Hormone Replacement Therapy

• L-dopa is the natural precursor of the neurotransmitter dopamine--which is a powerful physical arouser. I recommend using an extract of the herb Mucuna pruriens—a concentrated natural L-dopa source. Try Herbal Herbal Powers Mucuna Pruriens. Take 300 mg per day in capsule form, standardized to 60 mg L-dopa.
• L-arginine is an amino acid shown to be effective in sending blood to the clitoris, which boosts physical sensitivity and arousal. Take 500 mg one to three times a day, or try a product called ArginMax for Women. 
• Maca is a root vegetable with aphrodisiac qualities. The traditional dose is between 2 to 10 grams, but start low and work up to the dose that gives you the desired effects. 

While this may seem like the title of a bad B-movie, it is actually a pretty accurate description of polycystic ovarian syndrome (PCOS). If you are like me and suffer from PCOS, you know how frustrating and difficult this condition can be. On one hand, you suffer with the effects of too much testosterone, including acne and increased growth of hair on the face, abdomen, upper thighs, chest, and back. Plus, you must contend with estrogen dominance issues, such as infertility and menstrual irregularities.

As if that weren’t bad enough, us PCOS women are also at risk for insulin resistance, which can cause many sufferers to become severely overweight, putting us at risk for diabetes and diabetic complications.

Part of the difficulty with PCOS is that it has multiple underlying causes, namely a number of different hormonal imbalances. Specifically, the production of the pituitary’s luteinizing hormone is significantly elevated in women with PCOS, while the production of the pituitary’s follicle-stimulating hormone is normal or slightly diminished. The imbalances in these female hormones upset the normal production of estrogen, progesterone, and testosterone by the ovaries and adrenal glands, disrupting the healthy balance between all three of these female sex hormones.

Fortunately, by following a particular diet (namely one geared toward women with estrogen dominance), and taking some targeted nutrients, you can find relief from PCOS. I know, because I have. And I’ll share the diet and nutrients with you in future postings.

If you tend to eat out frequently, then you know that it is tough enough to make healthy choices, let alone having those choices reflect your particular hormonal makeup. To help you out, Dr. Lark and I created several tools in Hormone Revolution to make your food selections much easier when you are dining out.

Whether you tend to be overall acidic woman dealing with menopause problems or a more alkaline, woman with estrogen dominance or someone with low estrogen levels but excess yin, eating out can prove to be tricky since you are not the one preparing the food.

Traditionally, people have chosen mostly highly acidic dishes and entrées when eating in restaurants. Luckily, all-American, overly acidic fare such as the 16-ounce porterhouse steak, French fries, and rich, sugary deserts, and French cuisine with its heavy butter- and cream-based sauces have been replaced or supplemented in many restaurants by lighter, healthier, and less acidic, more alkaline dishes. This is true both in American restaurants and in those serving ethnic cuisines. The important thing is to know which dishes on the menu represent the less acidic, more alkaline options and to select a variety of these types of dishes when dining out.

International Cuisine

The following list can help you make healthy choices, particularly if you are working hard to balance your female hormones. In general, you will want to order salads, non-dairy soups, vegetable or bean appetizers and side dishes, and vegetarian or fish entrées. Remember, most restaurants are willing to make up vegetarian entrées and platters at your request, even if they are not on the menu.

• American cuisine: salad or salad bars, bean or vegetable soups, baked potatoes, rice, vegetable side dishes or platters, fish or shellfish entrées.
• Italian cuisine: escarole soup, bean or minestrone soup, white bean salad, Caesar salad, risotto, polenta (cornmeal) with a mushroom sauce, grilled eggplant entrée, fish or shellfish entrées.
• French cuisine: vegetable or seafood salads, nondairy soups, vegetable side dishes, stewed beans, fish or shellfish entrées.
• Indian cuisine: lentils, rice pilafs, cucumber salad, curried vegetable or shellfish dishes.
• Chinese cuisine: stir-fried vegetables, sizzling rice soup, tofu or bean curd dishes, steamed rice, shrimp and mixed vegetable entrées.
• Japanese cuisine: Japanese salads, miso soup, sticky rice, sushi, side dishes and soups made with vegetables and tofu.
• Mexican cuisine: mixed vegetable salads, tostada salad, bean and rice side dishes, bean or shrimp burritos, chicken or shrimp fajitas, bean or seafood tacos (skip the cheese and sour cream).

Interestingly, with age, the human immune system undergoes something called immunosenescence—a decline in the number and function of immune cells in the bone marrow, blood, and tissues; and a decline in the ability of immune cells to communicate with each other and find the infection, and fight effectively once they get there.

Before menopause, when your female hormones are abundant, your immune system is stronger than a man’s at any age because estrogen is a natural immunostimulant. But as hormonal imbalances and premenopause/menopause occur, another change occurs in your body--your defenses take a hit that’s harder than an older man’s body ever has to deal with. So, along with menopause symptoms like night sweats and menopause hot flashes, another effect of menopause is your immune system's weakening.

