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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 with me.

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 developments.

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!