I’m not sure what to do for the best? Herbal supplements vs HRT

[JMAngel1]

I’m 48 and have been peri-menopausal for approx 18 months now.
Main symptoms which I have controlled with the following supplements are as follows:
Anxiety and confusion - Ashwagandha
Jaw acne - DIM supplement (reduces oestrogen dominance)
Hot flushes at night. - DIM supplement and Sage
Energy - Korean Ginseng ( amazing stuff to be fair)

So my main concern now is reduced libido and vaginal dryness. I’ve started putting an Evening Primrose oil capsule in my vagina daily and this is helping dryness somewhat but not libido.

Do I need a topical progesterone cream like Serenity?
Do I just throw the towel in and go on topical oestrogen and progesterone via medics?
I had always thought that menopause was a natural stage of life that we shouldn’t interfere with chemically but now I’m here I feel differently
My worries are am I at increased cardiovascular risk by not being on HRT given that I’m under 50?
Also am I increasing my risk of vaginal atrophy and prolapse and infection given that I already have dryness?
Both my parents have had MIs in their 70s, no history breast cancer or stoke in family.
My last period was January.
Sorry loads of questions, but there’s some extremely knowledgeable MNers on here.

Jaw acne - DIM supplement (reduces oestrogen dominance Where has the idea of estrogen dominance come from? In peri your estrogen falls away. it doesn't 'dominate'.

Do I need a topical progesterone cream like Serenity?
No because it doesn't work. It's a scam. The strength is so weak it is useless and can't be absorbed enough to do anything.

Do I just throw the towel in and go on topical oestrogen and progesterone via medics?

Not sure why it's case of throwing in the towel. Would you say the same about prescribed treatment for anything else? eg headaches?If, after reading all the pros and cons, you want to!

I had always thought that menopause was a natural stage of life that we shouldn’t interfere with chemically but now I’m here I feel differently

All the alternative stuff you are using is made from chemicals. Everything that exists is made from chemicals :) Modern HRT is made from yams.

My worries are am I at increased cardiovascular risk by not being on HRT given that I’m under 50?

No because you are not yet post menopause- just peri. Cardio vascular risks apply to younger women who are post meno.

Also am I increasing my risk of vaginal atrophy and prolapse and infection given that I already have dryness?

Possibly. VA gets worse and it can get to a point where it's harder to turn back the clock if ignored for years. Can't see the point of sticking oil in your vagina when in fact any old oil would do! It doesn't reverse loss of estrogen there.

Both my parents have had MIs in their 70s, no history breast cancer or stoke in family.

what's an MI? some sort of heart disease?

Thanks Jingling

The oestrogen dominance is a theory that even though overall oestrogen plummets, progesterone also falls and this causes an overall oestrogen dominance. The DIM absolutely has cured my jaw acne and definitely helped with night flushes.

So Serenity is a waste of time. Ok. So which topical progesterone cream should I ask my GP for - will they prescribe progesterone without oestrogen? Or could I have a topical skin progesterone cream and intravaginal oestrogen together?

Yes I appreciate I’m taking a lot of chemicals already - I suppose so mean Prescription only drugs.

An MI is a myocardial infarction - heart attack.

So am I wasting my time tinkering with supplements and I should just get on the Prescription HRT?

The oestrogen dominance is a theory that even though overall oestrogen plummets, progesterone also falls and this causes an overall oestrogen dominance.

That's pseudo science and has been debunked a million times :)
The theory was started by a Dr John Lee who wanted to sell Serenity on the basis of estrogen dominance.

If the theory worked, women would not get better on estrogen HRT. The progesterone part is only given to protect the womb lining- there is no need for it otherwise, at all.

There is no topical progesterone cream in existence that works as part of HRT. It's just not made.

The option is a capsule, as natural progesterone , swallowed or used vaginally (off label in UK but recommended that way by meno experts) or other forms like the Mirena and other types of progesterone.

I think it's your choice what you choose to do. HRT has mainly benefits and a very small risk which doesn't kick in anyway till 51-ish age of menopause. before then you are just replacing what you ought to have.

You can use Ovestin or Vagifem estrogen treatment for the dryness- that's all you would need for that.

@JinglingHellsBells
Thanks very much - I feel a lot less confused now.
I'll try and see my GP (hah!) and take it from there.

@jinglinghellsbells - you really know your stuff. I have read numerous books (including "Estrogen Matters" by Dr Avrum Bluming and "The Estrogen Fix" by Dr Mache Seibel, as well as "Menopause: Your Management, Your Way" by Dr. Barbara Taylor). I just received "Menopause" by Dr. Louise Newson.

I think your doctors are more advanced in the thinking about HRT/menopause than doctors here in Canada.

Anyways, bravo to you for the excellent and sound advice you are providing to women on this board.

