News last week that hormone replacement therapy (HRT) may cause ovarian cancer has met with mixed reactions, but the nutraceuticals industry has seen it as an opportunity to promote the benefit of natural isoflavones as an alternative treatment for menopausal symptoms.
A study published in the Journal of the American Medical Association earlier this month claims that women receiving one kind of HRT - a combination of oestrogen and progesterone - have a high risk of contracting ovarian cancer. Women receiving the oestrogen/progesterone combination were also found to be at higher risk for coronary heart disease (CHD) and blood clots, the report said.
The researchers from the Women's Health Initiative (WHI), a multinational study set up to investigate the effects of HRT on postmenopausal women, decided that the risks associated with the treatment outweighed the benefits (such as a lower risk of colorectal cancer or bone fractures) and called an end to the research, just five years into the eight-and-a-half year study.
The combined HRT is given only to women who still have a uterus, since oestrogen-only treatment (ERT) is known to increase the risk of cancer of the endometrium (the lining of the uterus). ERT is still given to many women who have had a hysterectomy, and a separate WHI study is currently being carried out to test the long-term effects of this treatment. The results are expected in 2005.
Some 16,000 healthy post-menopausal women took part in the WHI, some taking HRT and others a simple placebo. Researchers discovered that while the rate of colorectal cancer was 37 per cent lower in the HRT group and the rate of bone fractures was 24 per cent lower, the rate of breast cancers was 26 per cent higher, heart disease was 29 per cent higher and stroke rates were 41 per cent higher. Blood clot rates were more than twice as high in those getting HRT.
While the risks to individual women are still very small, the researchers stressed, they nonetheless recommend that clinicians stop prescribing HRT to their patients for long term use (its short terms benefits on symptoms such as hot flushes are still be studied in depth).
Many alternative products
But this does not mean that menopausal women are being left to suffer - far from it. There has always been a wide range of 'natural' alternatives to HRT for women to use, and the recommendation against the long term use of the treatment is likely to lead to an increase in their popularity.
Soy-based products are among the most popular natural menopause treatments, as they contain phytoestrogens which can mimic the effects of HRT without the side effects. Soy is by no means the only natural source of isoflavones, however -chick peas and other legumes, as well as red clover are also good sources - but it is the plant with the highest concentration of phytoestrogens.
Among the products available on the market are Estroven from Amerifit Nutrition, which claims to be the leading herbal supplement product in the US, SoySlim from the company of the same name, SoyLife from Dutch group Acatris and Novasoy from ADM, as well any number of isoflavone supplements or soy-based foods such as soy milk, soy burgers, nutritional bars containing soy protein and tofu.
"Estroven is made with natural isoflavones from soy and other plants, and a unique combination of herbs, which work with the body to balance hormones gently and naturally," said Craig Larsen, director of research and development for Amerifit Nutrition. "Estroven also contains essential nutrients like calcium, folic acid and B-vitamins to form a complete hormonal support formula."
Larsen said that millions of women across the US alone have already turned to Estroven , a clear indication that HRT was already seen as only one of a number of options to help treat menopausal symptoms, and that sales were expected to grow further as a result of the JAMA article
The Emerita Women's Institute in the US has suggested that women use natural progesterone cream (such as its Pro-Gest brand) or phytoestrogen herbs such as red clover, black cohosh or liquorish. Emerita's director Dr Deborah Moskowitz said it was important for women to be aware of the difference between progestin, the synthetic hormone used in HRT, and natural progesterone, a molecule identical to the progesterone molecule that the body makes.
Hormone treatment not all bad
But the results of the WHI study do not necessarily mean the end of hormone therapy, according to Marla Ahlgrimm, founder and CEO of Women's Health America, and organisation which specialises in providing advice about the menopause.
"Women need to understand is that the study just halted was about a single synthetic drug, Prempro," said Ahlgrimm. "The 8,000 women in the study took only Prempro, at a standardised, one-size-fits-all dosage." The WHI study did not investigate other hormone options for women, such as natural hormone replacement therapy, Ahlgrimm added. "The study also did not examine individualised dosing, where hormone dosages are tailored to a woman's specific requirements."
She continued: "Women's Health America has long recognised that one-size-fits-all dosages of synthetic hormones like Prempro produce unfavourable side effects and potentially adverse health outcomes." In contrast, Ahlgrimm said, millions of women use natural hormone replacement therapy safely and effectively, with no evidence of the same potential ill effects associated with synthetic hormone replacement.
"Natural hormones are medications that are chemically identical to the hormones naturally produced by your body. These are medications, not over-the-counter products like soy or black cohosh," she said. Natural hormones have exactly the same structure as the hormones the body produces; but synthetic hormones such as Prempro used in the halted WHI trial have a similar structure, but are not identical to the body's hormones.
So, while many women will have been devastated to hear the news about the risks of HRT, they will not have to look too far to find any number of viable alternatives.