BioIdentical Hormone Replacement

I was upset to see news of a recent study conducted at the University of Illinois at Chicago and Northwestern University that concluded that placebo is better than black cohosh and red clover at reducing menopause symptoms like hot flashes. While I acknowledge that red clover has not been studied enough to conclude that it helps relieve certain effects of menopause, I completely disagree with their black cohosh findings. In fact, I have been recommending black cohosh for many years and my patients have experienced great relief from hot flashes, night sweats, and other effecs of menopause.

Black cohosh, native to North America, is derived from the dried rootstock and roots of Cimicifuga racemosa. Traditionally it was used to treat rheumatism, general malaise, kidney ailments, and malaria as well as to provide pain relief during menstruation and childbirth. Native Americans have used the herb throughout history to treat a wide variety of gynecological conditions.

Clinical studies have shown that black cohosh extract not only relieves menopause hot flashes, but also depression and vaginal atrophy. This research has prompted well-publicized studies on the standardized extract of black cohosh and its ability to treat menopause symptoms. 

In one of the largest studies on black cohosh, women with menopause symptoms received forty drops of liquid black cohosh extract twice a day for six to eight weeks. Within four weeks of treatment, a distinct improvement was seen in nearly 80 percent of the women. After six to eight weeks, all symptoms had completely disappeared in half of the women.

Another study found similar results. Scientists gave women with menopause symptoms either high- or low-dose black cohosh for a twelve week period. At the conclusion of the study, approximately 80 percent of both patients and physicians rated the treatment as "good to very good." The investigators reported no differences in either effectiveness or adverse reactions between the two groups.

The only good news that came from this newest study from the University of Illinois at Chicago and Northwestern University is that black cohosh won't hurt you and is considered safe. Well, this is GREAT news indeed, considering the only FDA-approved treatment for menopause symptoms--hormone replacement therapy--is dreadfully dangerous and increases your risk of heart disease, cancer (particularly breast cancer), stroke, and other serious problems. So if you have menopause hot flashes, night sweats, or other menopause symptoms, why not try a natural treatment that has been proven safe? I suggest taking 40 to 80 mg of a standardized extract of black cohosh twice a day. This dose should contain 2 to 4 mg of the active components (triterpenes, calculated as 27-deoxyacteine). 

* Melatonin: A good night’s sleep is a necessity for all women, but night sweats can seriously interfere with that. Inadequate sleep also interferes with your ability to get your natural nightly dose of melatonin—the hormone your pineal gland secretes when you’re in a deep sleep during the darkest part of the night. Taking supplemental melatonin can help you sleep better, even if your sleep disturbance is due to night sweats. Dr. Lark recommends taking 3 mcg–3 mg of melatonin every night, about 30 minutes before you go to bed. Start with the lower dosage and increase, if needed, until you get the desired effect.

Dr. Lark has dedicated herself to providing women with natural, safer alternatives for menopause symptoms. You can find many more of her solutions on her blog and web site.

To learn more about the recent study, click here.

With all the discussion surrounding conventional hormone replacement therapy and bioidentical hormones, it’s no wonder that women are at a loss for ANY solution, natural or otherwise, to their menopause symptoms. If you are looking for a quick, easy, effective, and delicious option to ease the discomfort of night sweats, hot flashes, and other signs of menopause, then soy is for you.

Soy contains phytoestrogens, weak, estrogen-like plant compounds. The specific phytoestrogens found in soy are genistein and diadzein. They are also often referred to as isoflavones. These soy isoflavones have been shown ease menopausal symptoms in thousands of women.

Plus, eating soy-based foods has other long-term health benefits. For example, soy does not appear to have a carcinogenic effect on uterine cells or breast tissue. Plus, the EFAs in soy are good for heart health and supple skin.

To ensure you are getting adequate amounts of soy in your diet, Dr. Lark suggests aiming for 50–100 mg of soy isoflavones per day. This translates to two cups of soy milk (35–40 mg in one glass), ½ cup of edamame (150 mg in ½ cup), or one cup of tofu (35 mg in ½ cup). Just be sure to always, always choose organic soy products, as soy is one of the two most common genetically modified crops in the United States.

