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HRT has been seen as a universal panacea, a solution to all menopausal problems from osteoporosis to ageing skin. It has been pushed by the media and is supposed to give us the energy of a spring chicken and the libido of a teenager. The principle behind HRT is that it supplies us with hormones when our own production slows down. Thus we can avoid the hot flushes, the night sweats and many of the other ‘symptoms’ of the menopause with the medical equivalent of one-stop shopping. Dr Ellen Grant, who wrote The Bitter Pill, suggests that HRT, which delivers a constant level of oestrogen, is like having a car stuck in a single gear. Surely it is better to let our own pituitary gland and ovaries work together to make fine adjustments constantly for our hormone needs at each moment, like a car with automatic gears? Given optimum health, our hormones are able to balance themselves. Our bodies are able to make the judgment on whether we have too much of one hormone, or need to produce more of another: just like a central heating thermostat, which will switch on the boiler if the room temperature drops and turn it off again when the room heats up.

Oestrogen therapy has been around since the 1930s when injections of oestrogen were given for menopausal symptoms. Because of the inconvenience of this form of treatment, implant pellets of oestrogen were introduced in 1938. HRT was originally called Oestrogen Replacement Therapy because only oestrogen was given as the treatment. However, it became clear that giving oestrogen alone could increase the risk of cancer of the womb and breasts. When research studies appeared to demonstrate that this increased risk could be up to seven times higher for womb cancer, there was panic. Oestrogen therapy declined sharply in popularity. Then progestogen, the synthetic version of progesterone, was added to the therapy for ten to fourteen days each month and HRT, using both hormone drugs, was re-marketed. Since then there seems to be no end to what HRT can do for us. There is always something new. Over the last year, I have seen newspaper reports that HRT might help patients with ME, inflammatory bowel disease, post-natal depression, pre-menstrual migraine – and prevent Alzheimer’s disease. An opera singer found that it had a wonderful effect on her voice. Most of us are much more interested in just what the risks of HRT really are. The main reasons for the addition of progestogen to HRT are to protect the womb lining from over-stimulation and subsequent cancer, and to cause a regular bleed. Women who have had a hysterectomy obviously cannot get womb cancer so they are not given progestogen.

It is important to make clear the difference between progesterone (our own naturally occurring hormone) and progestogen (the synthetic hormone in the Pill and HRT). Many people, even doctors, treat them as the same thing and they are not. Progesterone is made just prior to ovulation by the corpus luteum and is the major female hormone for the second half of the menstrual cycle. It is absolutely necessary to maintain a pregnancy. As progesterone raises at ovulation our body temperature rises ready to ‘incubate’ the fertilized egg. If we are pregnant, progesterone continues to rise. If we are not pregnant, both oestrogen and progesterone levels fall and we have a period. If a woman does not produce sufficient progesterone when the egg is fertilized, she can miscarry.

Progestogens, on the other hand, are synthetic. Though they are able to fulfill many of progesterone’s functions, the human body has difficulty ‘recognizing’ and coping with progestogens because they are not natural, hence the well-known side effects such as mood swings, depression, etc. These synthetic progestogens are used for their progesterone-like action but they can have additional male or female hormone effects. So one type of progestogen may cause enlargement of the breasts, while another can increase the growth of facial hair. All somewhat alarming.

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“Amino acids” are a buzz-word today. We buy amino acid shampoos and hair conditioners, amino acid skin lotions, even amino acid cosmetics. Unfortunately, most of this is pure sales hype; few people really understand how these amino acids affect our health and weight.

In the first place, they aren’t even what you think of as acids. They don’t sting or eat into your skin, and they’re not corrosive. You can swallow them without burning your throat. Their name comes from the fact that they belong to the chemical family of acids.

Amino acids are the building blocks of your body. You get them from the protein you eat, which is made up of combinations of different amino acids. Your body breaks protein down into its amino acid building blocks, then uses those blocks in various combinations to make your hair, fingernails, muscles, cells, tissues, and chemicals. In all, there are twenty-two different amino acids your body needs.

When I was explaining this to one of my patients, a sculptor and artist, her face lit up. “I get it, it’s simple. They’re just like the color chips of a mosaic. Each color is different, with its own identity and characteristics, but they all fit together to make the whole thing work!” I had to admit, after years of reading learned papers on the subject, that’s still the best explanation I’ve ever heard.

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Planning the diet means more than just including certain foods in the daily menu. There are many other factors that can influence the digestion, and these must be carefully considered before we get down to the selection of food. Among other things we have to think about overeating, eating too rapidly, eating when tired and taking food into the stomach when the digestion of a previous meal is still going on. When we are analyzing our daily habits these things are worth thinking about. It is not a matter of following rules like a rule of thumb; it is better to inculcate them into the general way of life.

We should have three mealtimes a day because this gives the stomach time to finish its processes. To eat between meals is plain folly like trying to do one job before the other is finished. This is often a mental rather than a physical habit, and certainly is not the call of hunger. Eating when tired is a bad habit, and is asking for trouble. Such a thing may set up indigestion that will hang on for many months unless it is carefully handled. Over-eating is not the bad habit today that it was many years ago. Still, it does exist, and must be eradicated as a habit that undermines the health of the system.

Rushing over a meal will often lead to trouble and is a matter of temperament more than anything else. Persons who practice this habit feel deep down in their consciousness that eating is not important and they begrudge the time that is given to it. This’ is a habit that has usually developed in early life and will take a good deal of patience to eradicate. But it must be overcome. Taking food quickly into the stomach without thoroughly chewing it and tasting is an act of sheer vandalism. Nature has added her exquisite flavours and aromas to foods to tempt the taste and smell so that they should be enjoyed leisurely and deliberately.

It is just as important, therefore, that we bear these points in mind as it is to get the proper food into the diet.   If we are out of temper with the world and ourselves and rush our meals, the digestion is bound to suffer; and no matter how pure and suitable the food may be, a stomach that is upset will fail to make good use of it. Before any kind of food can be digested and assimilated the alimentary tract must be in the condition to accomplish it, so that point precedes the regulation of the diet.

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