Alternatives to hormone replacement therapy for your menopausal patients
The female population finds the amount and diversity of information on menopause daunting because the subject has been raised to mythical proportions. During the next 10 years, more than 20 million women in the United States will experience menopause, and by 2010, that number will triple.1 As chiropractors, our role is to help women understand and implement how to move effectively through this phase of their lives with grace, composure, and health.
Entering a New Phase
Menopause and perimenopause—the years leading up to menopause—are natural phases in the dynamic process of life. Menopause signals the end of the childbearing years and the beginning of the more creative years.
We presently live in a society, however hard won, that no longer defines women solely by the ability to bear children. At one time, women whispered behind closed doors about the challenges of menopause and obediently marched to the doctor’s office for hormone replacement therapy. But now, they are fed up with the status quo and are taking matters into their own hands with global access of information to educate themselves in alternative menopause approaches. Women entering menopause today are more inquisitive, active, and unwilling to accept the stereotype of dried-up, overweight has-beens. Rather, they are a generation of women who want answers that echo their philosophy of living.
Attempts to control this natural phase in a woman’s life with hormone replacement therapy are being questioned. This presents the opportunity for chiropractors and nutritionists to step forward and assist women. More than other health care practitioners, our philosophy and erudition makes us the logical choice to guide our menopausal patients in the alternative approaches and to diffuse fears created by the scare tactics of the marketing industry.
Au Naturel Approach Natural methods for menopause challenges: - Vitamin C—1 to 3 grams daily. Stress increases the need for this water-soluble antioxidant.
- Vitamin B6—100 to 200 mg daily (do not exceed 300 mg). Fights stress and reduces bloating. Cofactor for enzymes involved in estrogen conjugation in the liver.
- Vitamin E—400 IU per day (may go as high as 800 IU per day). Helps control hot flashes. May also decrease breast pain. High levels may be toxic because it is fat-soluble, along with vitamins D, K, and A. Deficiency may adversely affect cytochrome P450 function, which affects estrogen conjugation.
- Vitamin B Complex—50 mg daily. When taking an increased dose of a B vitamin, also take a B complex. Reduces fatigue and increases energy.
- Calcium—1,500 mg per day. Determine what kind of calcium based on urine pH levels—for acid, take calcium citrate and gluconate; for alkaline, take calcium lactate.
- Calcium D-glucarate—Inhibits B-glucuronidase.
- Magnesium—150 to 400 mg daily. Primary player in cell function. Helps activate B vitamins, carries calcium, assists in estrogen conjugation, and conversion of linoleic acid to gamma-linolenic.
- Bioflavonoids—1000 mg. Works synergistically with vitamin C to help elevate hot flashes.
- Essential fatty acids (EFAs), linoleic acid omega-6 and alpha-linolenic acid omega-3—600 mg daily. Eat fish 3 times per week. May have chemo protective affects in postmenopausal women. Also carries minerals such as calcium and magnesium.
- Dong quai—phytoestrogenic (balancing hormones called the female ginseng). Regulates menses, relaxes muscles, and is antianemic.
- Chasteberry (Vitex)—Affects the pituitary to inhibit the secretion of follicle stimulating hormones (FSH). Normalizes the balance between estrogen and progesterone.
- Black cohosh—Recognized for generations by Native American as a tonic for many menopausal signs. Used as a relaxant, sedative, and antispasmodic.
- Indole-3-carbinol (I3C)—Promotes the breakdown of estrogen to the beneficial metabolite, 2-hydroxyestrone (2-OH).
- Progon B homeopathic progesterone—1 pellet equals 12.5 mg. Use of progesterone in any form should include regular monitoring.
- Natural estrogens in creams and oral forms—Women are frequently estrogen dominant and by giving natural progesterone, the estrogen may balance.
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Transitional Pause
Menopause is an individual experience. While there are some general signs of perimenopause and menopause, each woman will have different symptoms based on life experience, family history, physical health, diet, and attitude.
What is perimenopause and menopause? Ten to 15 years prior to the cessation of the menstrual cycle, the ovaries gradually stop producing eggs, and hormones begin to fluctuate—this phase is perimenopause. Classic signs experienced during these years, such as hot flashes, irregular periods, heavy bleeding or skipped or scant menses, longer or shorter periods, and vaginal dryness. Other signs may include mood swings, depression, night sweats, urinary tract infections and incontinence, insomnia, painful intercourse, and weight gain.
The ovaries continue to secrete estrogen and progesterone during this time, hormonal levels begin to decline, and the sex hormones become dependent on the adrenal glands and adipose tissue.2 The ovaries continue to produce important hormones during most, if not all, of the female lifespan and therefore should not be removed preventively, especially given that only approximately 1% of women are diagnosed with ovarian cancer.3
The actual cessation of menses occurs around 50 years of age. As estrogen and progesterone decline, testosterone becomes more erratic. In addition, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels are rising.
