Alternative Answers for (HRT) Hormone Replacement Therapy
By Andrew Pacholyk, MS, L.Ac Peacefulmind.com
Our lives are filled with transitions. From birth to death, women tend to go through a major transition cycle every seven years, with men it is every eight years. So looking at our lives in cycles helps us to map out in our mind or better understand our transitions and how to approach them.
For women, the seventh cycle in her life is related to menopause. Menopause is the progression and natural change a women's body goes through when she is reaching the end of her child-bearing cycle. This change signals a decrease in the production of estrogen and progesterone in the ovaries. Often, women are aware that they are nearing menopause once their menstrual periods start changing. The cessation of the menstrual cycle for a period of one full year is considered the medical diagnosis of menopause. There is menopause that occurs naturally and there is also menopause that may be induced by surgery. This medical “diagnosis” is not considered a disease but simply an upgrade from reproductive to non-reproductive years. It is simply a name given to this passing phase. This reduction in ovary function, follicles, hormonal changes and blood circulation does not happen overnight. This process or change often takes place over a span of 3-6 years prior to a diagnosis of menopause. This is considered peri-menopause.
Although the median age for women reaching menopause is age 50, worldwide, remaining unchanged for centuries, variations in this process occur based on constitutional factors and lifestyle. Constitutional factors are considered situations we are born out of based on family traits, genes and heredity. Lifestyle factors include situations that occur during our lifetime based on our choices, such as smoking, chemical dependency, obesity, type 2 diabetes and dietary choices. Of course it is never just one factor that is an indicator of this change, but a host of factors accumulating over a lifetime.
The severities of problems or symptoms, which can occur during peri-menopause or menopause, are the culmination of several factors brought together over time. For some women, no outward physiological symptoms are experienced. But on the other hand, many women will experience one or several of such symptoms as hot flashes, sweating, vaginal dryness, headaches, irritability, insomnia, anxiety, depression, fatigue or lack of concentration.
A Look At Hormones
Progesterone and estrogen hormone levels are the driving force during the reproductive years. These hormones then start fluctuating during menopause. Estrogen is the dominant hormone during the 3rd-13th day of the cycle. Progesterone is the dominant hormone in the 14th-28th day of the cycle. During the onset of menopause, a woman's body will not produce sufficient amounts of estrogen and progesterone during the cycle, which causes symptoms of menopause.
The endocrine system is the least understood of the body’s physiological processes. When the brain is called the “greatest sex organ in the body” it is for good reason. The master controller of all processes is the pituitary-hypothalamus-axis. This is the cross roads of a complex series of feedback interactions and influences within the hypothalamus, the pituitary gland and the adrenal glands. The ovaries are the main source of estrogen during the reproductive years. This form of estrogen is known as estrodiol. During the course of perimenopause, women can begin having less than regular menstruation. Estrogen may be high (dominant) at the beginning of perimenopause or estrogen may cease to produce. This can often explain why women in their 40’s experience symptoms and then the symptoms stop. Indicators of perimenopause can begin manifesting as symptoms such as irregular menstrual cycles, with scanty infrequent bleeding, heavy bleeding and/or clotting or skipped periods. These indicators are the body showing it’s hormonal imbalances. These symptoms can also be indicators of other disorders; therefore the past history can differentiate.
As a great regulator, the pituitary-hypothalamus-axis helps to control hormones. As a woman’s body starts entering here seventh life cycle, the kidneys (her constitution source of life) and better yet, the adrenal glands start producing more of the hormone, androstenedione. This hormone starts converting into an estrogen called estrone. Estrone becomes the dominant estrogen instead of estrodial, after menopause. The conversion of androstenedione to estrone is most prevalent in women due to the amount of adipose (fat) tissue she may have. Therefore, a woman who is overweight to obese will convert a much larger percentage of androstenedione to estrone (between 5-7%) were a thinner woman may only convert a smaller percentage (between 1-2%). Again, this shows how lifestyle can play a major part in how a woman experiences menopause.
