Early Menopause

In more recent black cohosh news, according to a study in the March 2003 issue of the journal Maturitas, specific formulation of black cohosh, known among researchers as “CR BNO 1055,” has been found to significantly reduce the frequency and severity of hot flashes in breast cancer survivors—completely eliminating the hot flashes in nearly half of the women.

Black cohosh also builds bone strength as effectively as estrogen, and it decreases vaginal dryness. In conventional review studies, black cohosh is the one therapy that is universally named as the most effective for hot flashes, night sweats, and mood swings--and overall balancing of estrogen levels.

I suggest taking taking 80–160 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). One good brand to try is Bionorica’s Menopret.

#5: Soy isoflavones

Soy is a hormone substitute that provides a safe, estrogen-like effect in your body to balance your female hormones.

Soybeans contain active compounds that mimic the effects of estrogen produced in your body. Soy contains two phytoestrogens--genistein and daidzein, which belong to the class of chemicals called isoflavones. Asian women eat much more soy products than most American women, whose isoflavone intake is very low. This was confirmed in a study published in the Lancet, which found that Japanese women who regularly ate a range of soy products had 100 to 1,000 times more isoflavone breakdown products in their urine than Western women. Additionally, menopausal women in Japan are rarely troubled by symptoms such as hot flashes.

In the meantime, for menopause relief and balanced estroten levels, take 50–100 mg of soy isoflavones each day, either through foods or isoflavone capsules, or a combination of both. If you are allergic to soy, or if it causes you digestive upset, then avoid consuming it entirely.

While I ususally focus my blog on alleviating menopause symptoms like hot flashes and night sweats, today, I'd like to address new mammography guidelines that the U.S. Preventive Services Task Force proposed yesterday. Essentially, the recommendations now state that women between the ages of 40 to 49 should not get annual mammograms unless they are high-risk (i.e., strong family history and/or positive for the breast cancer genes BRCA-1 or -2) because the risks outweigh the benefits. The new guidelines also state that women over the age of 50 should get mammograms, but every two years instead of yearly. Finally, they state that self-breast exams are no longer necessary.

There are aspects of these new guidelines with which I agree, and others that, quite frankly, anger me.

First and foremost, I have been speaking out against mammograms for decades because I, too, believe that the risks outweigh the benefits. As I stated in my February 2008 issue of Women’s Wellness Today:

A routine mammogram’s sensitivity (how good it is at detecting suspicious tissue) varies. If a woman is still menstruating, her breast tissue is denser, which drops the sensitivity of routine mammograms to below 70 percent. That means that as many as 30 percent of existing breast cancers are missed, which is troubling because cancers in younger women tend to grow faster. After menopause, a mammogram’s sensitivity is better, but still not great. Routine mammograms are hamstrung by the fact that any tumor smaller than about four-tenths of an inch across is less likely to show up, so a tumor might be just small enough to escape detection, and then have lots of time to grow and spread before the next mammogram. On top of all this, human error in reading the films is also a very real possibility.

Here’s another problem with mammography. Five out of six “suspicious” routine mammograms turn out not to be cancer. Those five women are undoubtedly relieved, but they also got the scare of their lives, underwent more tests, maybe got biopsies, and possibly even had surgery they didn’t need.

The latest studies show that for every 2,000 women who get a routine mammogram, one life is prolonged. If that seems mediocre, you should know that protecting any individual woman against breast cancer was never the goal of routine mammograms—it’s well known that they miss too many cancers in the early, most treatable stage. As a routine screening tool, their purpose is simply to reduce the percentage of women who die from breast cancer.

For these exact reasons, I recommend a breast imaging test called thermography over mammography. In short, mammography looks at the structure of a woman’s breast tissue, while thermography looks at its behavior--which is a much more accurate indicator of potential future problems.

Keep Up with Those Self-Exams
The Task Force’s belief that self-exams are no longer important really frustrates me. I strongly believe that becoming familiar with your breasts, and how they look and feel, can help you determine if any scars, dents, lumps, or bumps are normal for you. Plus, you'll be more sensitive to any little changes that might indicate the need for further testing.

In a nutshell, I recommend that you look into getting breast thermography done, and I strongly encourage you to keep up with your breast self-exams. To learn more about thermography, visit the International Academy of Clinical Thermology or Infrared Sciences Corp.

