Menopause Symptoms

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.

• 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. 

As we reach a certain age, it seems that more and more of our friends are being diagnosed with breast cancer. This can be disheartening and frightening. While we know women who are estrogen dominant or those who have eleveated estrogen levels are at greater risk for breast cancer, women in premenopause or even those experiencing menopause symptoms can be diagnosed with this awful disease.

However, cancer is not an inevitable part of growing older! Arming yourself with the right information on how you can prevent breast cancer from happening in the first place can help lessen your fears and improve your overall health. And a key piece of that information is an amazing nutrient that has been shown to significantly lower your risk of breast cancer: DIM.

DIM and Breast Cancer

DIM (diindolylmethane) is a compound found in Brassica vegetables such as broccoli, bok choy, cauliflower, cabbage, and Brussels sprouts. When you eat these vegetables, the chewing process releases plant enzymes, which in turn create a phytochemical known as indole-3-carbinol (I3C). DIM is formed directly from I3C in the acidic environment of the stomach. Best of all, DIM has also been found to be highly stable, requires no conversion, and promotes beneficial estrogen metabolism.

When we talk about estrogen or estrogen levels, we are actually referring to three different compounds: estradiol, estrone, and estriol. During estrogen metabolism, estradiol (the most potent of the three) is converted into estrone. Estrone then becomes either 2-hydroxyestrone (a “good” estrone metabolite) or 16-alpha-hydroxyestrone (a “bad” estrogen metabolite). The good metabolite (2-hydroxyestrone) is then converted into 2-methoxyestrone and 2-methoxyestrodial. These two estrogen metabolites have been shown to inhibit the growth of malignant tumors. Conversely, 16-alpha-hydroxyestrone has been strongly associated with cancer growth.

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.

After many studies confirmed that the 2-hydroxyestrone to 16-alpha-hydroxyestrone ratio was a good predictor of breast cancer risk, researchers set out to determine if consumption of Brassica vegetables could influence this ratio. In 2000, 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.

A similar study conducted in 2001 looked at the dietary habits of postmenopausal Swedish women aged 50 to 74. When asked how often, on average, they consumed a wide variety of foods, including 19 different commonly eaten fruits and vegetables, researchers found that those women who ate 1 to 2 servings of Brassica foods a day had a 20 to 40 percent lower risk of breast cancer than those women who ate virtually none.

What’s a Girl to Do?

Clearly, we all need to eat more Brassica vegetables. Aim for at least two servings a day to help keep estrogen levels of estrogen metabolites in the right balance. You can also augment your diet with a good, high-quality DIM supplement. Dr. Lark suggests taking 30 mg of DIM a day.

Fall is my favorite time of the year. Not only does it mean snuggly sweaters and football, but it is also the time to pull out those soup and stew recipes. As you look through your favorites, keep your hormone type in mind.

If you have low estrogen levels and are experiencing menopause symptoms, you will want to lean toward recipes that are light on the spice and acid and high in vegetables, gluten-free grains, legumes, and seafood/fish.

If you have high estrogen levels and/or are estrogen dominant, then you’ll want to lean toward a diet rich in fruits and vegetables, poultry, fish, eggs, and more acidic condiments like vinegar and lemon juice. You will want to steer away from a grain-heavy diet.

In some cases, you’ll find that perfect recipe that pleases both estrogen profile. And here is just such a one for you!

Butternut Squash Soup
Serves 6

Butternut squash is rich in beta-carotene and vitamin C. Beta-carotene helps balance the estrogen excess in women with estrogen dominance, while vitamin C has many menopausal benefits, including the ability to fight heart disease by preventing the oxidation of LDL cholesterol.

Plus, the onions in the recipe provide the antioxidant power of quercetin. And with an antiseptic boost from sage, this soup is sure to keep your immune system strong during the cold winter months.

1 cup red onion, chopped
2 teaspoon olive oil
1 teaspoon ground sage
½ teaspoon sea salt
½ teaspoon cayenne pepper
3 cups vegetable broth
1 large butternut squash, peeled, seeded, and cubed
2 tablespoons soy or rice parmesan cheese (optional)

1. In a soup pot, sauté onion in olive oil over medium heat until soft
2. Add sage, salt, pepper, broth, and squash. Bring to a boil. 
3. Reduce heat and simmer for 25-30 minutes, or until squash is soft. 
4. Ladle ¾ of the soup in to a blender or food processor and purée. 
5. Pour back into pot and reheat for 5 minutes. 
6. Stir in parmesan cheese (if desired) and serve.

• Genistein is a phytoestrogen that provides significant help for menopause hot flashes, night sweats, and other menopause symptoms. If your hot flashes occur four or more times per day, taking geinstein in divided doses should help. 
• Hops is best known as a flavoring agent in beer, but it also contains a potent phytoestrogen known as 8-prenylnaringenin (8-PN). Studies show that 8-PN brings significant relief from hot flashes and other menopause symptoms within just six weeks of taking 100 mcg per day.
• Kudzu is a prolific vine that contains the phytoestrogen puerarin. It has been used extensively in Traditional Chinese Medicine to relieve menopause symptoms.

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.

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.

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.

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).