Here are a few easy and delectable ways to ensure you are getting enough soy in your diet:

• Make a smoothie for breakfast. Mix one cup soy milk with one banana, a handful of strawberries, one tablespoon of ground flaxseed, and a few cubes of ice. Blend well and enjoy your 70 to 80 mg of soy isoflavones.
• Enjoy a hormone-healthy salad for lunch. Mix 1 cup chopped romaine lettuce with one tomato (diced), ½ a cucumber (diced), ½ cup edamame (whole soybeans), and 2 tablespoons of pumpkin seeds. Toss with a bit of extra-virgin olive oil and balsamic vinegar and enjoy.
• Whip up an easy dessert. Place four ounces soft tofu, one cup mango, one cup papaya, and 1 teaspoon honey in a blender. Mix well and share with a friend. You’ll each get about 15 to 20 mg of soy isoflavones.
   

Ever since the Journal of the American Medical Association (JAMA) reported on the dangers of conventional hormone replacement therapy (HRT) in the July 17, 2002 issue of the journal, women have been scrambling to find a safer, yet still effective treatment for menopause symptoms.

In case you are not familiar with the study, JAMA reported on the findings from one part of the Women’s Health Initiative, an 8.5 year project funded by the National Institutes of Health. According to the findings, menopausal women taking estrogen/progestin for five years or more had an increased risk for blood clots, coronary heart disease, strokes, and breast cancer. In fact, researchers felt so strongly about the negative implications of long-term combined HRT, especially the unacceptably high risk for breast cancer, that they ended the study three years early! Participants were contacted and instructed to stop taking the drug—immediately.

As you can imagine, the pharmaceutical companies have been in a panic ever since, as hundreds of thousands of women have stopped taking their medication and look to natural medicine for answers…answers that many have found in bioidentical hormones.

Dr. Lark has written about and prescribed bioidentical hormones for more than 20 years. In fact, in our book Hormone Revolution, we have devoted several pages to the topic. And when it comes to using bioidentical hormones to treat menopause symptoms such as night sweats, hot flashes, and other signs of menopause, the most commonly prescribed hormone is estriol.

Given the sudden drought in conventional HRT usage (and therefore loss of money to pharmaceutical companies), as well as the increased interest and media attention surrounding the usage and efficacy of bioidentical hormones—namely estriol—it shouldn’t come as a surprise that the FDA is now cracking down on these natural options.

According to the FDA’s Web site, the “use of ‘bio-identical’ as a marketing term implying a benefit for the drug, for which there is no medical or scientific basis.” They even go so far as to state that estriol “is not a component of an FDA-approved drug and has not been proven safe and effective for any use.”

This is simply ridiculous and just plain outrageous. Estriol is the weakest, and therefore safest, of your three main types of estrogen. It has been studied in various animal and human studies and has been shown to be less likely to promote excessive tissue growth, and even helps prevent breast and endometrial cancers.

To me, that seems to contradict the “not been proven safe” part of the FDA’s statement. And, as for the “not been proven effective for any use,” I cannot help but wonder if the FDA is familiar with the JAMA study that found that estriol was particularly effective in treating vaginal atrophy, mood swings, and hot flashes. Or, how about study from Alternative Medicine Review, which found that estriol provided the protection of conventional hormone replacement therapy without the risks. Plus, estriol was found to ease menopause symptoms, including hot flashes, insomnia, vaginal dryness, and urinary tract infections.

Don’t be fooled by the FDA’s “concerns.” Sadly, in this arena, their main concern seems to be with the pharmaceutical company’s checkbooks, not your health. Keep yourself informed by reading blogs, newsletters, and informative emails from trusted sources and doing research for yourself. And fight for your right to natural alternatives to all your health concerns.

Yesterday on Oprah, Robin McGraw (Dr. Phil’s wife) and Dr. Christiane Northrup discussed menopause and the effect it had on a woman’s life. In the course of the conversation, they talked about the pluses and minuses of bioidentical hormone therapy.

I was not able to watch the show, but I pulled video and some text off Oprah’s Web site to see if I could get the gist of the story. Two particular conversations were especially poignant to me. The first was Robin McGraw’s statement that her mother never discussed her experiences with menopause with her.