If you are have healthy estrogen levels or are in early menopause or premenopause, then you should quickly make lycopene your close and personal friend. A fascinating study from the International Journal of Cancer found that high carotene intake, especially a diet high in lycopene, significantly reduced the risk of ovarian cancer in premenopausal women. Investigators suggested that consumption of fruits, vegetables, and food items high in carotene and lycopene, particularly raw carrots and tomato sauce, may reduce the risk of ovarian cancer.

To reap these benefits, aim for 10 servings of cooked tomatoes or tomato products every week. Just be sure to mix the tomatoes in an oil base, such as olive oil, to enhance lycopene absorption.

If you do not want to eat this much tomato-based food, or you simply dislike their taste, then lycopene supplements are a good alternative. Dr. Lark recommends taking 5–10 mg per day. Lycopene is available in most health food stores.

Unfortunately, lycopene does not confer the same protection against ovarian cancer in postmenopausal women that it does in younger women. Luckily, foods high in alpha-carotene and alpha-carotene supplements have been found to significantly reduce the risk of the disease in postmenopausal women.

And, animal studies have shown alpha-carotene is 10 times more effective than beta-carotene in suppressing lung, liver, and skin cancer, while other research has found that the nutrient is 38 percent stronger in antioxidant activity than beta-carotene.

Foods highest in alpha-carotene are carrots, corn, squash, watermelons, green peppers, potatoes, apples, peaches, and leafy green vegetables. If you prefer a supplement, Dr. Lark suggests taking 25,000 IU of mixed carotenoids that contain a blend of both alpha- and beta-carotene.

When it comes to ovarian cancer prevention, there are definitely categories of foods that you should avoid, namely caffeine, dairy products, and red meat. In the case of caffeine, several studies have shown a connection between regular caffeine intake and cancers of the reproductive system. For example, in one study from the September 2000 issue of the International Journal of Cancer, researchers compared the coffee intake of 549 women who had been newly diagnosed with ovarian cancer with that of 516 women without the disease. They found that the consumption of coffee, and caffeine in general, was linked to an increased risk of ovarian cancer in women in early menopause or premenopause.

Similarly, dairy products and red meat can also increase your risk for ovarian cancer. According to a 2003 study, also from the International Journal of Cancer, women who consumed more dairy products and red and white meat were at increased risk for ovarian cancer. Most likely, it is the saturated fats found in these two food groups that put women at high risk for the disease, as they elevate estrogen levels. And, as I wrote about earlier, elevated estrogen levels can lead to or contribute to one of the biggest risk factors for ovarian cancer—estrogen dominance.

In addition to avoiding certain foods, there are others you should strive to eat more often. These include cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, etc.). In a study from the International Journal of Cancer, researchers looked at the frequency with which 609 ovarian cancer survivors in three Australian states ate certain foods and took certain supplements. They found a "survival advantage" in those women who consumed more vegetables in general, especially cruciferous vegetables. They also observed a significant advantage among those women in the upper third of vitamin E intake.

A second study found that vitamin E is not alone in its cancer-fighting benefits. In a 2001 study from Nutrition of Cancer, researchers asked 168 women with ovarian cancer and more than 200 cancer-free women to record their intake of specific foods and supplements. They found that women who took in more than 363 mg of vitamin C a day had a 40 percent lower risk for developing ovarian cancer, while women whose daily intake of vitamin E exceeded 75 mg had a 33 percent decreased risk for the disease.

A 2002 study from the same journal confirmed this conclusion. Researchers found that supplementing with vitamins C and E did indeed appear to significantly decrease the risk of ovarian cancer by about 50 percent.

The bottom line? To help avoid ovarian cancer, avoid caffeine, red meat, and dairy products. You can also increase your consumption of foods high in vitamins C and E, as well as cruciferous vegetables. These include: wheat germ oil, sunflower seeds, almonds and almond butter, and flaxseed and flaxseed oil (all high in vitamin E). For those high in vitamin C, aim for any fruit, tomatoes, red bell peppers, broccoli, cauliflower, spinach, celery, and avocado. Finally, your cruciferous veggies include broccoli, cauliflower, Brussels sprouts, kale, collard greens, bok choy, watercress, radish, and mustard seed.

I’m sure you don’t have to think too hard to name someone you know that has (or had) cancer. It simply seems to be a sad fact of life nowadays. And you can likely narrow that list down by type of cancer. For the next couple of weeks, I’d like to focus on one form of female cancer that has touched my family: ovarian cancer.

