.

Dame Dr. Shirley Bond


Dear Doctor,
I am experiencing menopausal problems and have been told that they may be due to a lack of vitamins and minerals. How can I know what to take?
Amy

Dr. Bond replies:

Dear Amy

The best thing to do is to have a hair mineral analysis test. This measures the actual level of minerals in your hair. These levels reflect the levels in your body. If you have this done via Harley Place Screening (see fact sheet) you will receive a very detailed report that will not only explain what your levels are but what may have caused any abnormalities and what you should take to correct these abnormalities.

Dame Dr. Shirley Bond


December 2002

Dear Doctor
I have been reading a great deal about how diet can help reduce the risk of breast cancer. Soya products seem to be very important and helpful but I find that I cannot digest them and hate the taste. Is there any other way I can obtain my isoflavones?

Dr. Bond replies:

One of the very best ways of obtaining isoflavones is by taking a specifically designed product. The advantage of obtaining your isoflavones this way rather than from soya food is that you know how much you are getting and it is in a form that the body can use. One capsule of Estroven a day will give you 55mgms of isoflavones. This is approximately the daily amount of isoflavones that would be found in an Japanese diet.


Dear Doctor
I have been diagnosed with breast cancer and would like to obtain as much information as I can on how I can help myself.

Dr. Bond replies:

I suggest that you purchase a copy of a book by Dr John Lee entitled What Your Dr may not Tell you about Breast Cancer. This is book discusses all the approaches to breast cancer and helps you to help yourself. I would also recommend this book as a guide to good breast health for everyone.


The following reply from Dr Sarah Brewer MA, MB, BChir was originally published by Dance Expression in response to a reader enquiry. We thought it relevant and therefore have added it this page.

Dear Doctor
You often recommend supplements. What do you feel about recent headlines saying vitamin pills are a waste of time and money? I've taken a multivitamin and mineral for over a year and certainly feel better as a result with more energy for dancing.

Dr Brewer replies:

These headlines quickly disappeared when journalists realised they had been misled. The comments were based on one trial involving adults aged 40 to 80 years with pre-existing coronary heart disease, arterial disease or diabetes. A short term secondary prevention trial in high risk populations such as these is not an appropriate setting to demonstrate the long-term benefits of antioxidants, and it is not really surprising that the trial failed to show significant differences in complications or mortality within the 5 year study period, although they did show that taking supplements is safe. The sensationalised headlines failed to acknowledge the extensive good-quality trials that have previously supported the benefits of taking multinutrient supplements and antioxidants. In fact, a scientific review that included 152 references was recently published in the Journal of the American Medical Association. An accompanying paper stated that lack of many vitamins is a risk factor for cardiovascular disease, some cancers, neural tube defects, osteopenia, bone fractures and other major chronic diseases. Although diet should always come first, even government surveys show that most people do not get all the vitamins they need from their food alone. The authors of the review actually state that 'Pending strong evidence of effectiveness from randomised trials, it appears prudent for all adults to take vitamin supplements." For those who find this difficult to believe, the reference is: Vitamins for Chronic Disease Prevention in Adults. Clinical applications. Fletcher RH, Fairfield KM, JAMA 2002;287:3127-3129.


Dear Doctor,
I have been taking HRT for about 7 years. I am now 54 and am very concerned about the possible side effects since I read the recent news article about the study in America and I would like to come off the HRT. I am also anxious as to how I would feel if I stopped my HRT because I went on it to get rid of the sweats and flushes and feeling awful.

Dr. Bond replies:

The first thing you should do is talk to your doctor and discuss the possibility of coming off HRT. You do not say what form of HRT you are on and it may be that what you are on is very different from the HRT on which the study was done.

However there are increased risks of breast cancer if you stay on HRT for more than 5 years and certainly more than 10. There is also evidence that HRT does not protect against many of things claimed for it in the past such as strokes, heart attacks and Alzheimers. It would help you to prepare for the discussion with your doctor if you looked at our fact sheets on HRT and coming off HRT.

Dame Dr. Shirley Bond


Dear Doctor,
I was very concerned when I read the recent reports on HRT. I have been told that the form of HRT they were doing these trials on is not prescribed in the UK. Is this correct ?

Dr Bond replies:

The form of HRT that was used for the study in the US was PremPro. This is a mixture of conjugated oestrogens obtained from the urine of pregnant mares and a chemical medroxyprogesterone. The conjugated oestrogens and the medroxyprogesterone are taken in a continuous, combined way and the woman should not have any bleeding.

In the UK we have two very similar products. One is called Premique and the other Premique Conti. These contain the same substances as PremPro. The difference is that PremPro has 2.5 mgms of medroxyprogesterone per daily dose and Premique has 5mgm. The Premique Cycle has 10 mgm of medroxyprogesterone but it is only taken for 14 days each cycle.

In view of the fact that most concern seems to be about the medroxyprogesterone I would advise women on Premique or Premique Conti to either come off HRT or change to another brand with the help of their doctor.

Dame Dr. Shirley Bond


Dear Doctor,
I am no longer taking HRT. I stopped it about 5 years ago when I was 55 but I had been taking it for about 12 years. I am very anxious that I might have put myself at increased risk of various health problems as reported in the recent study.

Dr. Bond replies:

The fact that you did not have any problems while you were on the HRT and have not had any since would suggest that you have not increased your risk of any problems. There are studies that show that women who stop HRT are at no greater risk of breast cancer and other problems when they have stopped HRT for 5 years than they would have been if they had never taken it.

One health problem that should be checked for in women who have been on and then come off HRT is osteoporosis. This is because while you are on HRT bone breakdown is virtually stopped by the oestrogen and there is no stimulus from HRT to build up bone. This action of oestrogen only works while you are taking it. When you stop the HRT the old bone comes away and you could be at risk. However if you have a screening you will be able to see whether this is the case for you or not. If there seems to be a problem then there are many things you can do to build up bone without using HRT.

Check our fact sheets on Osteoporosis and Screening for Osteoporosis.

Dame Dr. Shirley Bond.

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