Assuming your BP is good, and you don’t have any contraindications, the modern thought around oestrogen is that it has protective benefits for the cardiovascular system, which has a follow-up effect on brain health. Studies have shown it may prevent Alzheimer’s Disease as well as minimize stroke risk and improve bone health - BUT the kicker is that it is best not to wait for menopause, but to start during perimenopause. When you look in the boards here, it seems a lot of GPs seem stuck in the old school and are reluctant to jump in.

Hi!

I have a lot of health problems but am going through the menopause and really need help with what the different hormones do and what to take. I’ve put on more weight, feel anxious and depressed. No sex drive. Some hot flushes every now and again. I have osteoporosis and my bones are easy to break.

Thank you 😊

@Cathh39 If you already have a diagnosis of osteoporosis are you not under the care of a specialist? What treatment are you having for that?

You probably ought to be using hrt anyway for that as well as all the other symptoms- it's a bit of a no brainer really.

Have you been referred to a specialist for advice and treatment?

Hi!

The Drs practice where I live is bad so I’m not having any treatments or seeing and specialists about it. What specialists should I be seeing?

Thank you 😊

@Cathh39 so how did you come to be diagnosed with osteoporosis?

How long ago was that and how old are you now?

Osteoporosis needs treatment.

Whoever told you that you had it, and you are always breaking bones, should treat you- either your GP or they must refer you to a specialist who will treat you.

I find it hard to understand how you have osteo at a young age and no one is giving you treatment.

what's gone wrong someone along the line?

You need to see a rheumatologist- a bone specialist.

That's pseudo science and has been debunked a million times
Gosh you are annoying with your 'I know better than everyone else' attitude.

Oestrogen dominance is very real for SOME women. In my case, it was the sudden surges of oestrogen that made me very poorly. This why I actually started feeling much better after the actual menopause despite still having the occasional surge. This was especially notable as I would experience the characteristic egg white discharge, a lot of, triggered by oestrogen that normally indicates ovulation is near. This is why hrt made me feel much worse during peri.

The menopause presents itself differently for different women. Yes, most experience a steady drop of Oestrogen during the peri stage but not all. Your own experience doesn't represent every woman!

Interestingly OP, I too had the jaw acne at my worse, still very occasionally now in full menopause but didn't link it to oestrogen surges.

@dontdisturbmenow And you seem determined to be rude to me.Is there any need to be nasty when you have a different opinion?

I am a health writer and write for national publications and websites including Patient. I do masses of research which includes talking to consultants on menopause.

I give back a bit here, and what I post is as factually correct as possible.

If you search for estogen-dominance you should be able to find how it's been debunked as a myth, put out by Dr J Lee a US dr who sold cream progesterone as a remedy for it.

Where has the idea of estrogen dominance come from? In peri your estrogen falls away. it doesn't 'dominate'

That's pseudo science and has been debunked a million times

Don't you think these statements were patronising and condescending?

You have very firm views on the menopause and hrt. Without a doubt you are an amazing source of wisdom and knowledge on hrt, but you have a very fixed view of what the menopause is all about and struggle to appreciate that not everyone's menopause is textbook and alike your own.
If you search for estogen-dominance you should be able to find how it's been debunked as a myth, put out by Dr J Lee a US dr who sold cream progesterone as a remedy for it
It hasn't been debunked as a myth. Some experts do not agree with it, which is fine, others very much believe in it. Quoting one person, whose research was indeed a bit dubious, doesn't discredit a medical viee believed by other professionals.

When I suggested it to my GP, he had the same attitude than you. That's not how the menopause worked. When I finally discussed my experience with my gynae who specialises in the menopause, she said that from her experience, seeing a lot of women who had got nowhere with hrt and who experienced less usual symptoms, it was very much a thing and indeed, I'm far from the only one who found the transition from peri to menopause a massive relief.

I react strongly because of my experience dealing with a go who was so one dimentional, who thought that hrt was the answer to everything and refused to accept that the menopause wasn't an illness like the flu which presented with its specific symptoms and for which only one treatment could resolve. It's very frustrating dealing with people like that who can't see that what works best for one can be the worse advice for another.

I’m on HRT and my sex drive has died a death. Apparently testosterone can bring it back.

If you just wanted to improve your dryness without going full-on HRT, you can get oestrogen pessaries or vaginal oestrogen creams that help to juice up your bits and protect their health/flexibility, but with just a very low dose of oestrogen.

@dontdisturbmenow I really don't think there is much point us having a discussion on this. But all I will say is....

FWIW I am not as 'pro' HRT as you try to make out. My own consultant is very much into alternative options as well as HRT so it's not as if I am not aware of those.