These are just a few tips to help oost your immunity and protect yourself against illness this year:

Take zinc. Zinc levels, which are a critical competent for immune response, commonly decline with age, which accelerates immunosenescence. Take10–25 mg of zinc daily, plus 2 mg of copper (because zinc depletes copper). 

Take Propolis, a sticky compound bees produce to seal and protect honey-filled compartments, is rich in immune-modulating polyphenolic compounds. I recommend green Brazilian propolis from Uniflora Health Foods (http://store.uniflora.us).

 Vitamin D3, (the “sunshine” vitamin) is also critically important for immunity. It is critical for healthy mucosal barriers lining your respiratory tract, reproductive tract, eyes, and digestive system. Those barriers are your immune system’s first line of defense, keeping pathogens from getting past their guard. Take at least 2,000 IU of vitamin D3 daily.  

Wishing you the best of health this fall and winter!

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.

• gas with oily spotting
• loose stools
• more frequent stools that may be hard to control

To soy or not to soy…that is the question I am asked at least once a week. Unfortunately, there’s not a clear answer, even in the research. Part of the problem is lies in the underwriters of many studies. For example, many of the pro-soy studies are funded, in part, by John Deere and other companies that have a vested interest in soy production. On the flip side, some of the anti-soy studies are funded, in part, by the dairy lobby, which has an interest in less soy, more dairy. This makes the already murky waters a bit murkier.

For me, I tend to lean toward less soy less often. Here’s why.

For women with estrogen dominance or those suffering from perimenopause symptoms where estrogen levels are already a bit high, adding more estrogen (albeit phytoestrogen) to the mix doesn’t seem to make rational sense. Now, I’ve heard that the soy blocks the estrogen receptors and blocks you more potent estrogens from locking in and all that; but the reality is, you are adding an additional estrogen to a system that’s already overtaxed. That cannot be good.

For women looking for relief from their menopause symptoms, soy can be a Godsend for the exact same reason it’s questionable for estrogen dominant women. Meaning, you are providing additional estrogen where estrogen levels are low. Sounds good, right? Well, maybe, maybe not.

A study from the May 2002 issue of Cancer Research looked at the interactions between dietary genistein and tamoxifen (an estrogen antagonist used in the treatment of estrogen-dependent breast cancer). Researchers implanted estrogen-dependent breast cancer cells in mice who had had their ovaries and thymus removed. They found that genistein negated or overwhelmed the inhibitory effect of tamoxifen. Based on these findings, they urged postmenopausal women to exercise caution when consuming dietary genistein while taking tamoxifen.

Other studies that shown a correlation between dietary intake of isoflavones and thyroid disease for several species of animals. Additionally, some studies have found that animals fed soy isoflavones developed enlarged organs, particularly the pancreas and thyroid, as well as increased deposition of fat in the liver.

Additionally, Dr. Lark has written in the past that women who have inflammatory bowel disease, autoimmune thyroiditis, and/or a known allergy or sensitivity to soy should avoid soy. Finally, soy is one of the two most genetically modified (GMO) foods in the United States. That for me is a huge red flag.

My Suggestion

Given all the controversy, the GMO issue, the interaction with tamoxifen, and the possible thyroid concern, I personally err on the side of caution with soy. I limit myself to true soy foods only, meaning edamame (the beans themselves), tofu, and tempeh and always, always organic (eliminates the GMO concern). I also limit my soy consumption to no more than three times a week.

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). 

One of the best supplements to help with this is DIM. DIM (or the long fancy version diindolylmethane) is a plant compound found in Brassica vegetables such as broccoli, cauliflower, bok choy, cabbage, and Brussels sprouts. Researchers have found that this interesting little nutrient is quite beneficial in promoting healthy estrogen metabolism.

During estrogen metabolism, the most potent form of estrogen (estradiol) is converted into estrone. Estrone then becomes either 2-hydroxyestrone (a “good” estrone metabolite) or 16-alpha-hydroxyestrone (a “bad” estrogen metabolite).

This is where DIM comes in. Research has shown that when DIM is ingested, it not only encourages its own metabolism, but that of estrogen. While it is not an estrogen or even an estrogen-mimic, its metabolic pathway exactly coincides with the metabolic pathway of estrogen. When these pathways intersect, DIM favorably adjusts the estrogen metabolic pathways by simultaneously increasing the good estrogen metabolites and decreasing the bad estrogen metabolites.

A 2000 study from Epidemiology proves this point. American researchers took urine samples from 34 healthy postmenopausal women. They then added 10 grams of broccoli a day to the women’s diets. After taking another urine sample, researchers found that this dietary change significantly increased the 2-hydroxyestrone to 16-alpha-hydroxyestrone ratio.

This is good news for those of us with estrogen dominance and elevated estrogen levels. To ensure you are getting enough DIM, you can increase your consumption of Brassica vegetables and/or take 30 mg of supplemental DIM per day, with meals.