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Hormone replacement therapy (HRT) increases cancer, stroke, heart disease, and blood clot risk – these are the latest headlines. HRT is indiscriminately given to many women to reduce the side effects of menopause, but has also claimed to offer protection against heart disease. However, the most current research demonstrates that HRT does not offer heart protection as once thought and, in fact, causes more harm than good. Fortunately, there are healthier ways to gently move with this natural lifecycle.
More than 16,000 women participating in a study on HRT were abruptly told to stop taking their medication July 9th, 2002 after US government scientists' findings suggested that the drugs significantly increased the risk of breast cancer, heart attacks, strokes, and blood clots. This particular study was a component of the Women's Health Initiative and scheduled to run for eight years (until 2005). It was called off after five years when the findings indicated that long-term use of the leading HRT drug, Prempro (estrogen plus progestin), increased a healthy woman's risk of breast cancer, stroke and heart attack when compared to those women taking placebo pills.1 The HRT and cancer connection is not new. A study published in 1999 in the Journal of the American Medical Association found that postmenopausal women who used HRT for 5 years or less had an 80% higher risk of breast cancer than those who had not taken HRT. This risk rose to a 165% higher risk in those who had taken HRT for more than 5 years.2 Researchers found that HRT with estrogen alone or estrogen-plusprogestin was associated with an increase in breast cancer risk and that the risk increased with each year of use.3
The authors of a study published in the New England Journal of Medicine concluded that neither method of HRT "affected the progression of coronary arteriosclerosis in women with established disease" and that "such women should not use estrogen replacement with an expectation of cardiovascular benefit."4 Over the years, other studies have shown no heart benefit with HRT.5,6,7
One concept that is often lost in the confusion of menopause is that it is not a “disease,” but a stage of life that has been programmed into our body for a reason. The ovaries produce significant amounts of estrogen, progesterone, and testosterone during our reproductive years, but this production is shifted down for the rest of life.8 Since these hormones are vital to a number of physical and mental functions, the body continues to need a certain amount of them. Fortunately, hormone production does not come to a screeching halt after menopause; the body has a “back-up-system.” Once the ovaries have declined in production, the adrenal glands, the liver, and fat cells become the primary sources for hormone production.9,10,11 In the “perfect menopause scenario” the adrenal glands should be able to take over the hormone-producing functions of the ovaries and supply adequate amounts of the necessary hormones long after menopause; however, this is not always the case.12
A prime function of the adrenals is to produce corticosteroid hormones, which are responsible for mineral balance, sugar control, and responses to stresses of all sorts, including trauma, inflammation, and emotional stress. A lack of corticosteroids can lead to fatigue, immune dysfunction, hypoglycemia, allergies, and arthritis – often symptoms experienced later in life. Progesterone is actually the precursor to estrogen, testosterone, and the all-important adrenal (corticosteroids) hormones.13Chronic stress can cause hormonal imbalances and may contribute to a deficiency of progesterone. This is due to the fact that often times a majority of the progesterone produced by the body is used to make adrenal hormones for “survival” in our stressful world, rather than contributing to balancing and opposing estrogen. Dr. Lee explains it this way in his book What Your Doctor May Not Tell You About Menopause: “The adrenal cortex is capable of making progesterone, principally for its precursor role in making corticosteroids, but many women are so stressed out … that by the time they’re in their mid-to late thirties or early forties their adrenal glands have nothing left to give. My guess is that when Western women stop making progesterone in their ovaries, and their adrenal cortex and brain need to pick up 100% of that function to produce corticosteroids, there isn’t much progesterone leftover for other functions, such as balancing estrogen levels. The adrenals of many women in Western culture are so depleted they can’t even make enough progesterone to make the corticosteroids.”
