Herbal and Bioidentical Hormone Therapies
There is a great interest in natural menopause treatments, especially since the risks of conventional hormone replacement therapy have been brought to light with recent research studies. We now know that the risk/benefit calculations of conventional hormone replacement therapy are complicated. We used to believe that the risks outweighed the benefits on a long term basis. The risks that concern us include increases in breast cancer, heart attacks, strokes, uterine cancer and gallbladder problems. However, in looking more closely at the Women’s Health Initiative Study, those risks were with progestin use. Progestins are synthetic versions of progesterone. There was no increase in breast cancer with estrogen only (or with natural progesterone plus estrogen) for the 50-59 yr old women on hormones. Some other benefits to hormones include reduced osteoporosis and less colon cancer. There is a small increase in blood clots with estrogen used orally though.
Hormones are not right for everyone though.
Many women are asking, “Are there alternatives to hormone replacement therapy, and do they work?”
The answer is yes, but it is not as simple as taking a pill once a day. Healthy lifestyle choices along with nutritional and herbal support will bring the safest and greatest relief of menopausal symptoms and the best long term health. A healthy diet for most menopausal women will include non GMO soy protein, deep sea fish, and plenty of fruit and vegetables. Adding additional fiber in the form of ground flaxseeds will help hormone balance in addition improving colon health. Reducing caffeine and alcohol will help hot flashes, sleep and moods. Exercising regularly has also been proven to help hot flashes and enhance mood.
Black Cohosh is an herb with a long history of use for menopausal symptoms. Using a high quality standardized extract at an appropriate dose is required for good effects however. Other herbs used by naturopathic doctors for helping hot flashes include maca, chasteberry, licorice, sage and red clover. Chinese herbal formulas are often helpful using herbs such as bupleurum, haliotis and tang quai. Soy isoflavone supplements can also be used if dietary intake of soy is inadequate. Nutritional supplements that may be recommended for hot flashes include vitamin E and bioflavonoids.
Estrovera is a new Siberian rhubarb extract that has been extensively studied in Europe. It has no estrogen-like effects, but really works at a dose of just one tab a day. I am using this extensively now in my practice with good effects.
Bioidentical Hormones are an option for those women who require or prefer to use some form of hormone replacement therapy. This more natural form of hormone therapy can address symptoms that don’t respond adequately with herbal therapies alone. Based on our current knowledge, these forms of low dose hormones may have less risks than with the use of conventional HRT. Bioidentical hormones utilize the same forms and proportions of estrogen and progesterone that are natural to the body. Other hormones that also decrease after menopause, such as testosterone and DHEA, can also be added to these formulas. The doses and forms can be individualized based on your symptoms and if needed, testing results. They are made up by compounding pharmacies according to a doctor’s prescription. Naturopathic physicians in Oregon have prescription rights that include all types of hormone therapy. They are most commonly taken as sublingual lozenges called troches, capsules or put into creams that are absorbed through the skin. The doses are easily adjusted as your symptoms change, so that you always use the lowest effective doses.
Mood swings that don’t respond enough to the general menopause recommendations may require further support. The article on anxiety and depression addresses this issue in greater depth.
Sleep disturbances may require further support as well. Melatonin seems to help set the sleep cycle and is useful in those patients with low levels of this hormone. This typically manifests as difficulty with falling asleep. If the problem is with falling asleep and/or staying asleep, Valerian is the first herb to consider. It has been shown to improve the quality of sleep as well as decrease the time spent lying awake at night. Other herbs used by naturopathic physicians for insomnia include passionflower, hops, scullcap and chamomile. Nutrients like l-tryptophan and theanine can also be useful. The great thing about herbal treatments for insomnia is that these herbs show no potential for addiction or habituation, unlike some of the drugs used as sleep aids. Calcium and magnesium help with muscle relaxation and are often calming when taken in the evening.
The best way to achieve greater wellness is to find a licensed naturopathic physician to work with. They are the most highly trained health care professionals in natural treatment modalities. You will then also have access to the most effective professional quality herbal and nutritional supplements.