The Symptoms of Menopause
Woman may not experience any symptoms during this transition or may only have one or more of the following. Many woman, on the other hand can experience:
-hot flashes
-night sweats
-depression
-anxiety
-insomnia
-poor memory
-poor concentration
-vaginal dryness and/or atrophy
During menopause, women are at higher risk for:
-coronary artery disease
-artheriosclerosis
-osteoperosis
-thinning skin
-slow healing
-itching
-vaginal dryness
-atrophy
Hormone Replacement Approach To Menopause
The Western medical paradigm has been treating menopausal symptoms in women with the replacing of hormones or hormone replacement therapy (HRT). From the Western viewpoint, menopausal symptoms are only hot flashes and vaginal dryness; both solely considered an estrogen deficiency problem. Therefore, HRT is considered the cure.
The Women's Health Initiative (WHI) is a set of studies conducted by the National Institutes of Health, a division of the U.S. Department of Health and Human Services. Through these studies, WHI researchers gathered information about the health of women who have gone through menopause. In the HRT trial, researchers were studying the effects of HRT on the health of postmenopausal women. Researchers were trying to determine whether using HRT affects a woman's chances of developing breast and colorectal cancers, heart disease and osteoporosis after she has gone through menopause.
Two groups of women were involved in the HRT trial. In one group, women who had undergone hysterectomy (surgical removal of the uterus) took either estrogen or a placebo (sugar pill). Women in the other group were also postmenopausal but they had not undergone hysterectomy. These women took either combination HRT (both estrogen and progestin) or a placebo. The specific brand of combination medicine used in this group was Prempro. There are other brands of combination-therapy HRT available, but only Prempro was used in this study.
The HRT trial was scheduled to end in 2005. However, researchers decided to stop the combination-therapy part of the study in 2002 because they could see that the risks associated with combination HRT outweighed the benefits. Specifically, it was found that long-term use (5 years or more) of combination HRT resulted in an increase in a woman's risk of breast cancer, blood clots, heart attacks and strokes. For each of these problems, the increased risk was about 8 more events per 10,000 women per year, compared to women who did not use HRT.
The European Heart Journal, Europe's leading cardiology journal, published the largest study to look at the effects of HRT since the Women's Health Initiative trial was stopped early after finding that HRT increased the risk of women developing a range of conditions including breast cancer and thromboembolism. The research is an observational study of 698,098 healthy Danish women, aged 51-69, who were followed between 1995-2001. It has found that overall there was no increased risk of heart attacks in current users of HRT compared to women who had never taken it.
The results did find that in women (aged 51-54) who were taking HRT during the period of the study, their risk of heart attacks was about a quarter (24%) more than in women who had never taken HRT. In addition, in younger women there was an increasing risk with longer duration of HRT, which was not seen in the older age groups.
The study also found that the type of HRT and the way that the women took it made a difference to the risk of heart attacks. Continuous HRT (a continuous combination of estrogen and progesterone) carried a 35% increased risk of heart attacks compared with women who had never used HRT. But if HRT was taken on a cyclical basis (estrogen, followed by a combination of estrogen and progesterone) there was a tendency for these women to have a reduced risk of heart attacks compared to women who had never used HRT, and this was also seen if a synthetic hormone, tibolone, was used. If the method of taking the estrogen was via a patch or gel on the skin or in the vagina, the risk of heart attack reduced by more than a third (38% and 44% respectively).
The New England Journal of Medicine, in 1995 confirmed the link between estrogen therapy and breast cancer. Also, long-term use of estrogen may increase the risk of ovarian cancer.
The Brigham Multipurpose Arthritis and Muskuloskeletal Disease of Boston analyzed a recent report indicating a possible connection between long-term estrogen use and lupus.
HRT therapy is given to regulate a hormone called FSH (follicular stimulating hormone), which, during per/menopause, is running high through the blood stream. This surge in FSH is in response to the decreasing unresponsive follicles during ovulation. HRT therapy increases the estrogen in the body, causing the pituitary to think that ovulation and estrogen production are continuing. The therapy decreases the FSH levels and therefore symptoms of hot flashes and dryness decrease. HRT therapy therefore, “tricks” the pituitary gland into thinking it is getting what it needs, artificially. It appears to the body ovulation and estrogen production are continuing, decreasing FSH levels and therefore, decreases such symptoms as hot flashes, anxiety and dryness. Stopping the estrogen causes the body to revert back to its initial state.