The myth of menopause in mainstream medicine is that it is caused by estrogen deficiency, but estrogen levels drop only 40% to 60% at menopause, while progesterone levels drop to nearly zero. The research presented by Dr. Lee suggests the symptoms associated with menopause in many women are more of a consequence of a reduction in progesterone. Lee believes that during menopause the last thing a women needs is more estrogen!14 It has become clear that when estrogen is unopposed by progesterone, there is a decreased sex drive and an increased likelihood of fibrocystic breasts, uterine fibroids, uterine cancer, and breast cancer. Women may also experience fatigue, depression, weight gain, water retention, sleep disturbances, headaches, and mood swings. These undesirable effects of estrogen may be countered by progesterone.15
Although there are many similarities among women’s menopause experiences, there is no one magic hormone that works for everyone. Each woman has her own unique pattern of estrogen, testosterone and progesterone levels. Determining what hormones are out of balance is the first step towards creating an individualized hormone-balancing plan. Questionnaires, such as the one found in the book Dr. John Lee’s Hormone Balance Made Simple or online at www.johnleemd.com/store/resource_hormonetest.html, can help to determine which hormones are out of balance. There are also salivary hormone tests available through a holistically oriented health practitioner or without a physician’s order from ZRT Laboratory (www.zrtlab.com). Saliva testing measures the unbound “free” hormones available to the cells of the body, which have a consistent relationship to the levels in the blood and the rest of the body. Armed with information about your own personal hormone profile, specific nutritional, supplemental, herbal, homeopathic, glandular, and natural hormone replacement recommendations can be individualized for more effective relief from menopause symptoms.
The foods one chooses to eat or not eat can have a dramatic impact on menopausal symptoms. In addition to diet, the right nutrients and herbs may help curtail certain symptoms and prevent associated diseases. Those listed below should be in addition to a quality multiple vitamin and mineral, ample antioxidant nutrients, and most likely calcium and magnesium. Keep in mind, the herbal options presented are the most researched; you must find what is ideal for you. It is ultimately best to work with a trained professional to help meet your specific needs.
The two small adrenal glands that are nestled atop the kidneys must deal with all the “stress” we endure. In addition to the emotional and physical stress we commonly acknowledge, physical injury, overwork, lack of sleep, environmental pollutants, a poor diet, and chemicals all stress the adrenals. These stresses not only detract from hormone production, they also use up excessive amounts of nutritional reserves, which contribute to the body’s dysfunction and imbalance. Nutrients that are critical for adrenal support include minerals, like magnesium, calcium, zinc, potassium, sodium, and copper. These minerals are found in high concentrations in sea vegetables, vegetables grown in nutrient-rich soil, and supplements. The B vitamins (particularly pantothenic acid) are known as the anti-stress vitamins16,17 and are also essential for energy production.18Consider a B-complex in addition to what is found in a comprehensive multiple vitamin and mineral. Adrenal hormone production is dependent on vitamin C. 19 As much as 3,000 mg can be taken at times of chronic stress.20 Panax (Asian) ginseng is an adaptogenic herb that may help protect against mental and physical fatigue, increase vitality, counter the effects of stress, and support the adrenal glands.21 A double-blind trial found that Panax ginseng (200 mg per day of standardized extract) helped alleviate the depression and anxiety symptoms of menopause.22 Other adaptogenic herbs to consider include siberian ginseng, ashwagandha, and rhodiola.
This fat-soluble vitamin may help relieve flushing and hot flashes23,24 and improve vaginal dryness associated with menopause.25 Many doctors suggest that women going through menopause take 800 IU per day of vitamin E for a trial period of at least three months to determine if there is a reduction in symptoms. If helpful, this amount may be continued or can be reduced to 400 IU.26,27
Fish oil contains EPA and DHA, both omega-3 fatty acids that are critical for body function. They keep blood triglycerides in check and support a healthy cardiovascular system as well as modulate immune function.28 Try to consume wild, cold-water fatty fish when possible, in addition to a quality fish oil supplement.
