Considering that menopausal and perimenopausal patients comprise a significant portion of the chiropractor's patient base, astute management of this patient group is pertinent. Characteristically, estrogen levels drop approximately one tenth in postmenopausal women compared to premenopausal women, and progesterone is nearly absent in postmenopausal women.¹ Dwindling amounts of estrogen, associated with menopause, bring on a multitude of symptoms, the most notable being hot flashes and mood changes. Other symptoms associated with the onset of menopause include night sweats, sleeplessness, and vaginal dryness.

Typically, physicians have prescribed hormone-replacement therapy for women as an aid for the symptoms, which are coupled with dwindling estrogen levels.¹ Traditional prescriptive replacement therapy was also classically prescribed to prevent common conditions following menopause, principally osteoporosis and coronary heart disease. However, proper nutritional support can curtail or even prevent these conditions.

An Opportunity for DCs

The Women's Health Initiative recently concluded that a combination of estrogen and progesterone therapy increases the risk of invasive breast cancer. The study revealed a 26% increase in breast cancer following a 5-year period, compared with women taking placebo. Additional cited risks were an increase in cardiovascular disease, including heart attack, stroke, and venous thromboembolic disease (blood clots).²

An additional study has also implicated breast cancer as a risk factor in postmenopausal women on estrogen therapy alone (without progesterone).³ This risk is implicated during and shortly following cessation of estrogen-replacement therapy. Yet another study concluded that estrogen use for 10 or more years is associated with a higher death rate from ovarian cancer, and also correlated duration of use with increased risk of ovarian cancer.⁴ This risk also appears to be increased in women who used a combined therapy, estrogen, and progesterone, compared with estrogen alone.

To support the attributes associated with the transition into the menopausal years, chiropractors have the opportunity to recommend the use of natural alternatives for patients, specifically, nutritional supplements in lieu of traditional hormone-replacement therapy. This is a safe, alternative, and effective approach, void of the ramifications recently associated with traditional pharmaceutical therapy.

As an alternative to hormone-replacement therapy, the use of specifically designed supplemental support should be considered. For example, a comprehensive approach using an array of vitamins and minerals has shown beneficial results in the reduction or elimination of PMS symptoms. As well as supplying vitamins and minerals, a comprehensive formula or formulas should also include glandular components, as these have shown benefit in supporting and balancing the respective organ systems. Other endocrine components, such as adrenal complex and pituitary/hypothalamus complex, have also demonstrated beneficial effects. The combined tissues serve to aid in supporting the respective organ systems.

Supplementation

BioPause-AM is designed to address hot flashes and their associated palpitations often experienced during menopause. BioPause-PM addresses such complaints as night sweats, anxiety, and restlessness that often preclude a restful and rejuvenating sleep.

The fat-soluble vitamins A, D, E, and K are especially important. Vitamin A is an essential nutrient and is important for epithelial cell viability. There is also an interaction between vitamins A, D, and calcium. Vitamin E is a fat-soluble antioxidant that is stored in the liver, fatty tissues, heart, muscles, testes, uterus, blood, and adrenal and pituitary glands. Benefits of an adequate supply of vitamin E include its ability to retard cellular aging due to oxidation, and to prevent oxidation of LDL, a risk of heart disease and stroke. Additionally, studies to confirm the beneficial results of preliminary studies provided confirmation that favorable results were achieved with vitamin E supplementation. In two placebo-controlled studies, both Finkler and Rubenstein confirmed that supplementation reduced vasomotor symptoms and anxiety, as well as other complaints such as dizziness, palpitations, dyspnea, and fatigue.^5,6

Both calcium and magnesium are divalent molecules and are needed daily for routine bodily functions. The beneficial effects of adequate calcium have been noted in numerous studies. According to the NAMS Consensus opinion, "adequate calcium intake has implications that encompass a woman's overall health." Regarding women's health and premenstrual symptoms, a correlation between low calcium intake and premenstrual syndrome has been illustrated.^7,8

Magnesium is required as a cofactor in more than 300 metabolic reactions, and is of particular importance as a cofactor in nearly all phosphorylation reactions involving ATP.

Additionally, magnesium is a factor in the conversion of blood sugar into energy, as well as an essential factor for fat metabolism, and thus energy production. Magnesium also helps fight depression and supports the cardiovascular system, both of which may be problematic areas for the menopausal chiropractic patient.

