Post Reproductive Health

To estimate the extent of use of over the counter food supplements in women attending menopause clinics in the West Midlands

Questionnaire survey of women attending menopause clinics in Solihull Hospital, Birmingham Heartlands Hospital, Rugby and Walsgrave Hospitals and Birmingham Women's Hospital.

Type and rate of use of food supplements in hormone replacement therapy (HRT)users and nonusers and perceived benefits.

Three hundred and forty women completed the questionnaire. 95% (n = 326) belonged to the white European ethnic group. The median age was 53 years, with 50% (n = 170) in the 50–59 years age group, and 30 % (n = 95) in the age range 40–49 years. Overall use of over the counter supplements in the clinic was 43% (n = 147), with Oil of Evening Primrose (53%) and vitamins (44%) being the most commonly used preparations. 71% (n = 242) women were users of conventional HRT. Of these, 46% were also using food supplements. The use of food supplements was higher amongst HRT users (46%) as compared to non-HRT users (32%). The use was similar between smokers and non-smokers. The most commonly perceived benefit was a feeling of well-being, 39% (n = 58/147). The proportionate use was highest in social class I and class II (51% and 54% respectively), in keeping with amount of disposable income. Friends (27%), the internet (26%) and magazines (20%) were the most commonly quoted sources of information. 79% (n = 116/147) were spending up to £10 each month on alternative remedies. 10% (n = 14/147) of women were visiting practitioners of alternative remedies.

The use of food supplements is widespread and particularly in those already taking conventional HRT. This study was not designed to test confidence in orthodox medicine, but the prevalence of use of supplements amongst menopausal women attending menopause clinics. The most commonly perceived benefit is a feeling of well-being, but users of food supplements are unsure of any additional benefit when supplements are taken in conjunction with conventional therapy. There is a misapprehension that “herbal” or “natural” equals safe. In addition, the correlation between supplement use and side effects is very seldom made, as these compounds are mistakenly considered almost universally safe, and physicians often fail to enquire about their use in routine history taking.

To investigate in vitro the influence of the three most used progestogens in continuous combined HRT on cell proliferation of the human breast cancer cell line MCF-7.

Progesterone (P), medroxyprogesterone acetate (MPA) and norethisterone (NET) were investigated in the range of 0.01 nM to 10 μM alone and in combination with 10 nM oestradiol. Cell proliferation was measured after seven days using the ATP-chemosensitivity test.

P alone reduced cell proliferation by 20 and 40% at 10⁻⁷ and 10⁻⁵ M. MPA and NET displayed a significant inhibition of cell proliferation between 20 and 25% for MPA and 23 and 41% for NET over the whole concentration range tested. The effect was greatest at 10⁻⁷ M for MPA and at 10⁻⁹ M for NET. In combination with oestradiol, P still significantly reduced cell proliferation, the values being between 12 and 61%. For MPA too an inhibitory effect between 20 and 40% was found, whereas for NET the values were between 23 and 38%.

Our in vitro results indicate that the influence on breast cancer risk using HRT in postmenopausal women may depend on the type of progestogen used as well as on the regimen applied. However, the inhibitory in vitro net effect of the progestogens at clinically relevant dosages is rather minimal and it remains uncertain as to whether progestogens generally may reduce breast cancer risk in long-term treatment. Further clinical trials are urgently required to determine the appropriate choice - if any - of progestogen to complement HRT.