The Western medicine approach to HRT is given in several forms. They can be given in a combination of several estrogens (estradiol, estrone and estriol). They can be given as a conjugated equine estrogen or a synthetic estrogen. Synthetic estrogen is manufactured in laboratories and therefore not easily broken down in the body and because of this, tend to accumulate in the body. Dangerous metabolic changes can occur with synthetic estrogen resulting in increased incidents of high blood pressure, blood clots and fluid retention. Natural estrogens too are manufactured in laboratories, one of the most popular types being equine estrogen, manufactured from the urine of pregnant mares. These are sold under the name of Premarin and Estratab. As this is an extremely potent form of estrogen, it too can create metabolic changes in the liver. This form of estrogen is not recommended for women who are extremely over weight to obese, who currently smoke, have high blood pressure, high cholesterol or varicose veins. The other natural form of estrogen is estradiol sold under the names Estraderm, Emcyt and Estrace. These forms are more easily metabolized by the body and should be taken in the smallest dose possible, taken orally and every other day.
HRT can also be prescribed as a combination of estrogen along with progesterone. It was often given to neutralize such potential carcinogenic effects of the breasts and endometrium. Two classes of progestin are used, which include a progesterone and 17 hydroxyprogesterone combination or synthetic progestins. There has been an ever-growing body of research around replacing progesterone instead of estrogen. Natural progesterone cream is sometime recommended. There are two reasons to be cautious with this protocol. Often creams that say they are natural are actual synthetic ingredients, which make it no safer than synthetic progestins. The other reason is that women start feeling good on progesterone and do not regulate their dosage properly. Adverse effects of improper progesterone use include break through bleeding, changes in cervical erosion and secretion, breast tenderness, weight gain and edema.
Potential adverse effects of HRT:
-endometrial hyperplasia
-cancer
-thromboembolism
-stroke
-hypertension
-breast cancer
-gallbladder dysfunction
-nausea
-vomiting
-headaches
-water retention
HRT Therapy is contraindicated for any woman who ever had:
-breast cancer
-breast lumps of unknown origin
-active liver cancer
-a history of thromboembolism
-hypertension that is untreated
-vaginal bleeding of unknown origin
It is crucial to analyze your medical history. Women with a history of breast, uterine or ovarian cancer, fibroid tumors, breast cyst that have been diagnosed as atypical hyperplasia, or have liver or gallbladder disease, should not take estrogen replacement therapy.
In conclusion, HRT not only failed to provide the heart and bone health benefits promised, the research showed that these synthetic hormones would promote breast, ovarian and uterine cancer, as well as, cause blood clots, stroke and high blood pressure.
Estrogen therapy alone was shown to increase risk of endometrial cancer if not taken with progestin in woman with a uterus. It also increases the risk of stroke, developing gallstones and urinary incontinence.
Progestin therapy alone such as medroxy-progesterone, was shown not to relieve vaginal dryness and may increase the risk of atherosclerosis as well as negative effects on cholesterol. The effects such as coronary artery disease, stroke, breast cancer, blood clots and breast cancer are yet unknown. However, micronized progesterone appears to have fewer side effects and may not adversely affect cholesterol.
Combination therapy (estrogen plus progestin) was shown to increase the risk of coronary artery disease, stroke, breast cancer blood clots dementia and urinary incontinence.
There are other drugs that have been recommended to woman for treating symptoms of per-menopause and menopausal symptoms. Selective Estrogen Receptor Modulators (SERMs) function like estrogen in certain parts of the body and as an anti-estrogen in other areas. The drug Raloxifene, has been given to prevent and treat osteoporosis. Like estrogen, it helps with bone loss. Recently, it has shown to decrease the risk of breast cancer in postmenopausal women. However, it has been shown to increase the risk of blood clots, increase hot flashes in 1 out of 10 women and can cause leg cramps.
Selective Serotonin Reuptake Inhibitors (SSRIs) such as Fluoxetine, Sertraline, and Paroxetine have been prescribed to relieve anxiety, depression irritability and insomnia with an “a side” for relieving hot flashes. Depending on the drug, these SSRIs can cause such side effects as sexual dysfunction, nausea, diarrhea, weight loss (short term use), weight gain (long term use), dry mouth, mental confusion, and can have effects on blood pressure.
