Menopause Article, Boulder Women’s Magazine December 2002
Katie, a 53 year old woman, came to see me after the Women’s
Health Initiative (WHI) study was released. She had been on Hormone
Replacement Therapy for six years for symptoms of menopause, which
included hot flashes, vaginal dryness and extreme mood swings.
She hadn’t had a period for two years, so she was considered
to be post-menopausal.
After being on an HRT program , her bone density returned to
a good level. She tried to get off the hormones on her own, but
each time, after a few weeks, her symptoms returned in full force.
She was looking for a safer alternative to the Prempro prescription
she had been taking and she had heard that naturopathic medicine
could possibly help her. She called and set up an appointment
Since the WHI study was published last summer there has been
a lot of press coverage on HRT. I hope to present another dimension
regarding this issue to help Boulder area women make informed,
educated choices regarding their present or impending journey
through perimenopause and menopause. Menopausal symptoms that
are treated with HRT include hot flashes, sleeplessness, high
sweats, vaginal dryness, mood swings and osteoporosis. Where HRT
was once thought to prevent cardiovascular disease, more recent
research has shown that concept to be false. Unfortunately, the
recent research conducted by the WHI has shown that HRT can increase
risk of breast cancer and clotting disorders, though it is still
deemed beneficial in retaining bone density.
Naturopathic doctors as well as practitioners of Chinese
medicine have a long history of successfully utilizing herbal
and homeopathic alternatives, as well as nutritional and lifestyle
support in the treatment of menopausal issues for women philosophically
opposed to synthetic HRT. Now many women who previously used HRT
are seeking healthy alternatives that still provide relief from
their symptoms. The following herbs are often used for the relief
of symptoms most commonly associated sith perimenopause and menopause.
Soy contains isoflavenoids which have a weak estrogenic effect.
Epidemiological studies of Asian countries where soy is a large
component of the native diet show that these women do not suffer
from hot flashes, mood swings and other well known menopausal
symptoms. Asian women also have lower levels of breast cancer
than do Western women. Unfortunately, once they adopt a Western
non-native diet, Asian women suffer the same level of menopausal
ailments as Western women.
Black Cohosh (Cimicifuga racemosa) has been shown in several
studies to improve menopausal symptoms in 80% of the cases. It
has also been proven to be safe for women of have had a history
of breast cancer. Chaste Tree (Vitex agnus-castus) works to balance
the pituitary gland. It is often used to regulate irregular periods
and heavy bleeding which can be a perimenopausal symptom.
Wild yam (Dioscorea villosa) is also often used for menopausal
symptoms related to heavy bleeding. It has a progesteronic effect
on the body. Also, many women use this herb with the belief that
it will help their bone density, though to date it has not been
shown to have any effect on improving bone density.
Ginkgo biloba (ginkgo) is an important herb to think about taking
during menopause since many women, as their estrogen levels drop,
notice a decrease in mental clarity and memory. Though it is not
believed to affect hormone levels, it is an important ally in
getting through these challenging years. Its “method of
action” involves increasing blood flow to the brain.
Why , if some herbs have an estrogenic effect, are they considered
to be a saver alternative for women who have a history or high
risk of breast cancer? Can’t they produce the same problems
that HRT produces? These are questions I am often asked by both
patients ad other medical professionals. The answer lies in the
type of estrogen metabolites produced by the herbs. Soy, black
cohosh, and other phytoetrogens produce the metabolite 2-hydroxyestrone(2-OHE1)
which does not have an effect on cell proliferation and is actually
thought to be protective against cancer. The metabolic byproduct
of synthetic estrogen is primarily 16alpha-hydroxystrone (16alpha-OHE1),
which increases they rate of cell division and growth. This supports
the increase in breast cancer rates for women on HRT and backs
up the study claims that Asian women show decreased levels of
breast cancer. Unfortunately, there have not been any conclusive
studies proving that these herbal alternatives are effective in
preventing bone loss.
I have seen some women in my practice for whom herbal products
are not strong enough to manage their symptoms. Either that or
perhaps they have bone density issues. I often recommend bio identical
hormone replacement as a safer alternative. This treatment uses
the same form pf hormones that are found naturally in the human
body where conventional HRT does not. These hormones were often
originally plant based but have been manipulated in the laboratory
to create a human bio identical hormone. The estrogen products
contain more estriol, which is considered to be safer to the breast
and uterus and have also been shown to improve bone density. I
sometimes also recommend natural progesterone in some cases.
Katie opted to start her alternative treatment plan with a bio
identical product containing both natural estrogens and progesterone.
Due to the severity of her symptoms she did not want to risk experimenting
with something that might not work for her. I recommended she
find the lowest possible dose to manage her symptoms and in a
few months we could work on transitioning to a purely herbal product.
We also incorporated some diet ad lifestyle changes sucn as decreasing
alcohol intake and caffeine and sugar consumption, and eating
more whole organic foods and increasing exercise. Katie is adjusting
well to her very low dose of bio identical hormones. I am optimistic
that we will have a successful transition to the herbal product.
Exciting new breakthroughs in the realm of genetic testing are
now available to determine your individual risk of developing
breast cancer, osteoporosis, and clotting disorders. Though still
somewhat costly and not generally covered by health insurance,
these one-time tests can be invaluable in assessing risks and
individualizing a treatment plan. I am very excited about these
Many Boulder are women who are now entering, or already in “the
change” have traditionally not settled for conventional
treatments regarding their health care. Perhaps the WHI study
came as no surprise to many of us. The good news is that even
more women will now make wise health choices with grace, wit and
wisdom during a very natural transition. Be well!