It is amazing to me that, as women, we can discuss everything from our favorite books and recipes to the best hair salon or ob/gyn. But when it comes to really discussing how we feel, both physically and emotionally, we tend to hold back. Why is that? What’s wrong with saying that you have unbearable hot flashes, bed-soaking night sweats, or excruciating menstrual cramps? Even more difficult is admitting that we are sad, disappointed, irritable, or, God forbid, angry.

What are we afraid of? That someone will judge us as less than? Ladies, we need to be gentler with ourselves and our gender in general. These are tough times we are all living through and no one has the magic answer in how to cope with them. The best we can do is to be compassionate, share our feelings and experiences, and be there for each other.

The second thing that struck me was when Robin discussed changes in her overall attitude, sharing that she was normally a happy person and always smiling and that she felt as if she was losing that. Wow did that hit home personally!

It seems like, lately, I have been completely out of sorts. It wasn’t until I read Robin’s quote that it occurred to me that I might need to adjust my hormone protocol. I had a really solid program that has been incredibly beneficial for me for the past five to six years. But in the last six months, I have undergone IVF treatments (two). Of course it makes sense that my hormones may have been affected for longer than simply the weeks I was taking the hormone medications.

As Dr. Northrup indicated on the show, an imbalance in any other the key sex hormones (estrogen, testosterone, and progesterone) can lead to a whole host of physical and emotional side effects. For me, irritability was the one that was the most notable (to others beside myself, I’m sure!). And, sure enough, too little progesterone can lead to irritability.

You’d think I’d know better! After all, in Hormone Revolution, Dr. Lark and I talk at length about the signs and symptoms of hormone imbalance. Looks like a classic case of the shoemaker’s kids going without shoes!

And while both Dr. Lark and Dr. Northrup are big advocates of bioidentical hormone therapy (and for good reason!), I think I’ll just readjust a few of my supplements and try a progesterone cream for now. Hopefully my hormones—and my mood—will come back into balance soon.

According to a study published in the latest edition of the journal Cancer Epidemiology, Biomarkers and Prevention, long-term use of hormone replacement therapy may cut the risk of colorectal cancer. The greatest reduction in risk was seen in women who used a combination of estrogen plus progestin for two to five years. Current users had the greatest risk reduction, but past users who had stopped at least five years ago also benefited.

So, based on this study, would I recommend using conventional hormone replacement therapy now that it has been found to reduce your risk of colorectal cancer? My answer is unequivocally no! It has been well established that conventional hormone replacement therapy has been associated with a significant increase in the risk of invasive breast cancer, cardiovascular disease, strokes, heart attacks, blood clots, and Alzheimer’s disease. So, while HRT is helpful in reducing menopause symptoms like hot flashes and night sweats—and now colorectal cancer—it is at the expense of your breast, heart, and brain health!

There are much safer and more effective ways to reduce your risk of colorectal cancer—even if you are at high risk due to family history:

1. Eat a Mediterranean diet rich in fruits, vegetables, wild-caught fish, nuts, whole grains, free-range poultry, and unsaturated fats such as olive oil and almond butter; avoid red meat, dairy products, fried and processed foods, and refined sugar and flour. 

2. Add 4 to 6 Tbsp. ground flaxseed to your diet. It’s a great source of fiber, as well as mucilage and lubricants, which provide bulk and soften your stool, helping to promote its elimination through the intestines. 

3. Don’t smoke. Smokers are 30 to 40 percent more likely than nonsmokers to die of colorectal cancer.

4. Exercise. Inactive people have a higher risk of developing not only colorectal cancer, but many other types of cancer, including breast cancer.

5. Drink alcohol in moderation, if at all.

6. Take these supplements:

Selenium is an antioxidant that has been found to inhibit cancer in animal studies. Additional research indicates that selenium shows promise in colorectal cancer prevention in humans. I recommend 50–200 mcg a day.

Calcium helps reduce the risk of colorectal cancer and precancerous polyps. I recommend at least 700 mg a day, along with 800 IU of vitamin D.