One of my mother’s closest friends is Connie. I grew up listening to them giggle and plot throughout my entire childhood. I ate dinners at Connie's house and had sleepovers with her daughters. In fact, I’m friends with them on Facebook to this day.

Several years ago, my mother called me with very distressing news—Connie had ovarian cancer. What a shot that was. This is one of the wittiest, life-loving, fun people I knew. How could this happen to her?

While I don’t know the exact reason in Connie’s particular case, I do know that estrogen dominance is a major risk factor for ovarian cancer. To fully understand why this is case, you have to look at what happens during a normal menstrual cycle and how that changes as you get older.

When you are in your teens, 20s, and even 30s, your normal reproductive cycle begins with signals from the hypothalamus and pituitary glands. These glands secrete a hormone (called FSH), which stimulates the follicle surrounding each egg in your ovaries and causes an egg to mature. During this process, your ovaries produce a powerful form of estrogen called estradiol, while your adrenal glands produce a lower-octane form of estrogen called estrone.

At mid-cycle, a second hormone called the luteinizing hormone (LH) is produced by the pituitary gland. LH triggers the egg to be released from the ovarian follicle. It also increases the synthesis of prostaglandins, short-lived hormones needed for ovulation. Once ovulation has occurred, the egg leaves the ovary and travels down the fallopian tube to the uterus.

Both estrogen and progesterone are produced during this second half of the cycle. If the released egg isn’t fertilized, both estrogen and progesterone production decline rapidly, triggering menstruation at the end of the monthly cycle. Thus, estrogen is produced during the entire menstrual cycle, while progesterone is only produced during the second half of the cycle.

As you approach menopause, this process is even more exaggerated. Although your ovaries and adrenal glands continue to produce a lower potency estrogen (estrone), and some estriol (a weaker form of estrogen) is produced by your liver, the amounts don’t support your systems the way your premenopause hormone production does. During this process, four things happen simultaneously:

• your ovaries age and shrink;
• they are less responsive to the hypothalmic-pituitary signals;
• you have fewer eggs to mature; and
• the eggs you have left are older and less healthy.

In an effort to bring your cycle back into balance, your brain’s triggering signals increase as much as ten-fold, trying to stimulate ovulation. During the early stages of menopause, this becomes more and more difficult to achieve. While estrogen production declines significantly, your progesterone levels decrease much more significantly, with production almost ceasing completely. This can lead to estrogen dominance, and consequently, put the health of all of your tissues—especially your reproductive organs—in jeopardy.

That’s because research has shown that unopposed estrogen levels may be carcinogenic to estrogen-sensitive tissues such as the ovaries, and may be a key cause of most female cancers.

If future blogs, I’ll discuss the nutritional and emotional steps you can take to keep estrogen levels in balance and reduce your risk for both estrogen dominance and ovarian cancer.

In the meantime, you can try using natural progesterone to balance your hormone levels. A typical dosage of natural progesterone cream is 1/4 to 1/2 teaspoon applied to any clean area of the skin once or twice a day.

If your menstrual periods are regular, Dr. Lark recommends using progesterone cream about 10 days before the expected start of your period. However, if you suffer from heavy or irregular menstrual periods, apply progesterone cream from day 12 to day 26 of your cycle.

If you are experiencing menopause symptoms and using some sort of estrogenic support, natural or otherwise, Dr. Lark suggesst using natural progesterone three weeks a month, with one week off.

As I indicated in my last blog, I believe that soy should be consumed only a couple of times a week by anyone with estrogen dominance, premenopause, or other conditions where estrogen levels are out of balance with progesterone levels. Additionally, I believe that women who are in menopause but who are taking tamoxifen for breast cancer or those who have a thyroid concern should also limit their soy intake.

That being said, I do feel it is okay for a woman who is experiencing menopause symptoms such as hot flashes, night sweats, and other menopause problems to consume soy. The key to soy for menopause relief is the natural isoflavones in soy. Therefore, the key is to eat the right amounts of soy foods in the right forms to help you ease the negative side effects of menopause.

I still maintain that you should limit your consumption of soy no more than one serving a day in a “pure” form such as edamame, tofu, or tempeh. On the isoflavone front, Dr. Lark recommends having 50-100 mg of soy isoflavones a day to effectively treat menopause symptoms. In relation to soy foods, this breaks down to one cup of tofu (70 mg isoflavones), 1 cup of tempeh (70 mg isoflavones), or ¼ cup edamame (75 mg isoflavomes) a day.

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). 