Once the ovaries and uterus stop producing adequate amounts of hormones, "the adrenals produce androstenedione, an androgen that is converted to estrogen via the aromatase enzyme in peripheral tissues such as skin, adipose, and muscles."2 This is when cholesterol becomes necessary, which is why fat-free diets have become the bane of menopausal women. The synthesis of adrenal androgens begins with cholesterol, which is converted to pregnenelone. This is then converted to either the stress hormone cortisol, or to dehydroepiandrosterone (DHEA), which is converted to androstenedione. Finally, androstenedione is converted to either estrogen or testosterone.4
Stress causes the adrenals to release cortisol and other stress hormones that inhibit the ability to function as the primary hormone producers during menopause. Additionally, excessive activation of the stress hormone may affect overall health—contributing to high blood pressure, obesity, peptic ulcer, and asthma.5
There is a diverse selection of tools available to assist in determining the specific needs of menopausal patients, such as the saliva hormone test. "Saliva is an ultrafiltrate of blood, making it an excellent diagnostic medium for measuring levels of various constituents that are routinely found in the blood. Saliva levels reflect only the bioavailable portion of hormones—those not bound to protein—and thus directly impacting cells, tissue, and organs within the body. These bioavailable levels frequently correspond more closely with symptoms and conditions than total blood levels."6
Supplements in Demand
Of great concern for females is whether or not they should take hormone replacement therapy (HRT), which refers to estrogen and progesterone taken together. Many prefer a more natural approach, such as natural supplements to help ease menopausal symptoms (see sidebar).
For many years, it has been accepted that unopposed estrogen increases the risk of certain cancers—the solution was taking estrogen and progesterone concurrently. However, the National Cancer Institute, Division of Cancer Epidemiology and Genetics, Rockville, Md, conducted a study (Menopausal estrogen and estrogen-progestin replacement therapy, 1980–1995) and concluded that "Our data suggest that the estrogen-progestin regimen increases breast cancer risk beyond that associated with estrogen alone."
Although hormone receptors in the body will recognize synthetic hormones (not chemically identical to hormones produced in the body), these hormones produce different chemical reactions on the receptor sites. Natural hormones are identical to the hormones in the body. The distinction between natural and synthetic hormones is the chemical structure and not the source. While synthetic hormones are not always bad or natural ones always good, the affect depends on the unique circumstances of the individual patient. Therefore, careful consideration must be taken when considering treatment.
When using hormones identical to individual body hormones, I find this reduces risk of adverse effects. Jean, one of my patients whom I have been working with for a number of years, began having hot flashes and periods of unreasonableness—as described by her husband. After testing her hormone levels, I determined that her progesterone and dehydroepiandrosterone (DHEA) levels were very low. Her high-stress job contributed to overworking her adrenals. A low DHEA level is a signal to address adrenal insufficiencies. Eliminating coffee and other stimulants was the first step. Second, I increased her progesterone levels by with a homeopathic form. The results of the saliva test indicated that progesterone was only needed on the last 14 days of her cycle. I also started her on incole-3-carbinol, which promotes C-2 hydroxylation of estrogens—the least cancer-causing estrogen. After having her on this protocol for a few weeks, her husband called to thank me for the return of his pleasant wife. I monitor her yearly to determine her changing needs.
As practitioners, we should encourage every woman to take an active role in discovering personal needs and find a solution to her unique circumstance. A natural approach can make an amazing difference in the quality of life for your menopausal patients.
About the Author
Shirley Watson, DC, DACBN, QME, CCN, has a practice in Culver City, Calif, and is a certified clinical nutritionist. She is the former director of education for the American Chiropractic Association Council on Nutrition. Watson can be reached via email: swatsondc@msn.com.
References
1. Hudson T. Naturopathic specific condition review:menopause: the protocol. J Botanic Med. 1996;1(4):99–103.
2. Ojeda L. Menopause Without Medicine. 2nd ed. Alameda, Calif: Hunter House; 1992:30.
3. Barbach L. The Pause. New York: Penguin Publishing; 2000:106.
4. Mayo JL. A natural approach to menopause. 1997;5(7):2.
5. Somer E. The Essential Guide to Vitamins and Minerals. New York: Harper Collins; 1992: 49–53.
6. Lac G, Lac N, Robert A. Steriod assays in saliva: a method to detect plasmatic contaminations. Arch Int Physiol Biochim Biophys. 1993;101(5):257–62.
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