With the controversy surrounding HRT, suggest natural alternatives to your menopausal patients

The trials and rewards associated with menopause present many dilemmas for women. On one hand, a monthly nuisance is defeated, thereby ending years of inconvenience. On the other hand, menopause presents finality to the childbearing years and creates a multitude of problems and dangers.

Menopause is a normal part of the aging process, usually occurring naturally between the ages of 45 and 55. The process usually begins 2 to 5 years before the last menstrual period and is completed when a full year has passed without menstruation. Menopause occurs when the amount of hormones in a woman’s body, particularly estrogen, declines. Decreasing levels of estrogen have an effect on many long-term health problems, such as heart disease and osteoporosis. Other common side effects of depleted estrogen levels include sleep deprivation, vaginal dryness, mood swings, and hot flashes.

Raging Hormones
To help control the symptoms, many women have turned to hormonal replacement therapy (HRT) since the 1960s. Recently, the long-term effects of HRT have come under scrutiny as women taking the combined estrogen/progestin (progesterone) supplements were found to be at higher risk for debilitating health conditions. With the avatar of doubt now shrouding HRT, the importance of natural alternatives has risen to the forefront.

On July 9, 2002, the National Heart, Lung, and Blood Institute (NHLBI), a division of the National Institutes of Health (NIH), abruptly halted a major clinical trial of the risks and benefits of combined estrogen and progestin (this study is described in detail on the NHLBI website: www.nhlbi.nih.gov). The study, involving 16,608 women, was due to continue for 3 more years until data revealed that there were noticeable increases of invasive breast cancer, coronary heart disease, stroke, and pulmonary embolism in women taking the therapy compared to those taking a placebo. The purpose of this study was to see whether HRT would help prevent heart disease and hip fractures. The resulting data showed that estrogen/progestin therapy led to:

• 26% increase in breast cancer,
• 41% increase in strokes,
• 29% increase in heart attacks,
• doubled rates of blood clots in legs and lungs,
• 37% less colorectal cancer, and
• 34% fewer hip fractures and 24% less total fractures.

Prempro, the only drug used during the trial, is now under scrutiny as class action lawsuits are being filed against drug manufacturer Wyeth-Ayerst Pharmaceuticals Inc, Madison, NJ. The decision to use this type of therapy is now suspect. Does the decline in hip fractures and colorectal cancer outweigh the risk of cancer, heart attacks, and strokes? Are there other less risky methods of achieving the decreased symptoms?

Many women today challenged with the symptoms of menopause and perimenopause—ranging from physical to psychological—are seeking natural support, not only because of the risks associated with HRT, but also because of the recognition that menopause is not a disease but a natural transition.1 Nutritional support for menopausal women should focus both on symptom relief and disease prevention.

Treatment should be directed at supporting hormonal balance and the complaints and health risks associated with menopause. It should also include foods, herbal plants, and supplements that support the nervous and cardiovascular systems, as well as the adrenal glands and liver function.2 Finally, a change to a healthier lifestyle is paramount to women entering their menopausal stage.

There are some commonly available herbs, vitamins, and natural supplements that can be helpful during menopause.

Natural Supplements
Transdermal progesterone creams provides a convenient means of supplementing progesterone and supporting progesterone deficiency seen in menopausal and perimenopausal women. This supplement must be United States Pharmacopeia (USP) progesterone made from naturally occurring plant sterols in a patented process developed by chemist Russell Marker in 1942.3 Diosgenin, a sterol from the wild yam (dioscorea) root, has historically been used for the production of natural progesterone. Progesterone is produced by the corpus luteum of the ovary, and to a lesser degree from the adrenal glands in both sexes.

Phytoestrogens are compounds found in plants that influence estrogen activity. If estrogen levels are low, as seen in menopause, empty estrogen receptor sites can be filled with phytoestrogens that exert a weak pro-estrogenic effect.2 If estrogen levels are high, as in some women who experience premenstrual syndrome (PMS) and other effects of estrogen dominance, then phytoestrogens can compete with circulating estrogens for binding to receptors, decreasing estrogen’s effect. Phytoestrogens work best in conjunction with transdermal progesterone creams.

Vitamins and Minerals
Pyridoxine (vitamin B6) is a B complex vitamin known as the antistress vitamin. B6 plays a major role in energy production, hormone synthesis, and neurotransmitter formation. It helps to regulate mood, sleeping, eating habits, and pain. It also plays a role in affecting cardiovascular health.

Pantothenic acid (vitamin B5) is another B complex vitamin that plays an important role in energy metabolism. When converted to coenzyme A, it assists in the breakdown of fats, carbohydrates, and protein for energy.2

Vitamin C bolsters the adrenal glands, especially during reactions to physical and emotional stress. This important vitamin also supports liver and immune function and helps protect against free-radical damage.