“Corby” asked a question related to my post about the use of melatonin for insomnia. The questions was does melatonin increase or cause depression. The short answer is…maybe, but not likely.

Several studies have confirmed that people who suffer from depression have low levels of melatonin (Lancet, 1979) (Biol Psychiatry, 1984). Other studies have linked depression to a delayed melatonin cycle (Psychoneuroendocrinology, 2004).

Melatonin is produced from serotonin and secreted by the pineal gland. Its secretion takes place at night and is inhibited by light. As such, it sets and regulates the timing of your body’s natural circadian rhythms, such as waking and sleeping. When this cycle is delayed, depression and depressive symptoms can occur.

This cycle is particularly affected during early menopause and, in fact, during all stages of menopause. As you get older, you produce less and less melatonin. Melatonin is produced from serotonin, and serotonin production is stimulated by estrogen. Low estrogen levels equates to low serotonin, which results in low melatonin.

As you can imagine, there is research to suggest that taking supplemental melatonin can help treat mild depression (Psychiatry Research, January 1998), including depression related to menopause and even premenopause. However, there are a few studies that have shown that melatonin can have a negative effect on depression (J Psychiatry, 1976).

Though the studies are small in scope and often include a small number of trial participants, it is always best to err on the side of caution. As the University of Maryland Medical Center advises, “Melatonin should be used with caution in people with depression and should be appropriately timed with…sleep-phase changes. Disruption of normal circadian rhythm by poorly timed melatonin administration may worsen depression."

In the May 8, 2009 issue of Menopause, there were two powerful studies that looked at the use of intravaginal DHEA to treat vaginal atrophy.

The researchers explained that DHEA, the “exclusive source of sex steroids in postmenopausal women, is already decreased by 60 percent and continues to decline at the time of menopause.” For this reason, they wanted to determine if intravaginal DHEA could alleviate the symptoms of vaginal atrophy, just one of the effects of menopause.

After 12 weeks, researchers found that daily intravaginal DHEA at doses of 3.25–13 mg was able to “rapidly and efficiently achieve correction of all the signs and symptoms of vaginal atrophy and improve sexual function and caused no or minimal changes in serum sex steroid levels, which all remain within the normal postmenopausal range, thus avoiding the risks of all estrogen formulations.” In other words, DHEA did not raise estrogen levels, which is good news for women who are sensitive to estrogen, or whom have cancer or blood-clotting risks.

Natural Hormone Levels

This is all great news! DHEA has been referred to as the “fountain of youth hormone.” DHEA is one of the five major sex hormones. It is made from pregnenolone, a steroid hormone made from cholesterol that is the precursor to all the other sex hormones.

Pregnenolone converts to the other four sex hormones (DHEA included) via two different pathways. In the first, pregnenolone is converted into DHEA, which is then converted into testosterone and subsequently estrogen. In the second pathway, pregnenolone is converted into progesterone. The progesterone is then converted into testosterone and, finally, into estrogen. This pathway takes place during the first half of your menstrual cycle, when estrogen is the dominant hormone.

In the second pathway, pregnenolone is converted into progesterone. The progesterone is then converted into testosterone and, finally, into estrogen. This pathway occurs during the second half of the menstrual cycle, when progesterone and estrogen are both dominant.

When you are in your reproductive years, or even during premenopause, you experience both pregnenolone pathways. However, once you enter the later stages of menopause, you only go through only the DHEA pathway and not the progesterone pathway. This is one reason why estrogen levels are so much lower during menopause.

DHEA Eases Menopause Symptoms

Low serum (or blood) levels of DHEA have been associated with risk of heart disease, cancer, and immune-related conditions. Conversely, as the study shows, supplementing with DHEA helps with vaginal atrophy, as well as other menopause symptoms, including poor memory, joint pain, increased body fat, insomnia, and more.

According to Dr. Lark, women looking for menopause relief should take 15–25 mg of DHEA before bed. Be careful not to take more than this, as overdosing may result in increased levels of testosterone, which can lead to acne, increased facial hair, or deepened voice. It can also lead to increased estrogen levels, which can cause sleep disturbances, fatigue, anxiety, and irritability.

As is the case with any hormone replacement, you should have your hormone levels checked before you take DHEA. If your levels are low (below 130 ng/dl in blood; under 40 pg/ml in saliva) and you choose to take it in supplemental form, start with the lowest dose, and increase as needed, being careful not to exceed the abovementioned dosage.