Plant based oestrogen

[SurlejTiger]

Does anyone take this? I went to the doctors nearly 2 years ago now with peri symptoms. Fobbed off and told to come back after the summer if I still had symptoms. Huge fuss over having a blood test (issues with the surgery not understanding I didn't have a cycle as such as I'm on the mini pill). Told all was normal. At check up in May this year, told I could start natural oestrogen if I still felt I wanted to in October. Called back, need a blood test. Tell them they've done it, don't have a cycle etc etc.

Doctor has called back to apologise, forgotten he'd already ordered bloods, forgotten I was on the pill, says my levels are normal, don't need HRT. But if I still want to try something then I can try a plant based oestrogen.

Has anyone experience of this or is this just a homeopathic HRT to shut me up? Studies seem inconclusive/non existent/behind a pay wall.

Hormone levels can be normal as they fluctuate during the day. The GP should be going by your symptoms.

Body identical HRT is plant based and recommended by NICE, it has the same molecular structure as the hormones your body produces.

I've been told to take a 6.5mg black cohosh root extract tablet for min. 3 months and see what happens.

So what you are saying is your GP has refused you HRT based on a blood test and suggested you use a herb ?

(It's not a homeopathy treatment, it's a herb you can buy in health shops and supermarkets etc.)

I'd suggest you go back and say what you want - if it's HRT.

Blood tests are not reliable and if you are having symptoms, then ask for HRT. They are also LESS reliable if you are using hormonal birth control.

You GP has to give you a sound medical reason why HRT would be unsafe for you as really, it's your choice, not theirs, if you have no medical contraindications.

He said I'm too young and the bloods show a normal level for oestrogen and thyroid and I should try this. I've been reading about it and honestly I'd far rather have a proper drug than an inconclusively trialled herb 😂

How old are you? Just wondering!

41

How old are you?

This is from the British Menopause Society

[[https://thebms.org.uk/2015/09/treating-hot-flushes-without-hormones-what-works-what-doesnt/

Studies on over-the-counter and herbal therapies (such as black cohosh, dong quai, evening primrose, flaxseed, maca, omega-3s, pollen extract, and vitamins), relaxation, calibration of neural oscillations (a brain-training technique), and chiropractic intervention show that these therapies are unlikely to help, so the panel advises providers not to recommend them at this time. The panel also advises providers not to recommend stay-cool techniques and avoiding hot flush “triggers” at this time. These approaches are risk-free but don’t have studies testing their effectiveness, and sticking with these can just delay appropriate and effective treatment*

Many women start peri at 41.

You need to see another GP who is more open minded.

It's illogical to suggest you try a herbal alternative to HRT, at the same time as telling you that you are too young to be peri-menopausal. 🤔

Most women are prescribed HRT that is plant based, anyway! It's formulated from yams. Perhaps the GP is still thinking along the lines of mares's urine, which isn't prescribed very often in the UK now.

Well your GP is talking bollocks. I would see another one. Have you looked at the NICE guidelines or listened to Dr Louise Newson’s podcasts? They’re useful for gaining information before hand.

Not sure what your dr means by a 'plant based estrogen' when in the next breath they suggest black cohosh. Are they saying that black cohosh is an estrogen???

(it's not)

Yes, it's certainly what he implied. My faith in this doctor has just gone down. A lot. He didn't even say it was a substitute or a herbal alternative he definitely sold it to me as a plant based oestrogen. I read that it can interact with an oestrogen receptor but the review I read basically said it has the same effect as a placebo.

Is he actually a doctor, I wonder?

Seriously, he sounds slightly deranged.

Many herbal 'remedies' have some estrogenic activity, but none stand up in the trials that have been done (see the extract I left from the BMS.) Their effects are mainly placebo and black cohosh is linked to possible liver issues (in some women) if used long term.

If he is in favour of plant based treatment, he ought to prescribe body identical estrogen that is made from yams.

Maybe he isn't aware of this?

He is, well I certainly hope so as he's a gynae whose operated on me a couple of times! I have been doing some guideline searching for where I live. There are two relevant ones and on the non hormonal therapy one specifies a trial in which this extract did significantly reduce symptoms over a placebo. They don't provide references, but I have requested them. The same Dr who wrote the guidelines has an article on her website, however the paragraph citing a study on black cohosh has no references, every other claim she has backed up with a reference. Neither does she give a reference in a PowerPoint summary she has online, there she states that prescribing for meno symptoms is an "off-label use". Oh and she declares a conflict of interest in that she gets research grant from the company which is licensed to sell it.
Can PM you the details if you want, will be interested to see if they respond with the list of references. Haven't cashed in my prescription yet. Still not sure I want to try it out. I'd rather have something that's proven to work and has been tested long term!

There have been quite a number of trials @SurlejTiger on herbal products, over many years.

Usually, the number of women on the trial is small and the trials don't run for long. (Maybe a few months.)

This makes it very hard to be confident that it's not simply the placebo effect.

That's why the BMS consensus statements are helpful- they have looked at all of the evidence.

ALL drugs- even the most prescribed ones- have a placebo effect of 40%.

Your dr must be quite high profile if she is writing a guideline for a herbal product. But as you say, a recommendation without a link to the trial is pointless.

Black cohosh has been around as an option for decades. But it is linked to liver inflammation, used long term. I don't get why it's on prescription when it can be bought at health food shops etc.

It may help with hot flushes, but it's not going to help with bone density and heart disease prevention. If it was that powerful, it would (presumably) come with all the same risks as estrogen HRT !

Be interested to see the links and evidence you have found.

Drewe J, Bucher KA, Zahner C. A systematic review of non-hormonal treatments of vasomotor symptoms in climacteric and cancer patients. Springerplus. 2015;4:65.

I've had a response to my request for references. This is the paper they referred to for that part, haven't read it yet!

@SurlejTiger I've had a quick look at the link.
Two points:

1 It's not actually research, it's a compilation of all other research some of which is very old.

2 The authors refer all the time to previous research into HRT which has now been discredited and flawed. (WHI and MW studies.) These over-estimated the breast cancer risk, and are now no longer considered valid research.

The authors of this paper seem to be comparing all alternatives to HRT with those (to prove their point.)

They also say this

Several non-hormonal alternatives to hormonal therapy have been established and confirmed for the treatment of vasomotor climacteric symptoms in peri- and post-menopausal women. Although there are indications that these treatments are useful in patients with a history of breast cancer, this still requires confirmation by larger clinical trials.

This systematic analysis did not carry out any of its own clinical research involving patients and the statements relating to the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments thus do not apply.