Vitamin E is best known for its role as an antioxidant and for its support of cardiovascular health. Vitamin E protects the unsaturated fatty acids in cell membranes from breakdown caused by free radicals. Supplementation of vitamin E is known to help relieve menopausal vasomotor symptoms such as flushing and hot flashes.

Calcium is a key element necessary for preventing the excessive bone loss associated with osteoporosis. Other supplements that assist in the maintenance of bone density include vitamin D, magnesium and trace minerals, zinc, copper, and manganese.

Bioflavonoid supports capillary integrity and assists in decreasing hot flashes. It is also an effective defense against free radicals, increasing antioxidant activity.

Food Sources
Soy/soybeans are rich in phytoestrogens known as isoflavonoid glycosides. These plant compounds are converted by intestinal flora to hormone-like substances possessing weak estrogenic activity, binding to estrogen sites and influencing estrogen metabolism.2 If estrogen levels are too high, isoflavonoids compete with the estrogen and act as an antagonist. If estrogen levels are too low, isoflavonoids fill the empty binding sites, providing weak estrogenic effects and acting as an agonist. Diadzein, which is one of the more active isoflavonoids found in soy, has recently been shown to act as an antioxidant and may help to reduce oxidation of LDL cholesterol.

Flaxseed contains a class of phytoestrogens known as lignans that interact with intestinal bacteria to produce enterodial and enterolactone.2 These substances are structurally similar to estrogen and produce estrogenic and anti-estrogenic effects like soy products. The best way to consume isoflavonoids glycosides from soy and lignans from flax seed is by eating them as complete foods on a regular basis because they rapidly degrade.

Herbal Plants
Black cohosh is an herb native to North America and was frequently used by Native Americans to help relieve female complaints. Several studies have demonstrated the ability of black cohosh extracts to bind to estrogen receptor sites on the uterus and to reduce serum levels of leutinizing hormone known to increase symptoms of hot flashes.3 Black cohosh has also been used as a relaxant, sedative, and antispasmodic.

Chaste tree berry, which has a progesterogenic effect, is found to decrease or inhibit the secretion of prolactin.5 Increased levels of prolactin decrease the life and action of the corpus luteum, decreasing the production of progesterone. Symptoms associated with increased prolactin and decreased progesterone include water retention, depression associated with PMS, fibrocystic breast syndrome, and breast soreness. Chaste tree berries may also possess the ability to prolong progesterone’s positive effects throughout menopausal phase.

Valerian root is known as a nervine and antispasmodic, which allows relaxation without the side effects of prescription tranquilizers.

Motherwort herb traditionally has been found to calm, nourish, and strengthen a woman whose physical reserves have been diminished by multiple childbirth, famine (current poor eating habits), or illness.

Lifestyle Changes

• Reduce or eliminate stimulants, such as coffee and nicotine. Both are known to have a severe negative effect on bone density and health.
• Reduce or eliminate alcohol, which affects stress reactions and has a negative effect on bone health.
• Reduce animal fat and animal protein, which contains aracadonic acid—known to negatively affect cardiovascular health and influence cancer. Substitute with soy protein.
• Increase fiber intake. Fiber assists in lowering the risk of heart disease and cancer.
• Exercise to increase bone density, eliminate excess weight, and reduce stress.
• Reduce stress. Stress is associated with increase risk of heart disease and reduced immune response.

With the advent of Internet technology and numerous other vehicles of news delivery available, women today have access to more information than any generation that preceded them. As clinical trials are publicly debated and a plethora of alternatives to traditional medical based therapies are becoming more common, women approaching the change of life have a wide variety of information to guide them on how to best maintain their bodies. Emphasizing wellness and using natural methods of hormonal management will enable this and future generations of women to protect their health and make the transition to their golden years without distraction.

Kathleen D. Baumgardner, DC, DACBSP, maintains her practice, Health Goals Chiropractic Center in Marlton, NJ. She specializes in athletics and fitness training by offering one of the state’s leading chiropractic rehabilitation programs and lectures on gender differences, women’s health issues, children, and allergies.

References
1. Northrup C. The Wisdom of Menopause. New York: Bantum Books; 2001.
2. Mayo JL. A Natural Approach to Menopause. Clinical Nutrition Insights. 1997;5(7):1–8.
3. Martin R. The Estrogen Alternative. Rochester, Vt: Healing Arts Press; 2000.
4. Weiner MA. Herbs that Heal. Mill Valley, Calif: Quantum Books; 1994.
5. Tyler V. The Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. New York: Pharmaceutical Press Products; 1993.