Resveratrol, a naturally-occurring compound found in grapes, may help protect against the growth and proliferation of colon cancer cells. In fact, a study published in Cancer Letters found that resveratrol reduced the growth rate of colon cancer cells by 70 percent! I recommend 200 mg, standardized to at least 8 percent total resveratrol, mixed with flavonoids for better bioavailability.

Wyeth Pharmaceuticals is the largest maker of hormone replacement therapy (HRT) drugs, including Prempro—which was found to be associated with an increased risk of breast cancer in the Women’s Health Initiative studies. However, that didn’t stop Wyeth from developing a new HRT formulation named Aprela for the relief of menopause symptoms such as menopause hot flashes and sleep disturbances, reportedly without increasing a woman’s risk of estrogen-related cancers.

 According to Wyeth, Aprela combines estrogen (Premarin) with a SERM (selective estrogen receptor modulator) called bazedoxifene. SERMs block the action of estrogen in certain tissues, including the breast, by occupying estrogen receptors so that estrogen cannot attach to the receptor sites. At the same time, SERMs reportedly stimulate estrogen receptors in other tissues, such as the liver, bone, and uterus (which increases your risk of uterine cancer!). But Wyeth’s studies suggest that bazedoxifene doesn’t have that uterine-stimulating effect, thereby making it a better SERM for a safer HRT drug. In clinical trials, women have been taking Aprela daily for two years while being monitored for breast cancer. However, the study is less than three years old, and it can take 10 years for breast cancer to develop!

If you need to take hormone replacement therapy to relieve menopause symptoms, I much prefer that you consider taking bioidentical hormones, which can provide menopause relief without increasing your risk of life-threatening cancer. Talk to your doctor about bioidentical hormones, a much safer and more effective option.
 

One of my patients had a hysterectomy in her late 30s for endometriosis, and her doctor at the time put her on low-dose hormone replacement therapy. She was on hormone replacement therapy for seven years, but found that when she hit her early 50s, her body began to change. Her nails began to crack and split and her skin became incredibly dry. Lotions and other solutions didn’t work.

She came to me to see what we could do about this problem. I looked at her diet and made some changes that would support estrogen production in her body. First and foremost, she cut out caffeine and alcohol. I started her on wheat germ oil and flaxseed (a great omega-3–based food) to moisturize her skin from within. She also started eating wild salmon, butterfish, and other fish high in omega-3s. In addition, I recommended that she up her B-vitamin and silica intake.

Within months, her nails went from being really soft to strong and firm. Her skin also became much more moist and supple. We also noticed a slight increase in her estrogen levels, which helped to ease her other menopause symptoms, such as hot flashes and night sweats.

If you are already taking hormone replacement therapy but want to transition to some of the natural therapies I’ve discussed throughout my blog, discuss your decision and alternative therapies with your doctor before you make any changes. A good physician will work with you to come up with a plan specific to your needs.

One of the first things you should talk to your physician about is weaning yourself off your current hormone replacement therapy dose. You should do this slowly, because stopping abruptly can increase the severity of the symptoms for which you began taking hormone replacement therapy, such as night sweats and menopause hot flashes.

Begin by cutting the dose of estrogen by one-half each month for one or two months. Then cut back to every other day for a month, then to twice each week, and then once a week each month. Continue to take the progesterone regularly until you have stopped all estrogen, so that you stay in balance.

Tired?

You’re not alone! I can’t even begin to tell you how common insomnia can be during menopause. And menopause symptoms such as hot flashes and night sweats are some of the major reasons for insomnia, as well as stress, anxiety, and thyroid disorder, just to name a few.

If you are menopausal, I urge you to use a natural form of hormone replacement therapy to treat your symptoms. Acupressure is also a great remedy. The two acupressure points traditionally used to relieve insomnia are the Spirit Gate and the Inner Gate. The Inner Gate is located in the middle of the inner side of the forearm, two and one-half finger widths from your wrist. The Spirit Gate is located on the inside of the wrist crease, in line with the little finger. To promote sleep, apply pressure to one point and then the other. You’ll soon learn whether you get the most benefit from pressing both points or one in particular.