I pop along here to give information which is in line with what menopause experts are saying- it's not my opinion however much you try to force that point. Most of the time I post it's to correct misinformation given to posters by their GPs, or in the media which is outdated.

I don't think my comment was patronising because too many women have wasted a huge amount of money on such products as progesterone cream, following the Dr J Lee 'theory'.

If you study the actual biology of the menstrual cycle, it's unclear (at best) how estrogen can 'dominate'. Estrogen is produced in the first half a cycle then disappears after ovulation when progesterone kicks in. It doesn't keep rising each month when ovulation doesn't occur.

Ok, HRT didn't suit you- that's fine. Maybe it was the wrong brand, the wrong sort, OR as you were still in peri, you just didn't actually need it!

And please, cut out the rude personal comments. I've not made any against you and have always tried to stick to factual replies rather than personal abuse.

FWIW, I appreciate your advice and opinion on these matters @JinglingHellsBells. I have read and watched literally hundreds of books and videos on YouTube (has everyone heard of Dr Barbie Taylor "Menopause Taylor" on YouTube??). Your advice is in-line with what she and other menopause specialists are saying.

I do think @jinglinghellsbells is giving you very good advice. I don't know either of you (hello from Canada!) but from everything I have read, it's spot-on.

PS That previous message is for @dontdisturbmenow (sorry - I'm a newbie on mumsnet and still learning how to use it!).

I've denied that you give excellent advice Jungle, indeed in line with what most experts say.

The issue is that not everyone fit the typical menopausal woman, who struggles with the drop in oestrogen, and the standard symptoms of anxiety, depression, lose of libido, vaginal atrophy and hot flushes.

As matter of fact, I suffer and have suffered very little from these, my symptoms were very different.

Oestrogen is secreted by other glands than the ovaries, at much smaller quantities...for most.

It's you refusal to accept that there are some women whose experience of the menopause is not standard that is frustrating just as it is with the professional bodies who discuss the menopause as if they are rehearsing text books.

I'm so glad I finally met with my gynae who said that indeed, some women did experience issues not with oestrogen dominance but surges. This comes with symptoms that are not atypical as in my case.

And no, it's not because I was on the wrong dose that hrt didn't work for me. The time I felt the best in years were the 3 weeks after I came off it 4 months later.

Just as much as I respect your expertise and knowledge of the standard experience of the menopause, it would be great if you could respect that for some women, their experience is different. In my case, there is no doubt that it was oestrogen surges that made me so unwell.

@dontdisturbmenow Is your menopause specialist on the BMS website as approved meno specialists?

From what you say you have found ONE dr who agrees your symptoms were caused by 'surges' which is not the same as 'estrogen dominance'. She appears to have said you don't fit the typical picture for peri meno but I'm not sure if she is saying estrogen dominance exists, or if that is your own label for what you felt.

When the ovaries give their last gasp and push out the last few eggs, there is a rise in FSH level but that is not the same as an estrogen surge.

Many many women have been duped into buying Serenity cream and similar types for estrogen dominance, a term that began in the US decades ago by a dr who is no longer alive.

Most of the sites promoting this theory are commercial sites selling the product.

@dontdisturbmenow - Please also be aware that you need to be on a specific dosage of estrogen to help with bone, heart and brain health. Dr Taylor (Menopause Taylor on YouTube) has hundreds of videos about menopause, and she has several specific to dosage of estrogen. You may wish to take a look at them.

@JinglingHellsBells I'm not going to justify my decisions to you.

You mention Serenity cream that has absolutely nothing to do with me. I've never considered it and have no interest in it whatsoever. The bottom line in my case is that hrt not only didn't work but made me feel worse, end of. There are no buts about it. It does suit everyone.

@ChocolateTruffleCake, I had a private dexa scan and my results were excellent. I walk on average 16k steps a day and run 10k every week. No history of low bone density in my family. As for my heart, it couldn't be healthier. I have very low blood pressure and resting heart rate. I don't drink, don't smoke and eat healthily, so have no concerns about these thankfully.

@dontdisturbmenow - glad to hear that.

@dontdisturbmenow
Yet your posts are entirely about justifying your decisions (and criticising my posts.)

It's perfectly reasonable to ask if the dr who said something about your estrogen 'surges' with your opinion/ is a member of the British Menopause Association menopause approved specialists.

You mentioned estrogen dominance.

You mention Serenity Cream that has absolutely nothing to do with me. I've never considered it and have no interest in it whatsoever

Maybe not. But millions of women have tried Serenity based on the idea of estrogen dominance. Because every website pushing estrogen dominance is also a site selling progesterone creams.

So if you come along saying you had that and HRT didn't help, what do you think they might buy?

This thread has come a long way from the OP asking if HRT or herbs were right for her. This discussion you started doesn't add much to that.