Statins (lipid lowering drugs) are sometimes prescribed for preventing atheroslerosis and coronary artery disease. The side effects of these drugs include constipation, loose stool, abdominal pain, nausea, bloating, rash, muscle weakness, muscle inflammation, increased levels of liver enzymes and fatigue.
Antihypertensive drugs (used to treat high blood pressure), such as the drug Clonidine, have also been given to lessen hot flashes. But again, caution should be used as they can cause drowsiness, dry mouth and fatigue, abnormally slow heart rate, rebound high blood pressure when the drug is withdrawn as well as sexual dysfunction.
Testosterone (used in combination with estrogen) has been given to increase sex drive in women. It does prevent osteoporosis and may improve mood, yet it decreases HDL cholesterol (the good cholesterol) as well as having some masculinizing effects such as lowering the voice and facial hair growth. They also increase the risk of liver problems including liver cancer.
The Holistic Approach In Treating Menopause
The Eastern approach to treating menopause as a holistic therapy is connecting the relationship between the mental, emotional, physical and spiritual outlook. The Eastern medicine paradigm treats the whole person, as the belief is that nothing works independent of each other, but in conjunction with one another. This paradigm also sees symptoms as a differential factor. As an example; hot flashes and night sweats are one diagnosis where as, hot flashes, night sweats with cold hands and feet is a completely different diagnosis. The Eastern approach also looks at lifestyle concerns, environmental issues and diet, nutritional choices and exercise as a complete effort in treating menopause.
With this said, a holistic approach must have a course of action. A holistic therapy needs to address all of the above aspects (mental, emotional, physical and spiritual) in order to be “whole”. I have many women come into my practice to tell me how they have begun dabbling in alternative medicine for their situation. I do think it is wonderful that more and more patient are becoming empowered and willing to take responsibility for their health and health care. What I would love to see more of is addressing all aspects of their whole selves.
For example, I had a new patient come to me for hot flashes that are worse in the morning, with fatigue, loose stool and frequent urination. Here stress levels were extremely high and she was constantly complaining about gas and bloating. Her solution was to take Vitex (chasteberry) to address hot flashes and DHEA, because she read somewhere this could help. She was taking an over the counter remedy for here loose stool and a prescription from her doctor for the frequent urination. She did nothing to address her stress levels and was eating whatever she wanted because she was so stressed and called herself an “emotional eater”. This was here holistic approach.
Unfortunately, not only was she taking an inappropriate combination of medications and herbal supplements, she was not taking the correct doses. She was not addressing the root of her problem (menopause agitated by stress) and was sabotaging herself with what she was putting in her mouth. She was simply addressing “symptoms”, which is no better than a Western approach. Of course, symptoms must be address, but the root of the problem will continue to remain and rebound back into her life the minute her remedies for the symptoms wear off. By reaching down to the root of the problem and “rebuilding and fortifying” the foundation, she can affectively resolve so much more of her imbalances.
A holistic course of action takes into account the mental, emotional, physical and spiritual balance achieved throughout life. It is the accumulation of the whole based on our constitutional health (what we are born with/into) and the lifestyles choices we make during our stay here. Following a holistic lifestyle should be one of continuous education, exploration and self-discovery. So many, many people give their lives and bodies away to the trust of. advertisers, doctors, friends and family members.
Learn to listen to your body and your intuition. Trust only your body, as it will do its best to take care of itself. And when it does not, a health professional is a good place to get an idea as to what is happening. But… no matter who you see for your health, I encourage you to get a second and even third opinion. All health care professionals will give you their opinion, based on their expertise, signs, symptoms, physical findings or tests. Again, I stress the word opinion, as this is exactly what it is. An opinion is based on a culmination of information originating from everything including hearsay to practical means. Some practitioner’s scope is broad and far reaching. While other practitioner’s scope of practice is not so amassed or open. Regardless, listen and learn. The more responsibility you take for your health the greater your knowledge grows. This goes for what you read in books and on the Internet as well. Everyone with an opinion has a belief or set of beliefs that formulate that opinion. Sometimes, the formulation of these beliefs into an opinion may not always be the most altruistic. Discern information you receive carefully. Crosscheck this information and do more research before giving yourself and your body over freely. Formulate your opinion or belief system based on your own research as well. Be a well-informed patient, first.