Incorporation of folic acid and B6 into the diet has been shown to reduce the risk of heart attacks by 42%. Folic acid acts to reduce homocysteine, thus lowering the risk of heart disease. Essential folic acid is also necessary for the formation of red blood cells, through its action on the bone marrow, and aids in amino acid metabolism. Vitamin B6 is necessary for the synthesis and breakdown of amino acids, and it acts as a strengthening component of the immune system. Adequate B6 also helps to maintain the central nervous system and a proper balance of sodium and phosphorous. An additional benefit is the capability to help prevent kidney stone formation.

Other B vitamins are also important to support menopausal symptomatology, including vitamin B1 (thiamin), B2 (riboflavin), B3 (niacin), B12 (cobalamin), and biotin. Adequate dietary B1 is essential for normal functioning of the nervous system, muscles, and heart. Vitamin B1 also plays a key role in generating energy, as a necessary part of the body's metabolic cycle. Additionally, an adequate supply of B1 supports a healthy mental attitude and helps stabilize the appetite. Increased amounts of B1 may be beneficial for people who smoke, consume large quantities of sugar, or take birth control pills.

Vitamin B12 is needed for proper calcium absorption, as well as for carbohydrate, fat, and protein metabolism. An adequate source of B12 increases energy, maintains a healthy nervous system, and relieves irritability. Symptoms of deficiency include fatigue, nervousness, and depression.

Herbs

Herbal components of interest include black cohosh (Cimicifuga racemosa) and Dong quai (Angelica sinensis). Recent European studies have shown that black cohosh has actions on the various symptoms associated with menopause, and the actions have been linked to the active chemical constituents of the herbal, particularly the triterpenes and flavonoids.

Menopausal symptoms, including hot flashes, night sweats, headaches, heart palpitations, and drying and thinning of the vagina, have been associated with high levels of LH in the blood. Unlike standard hormonal therapy with estrogens and progestins, black cohosh does not seem to have an effect on either follicle-stimulating hormone (FSH) or prolactin, suggesting that its action is more selective than traditional hormonal therapy. Other beneficial properties include the production of an "estriol-like" effect, an improvement in appetite and digestion, and an influence on the nervous system, demonstrating the promotion of mild relaxation. It is also documented to exhibit beneficial effects on both the heart and the circulation system.⁹ Black cohosh constituents have also been reported as serotonin receptor binders, which was correlated to the mitigation of hot flashes.¹⁰

Dong quai (Angelica sinensis), a staple of eastern medicinal practice for thousands of years, is used as a uterine tonic, for the treatment of irregular menstrual flow, and for weakness during menstrual periods. As an antispasmodic, it is considered a remedy for menstrual cramps and nervousness.

Rachel Olivier, MS, ND, PhD, serves as a physician advisor for Biotics Research Corp. She holds a master's degree in molecular biology from the University of Southwestern Louisiana, along with a traditional naturopathic degree from Honolulu University and a PhD in nutrition from California University. Contact her at (800) 231-5777 or via www.bioticsresearch.com.

References

1. National Cancer Institute, Q&A: Use of Hormones After Menopause, newscenter.cancer.gov. Accessed October 4, 2007.
2. Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA, 2002:288(3):321–333.
3. Clemons M, Goss P. Estrogen and the risk of breast cancer. NEJM. 2001;344(4):276–285.
4. Ridriguez C, Patel AV, Calle EE, Jacob EJ, Thun MJ. Estrogen replacement therapy and ovarian cancer mortality in a large prospective study of US women. JAMA, 2001;285:1460–1465.
5. Finkler RS. The effect of vitamin E in the menopause. J clin Endocrinol Metab. 1949; 9:89–94.
6. Rubenstein BB. Vitamin E diminishes the vasomotor symptoms of menopause. Fed Proc 1948; 7:106.
7. North American Menopause Society. Menopause. The role of calcium in peri- and postmenopausal women: consensus opinion of The North American Menopause Society. Menopause. 2001 Summer;8(2):84-95.
8. North American Menopause Society. Menopause. The role of calcium in peri- and postmenopausal women: 2006 position statement of the North American Menopause Society. Menopause. 2006 Nov-Dec;13(6):862-77
9. Felter HW, Uri Lloyd JU. Kings American Dispensatory. 1898. www.henriettesherbal.com/eclectic/kings. Accessed October 4, 2007.
10. Burdette JE, Liu J, Chen SN, et al. Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor. J. Agric. Food Chem. 2003;51(19):5661–5670.