Why I won't push general practice
I am concerned that many 'experts' are recommending so-called natural alternatives such as black cohosh in place of conventional HRT. We know there are differences in some of the risk factors between different routes of administration (patches versus pills) but there are no controlled long-term trials of these alternative remedies.
If these natural products achieve their effects by action of oestrogenic receptors, how can we be sure they do not carry the same risks? I often have to remind patients that natural is being eaten by a lion or dying of your disease without medical intervention. I don't think that is quite what they have in mind when they raise the question.
Dr Michael Blackmore