I'm 38 years old and I'm having a total hysterectomy next Friday due to severe endometriosis (previously had excision via lap 18 months ago). This means I will go into premature menopause. I've been given the option of HRT patches until I'm 50, but I want to explore natural alternatives to any symptoms I'll experience. I am a therapist so I'm very open to natural remedies/herbs/nutrition etc. What do you recommend?

I can understand your wish to use natural remedies where possible, but unfortunately a total hysterectomy is not something that lends itself to natural treatment because oestrogen levels plunge dramatically overnight.

I am also a practitioner and always use natural treatments where possible, but quite frankly this is one situation where I would say HRT is a sensible option - and you don't hear me saying that without considerable experience.

Endometriosis involves high oestrogen levels, as you'll know, so the change from all to nothing would be very severe. 

If you want to minimise your time on HRT you can ensure that your adrenal health is good (once you're over the stress of the operation!), because that will enable your adrenals to make back-up hormones for oestrogen when you start to come off HRT.

I suggest that you don't do this until everything has stabilised after the operation, which may take quite a while. Then discuss a slow withdrawal from HRT with your doctor - 6 months to a year would be ideal, to give the body time to adapt.

In the meantime, you would also be supplementing phyto-oestrogens (plant oestrogens), which don't have anything like the power of HRT, but at least gives some support as the HRT is withdrawn.

These aren't going to be strong enough to support you right after the operation, but give support whilst coming off HRT. I use soya isoflavones for this purpose, as they are well researched and I've seen them work for women low in oestrogen. 

You may also benefit from having a really big liver cleanse, as your liver will have been struggling under the weight of the oestrogen dominance, and will then have to deal with the HRT.

Luckily the liver is very amenable to support! I use Milk Thistle Complex because it's a tincture and gets delivered to the liver in the bloodstream, and you can take it alongside medication such as HRT.

You can use dietary support too - no alcohol or caffeine, no highly refined foods, lots of vegetables, wholegrains, more fish than meat - I'm sure you know the drill!

Eileen Durward