When combined with vitamin C, hesperidin and other citrus flavonoids may be effective in relieving hot flashes. One preliminary trial reported that 1,200 mg each of vitamin C and hesperidin, taken over the course of the day, helped relieve hot flashes.29 After one month, of the 94 participants, 53% found hot flash relief and 34% found a reduction.
This uterine tonic enhances metabolism, improves liver function (which improves the excretion of hormones), aids in the utilization of vitamin E, and has a mild sedative activity.30 Traditionally, dong quai is believed to have a balancing or “adaptogenic” effect on the female hormonal system. In Traditional Chinese Medicine, dong quai is rarely used alone and is typically used in combination with other herbs.31,32 A general dosage suggestion for dong quai is between 500 and 750 mg, one to two times per day.33
Vitex increases luteinizing hormone (LH) production, which results in a shift in the ratio of estrogen to progesterone, in favor of progesterone.34,35 Ultimately, vitex may possess the ability to provide progesterone’s positive effects throughout the menopausal phase.36 A general recommendation falls between 500 and 1000 mg one to three times a day.37
This non-estrogenic herb has been reported to help reduce hot flashes38 as well as night sweats, headaches, heart palpitations, insomnia, depression, anxiety, and vaginal dryness and atrophy.39,40 A review of eight trials concluded black cohosh to be both safe and effective.41 It is believed that black cohosh contains compounds that impact endocrine regulatory mechanisms.42,43 Many doctors recommend 20 to 40 mg of a standardized extract taken twice per day.44
Natural progesterone, made from wild yam, is chemically identical to the progesterone that is produced by a woman's body, unlike the synthetic prescription version. Natural progesterone is used to balance excess estrogen. Progesterone cream must be used with caution due to the complexity of the hormonal system. Side effects are rare with natural progesterone; however, concerns surround the fact that progesterone is fat-soluble and will accumulate in a woman’s fat tissue and may contribute to disruptions in adrenal hormone balance. 45 Dr. Joseph Mercola, an osteopathic physician and author, has found that after balancing the adrenals with diet and nutritive therapies, progesterone levels frequently normalize and many women do not need progesterone cream or supplemental hormones of any kind.46Consider starting at a low dose to find your ideal amount and re-evaluate and adjust your dose over time. Testing your hormone levels often and working with a holistic practitioner would be best.
This herb may aid mood swings and hot flashes as well as reduce excessive perspiration due to menopausal hot flashes during the day or at night.47 A general dosage recommendation is 500 mg, one to three times a day.48
Phytoestrogens in herbs are capable of exerting estrogenic effects, although their activity compared with estrogen is only 2% as strong.49 This low activity produces a balancing action of estrogen effects. If estrogen levels are low, the phytoestrogens will exert a slight estrogenic effect. If estrogen levels are high, the phytoestrogens compete with estrogen for absorption at the binding sites and there will be a decrease in estrogen effects.50 A variety of herbs with weak estrogen-like actions, such as licorice, alfalfa, and red clover have traditionally been used for menopausal symptoms.51
These compounds naturally occur in the fruit, bark, leaves, and seeds of many plants. Sometimes called OPCs (oligomeric proanthocyanidins) or PCOs (proanthocyanidin oligomers), these compounds are polyphenols that offer significant health benefits. Proanthocyanidins are best known for helping the body fight free radicals and in particular for protecting the integrity of the blood vessels. However, in a lesser known role, they may also improve physical and psychological symptoms of menopause.52,53,54 It is somewhat of a mystery how proanthocyanidins impart their benefits because they don’t appear to alter hormone levels directly. 55 The most concentrated forms of proanthocyandins are grape seed extract and a patented extract of maritime pine bark called Pycnogenol®.
Every menopause experience is different. Yet, there are definite measures women can apply in their lives to support their body’s own natural hormonal balance. The principal way is through stress management. As for the natural remedies, there is no exact “prescription” for every woman. Only through education and experimentation will women find the natural tools to help support their own menopause experiences.