A holistic course of action for peri-menopause and menopause needs to address the change in the body’s physical characteristics. The mental and emotional side of menopause is often an even larger hurdle to overcome, as our attitudes and beliefs create our mind/body structure. Elements that are seldom looked at during this seventh cycle of life include sleep patterns, bowel movements, urination, digestion and the assimilation of food in the body, body temperature in general, body temperature in specific areas, movement and exercise, food choices, situations that bring us stress and joy and mental attitudes that contribute to our spiritual growth.
In Eastern medicine the kidneys are looked at as an entire system, not just an anatomical object. The “energy” of the kidney system encompasses not only the physical traits of regulating blood, waste products and water metabolism, but dominates reproduction growth and development. The kidney system is the producer of marrow (or essence), dominates water metabolism working in conjunction with the urinary bladder and the lungs. The kidney “system” in Eastern medicine is the dominant force in our life vitality. They share a corresponding emotional connection (fear), tissues (the ears), sensory organ (bones) and element (water). As we age, the energy of the kidneys decline. Since the kidneys are associated with our essence, they are the main organs treated during menopause. Kidney disorders are generally of a cold and or deficient nature. Therefore, tonifying and moistening the kidneys is the primary approach.
The bladders along with the kidneys form an important pair. As they are anatomically connected through the ureters, the bladder not only excretes waste material but also is a temporary receptacle for vital fluid retention and transformation. The bladder functions largely at its optimum when the kidneys are normal, strong and healthy. Therefore, water is metabolized properly and the storage and excretion of waste through the bladder, is related to the general function of the kidneys.
A Look At Lifestyle
Lifestyle factors include situations that occur during our lifetime based on our choices, such as smoking, chemical dependency, obesity, type 2 diabetes and dietary choices. Of course it is never just one factor that is an indicator of this change, but a host of factors accumulating over a lifetime. Many times, the symptoms from the aging process are confused with symptoms of peri/menopause. In general, symptoms associated with the aging process include weight gain; change in sleep patterns, hearing loss, a rise in blood pressure and/or cholesterol. These changes are often confused as a direct result of peri/menopause. Often, by changing some lifestyle choices these symptoms of aging lessen or disappear all together. Regardless, if symptoms are due to peri/menopause lifestyle/aging problems, the solutions can affect both outcomes.
Not smoking, regular exercise and decreasing stress levels may help with sleep problems but will also help relieve hot flashes.
Weight gain increases body fat, which in turn affects hormone levels. By reducing the number of calories per day to 1200, a decrease in weight will occur. Increasing your exercise to 4 days will have additional benefits such as lowering cholesterol and burning more calories. In addition, weight bearing exercises (walking, weight training, jogging…) along with supplementing such as 1500mg of calcium and 400mg of vitamin D in divided doses, will not only help with sleep but will increase bone density as well.
Vaginal dryness can often be an issue as hormone levels fluctuate. Vaginal lubricants can be helpful. Staying sexually active will increase blood flow to surrounding tissue. A wonderful natural lubricant is a paste made of aloe vera gel and slippery elm powder. Use a tablespoon of pure aloe vera gel and slowly stir in the slippery elm powder to create a consistency of toothpaste. Insert a teaspoon of this paste inside the vagina at night to relive dryness. Vaginal itching can be addressed by applying a non-fragrant vitamin E cream or by opening up a vitamin E capsule and applying the oil directly.
Kegal exercises can and should be done several times daily to keep the pelvic floor tight and strong. These are wonderful exercises for bladder control due to shrinkage of urethral and vaginal membranes, which can cause incontinence.
Stress plays a major role in all biological and physiological functions. Exercise, meditation, yoga, relaxation techniques, massage, acupuncture, guided imagery are just a few therapies that can all help to relieve depression, anxiety, irritability, mental forgetfulness, fuzziness, over thinking and fatigue. Stress puts a great deal of burden on the adrenal glands, which, in turn, causes them to work harder. This decreases the amount of hormones needed to help reduce the effects of declining estrogen needed by the body.
Exercise, like work, eating, sleeping… must be scheduled into your day in order for you to do it! You know when to go to work, you know when to eat, and you must know when to exercise. The best way to do this is to make it apart of your day.
Treating Hot Flashes is probably the number one issue with the change from reproductive to the non-reproductive years. Nutritional recommendations must be followed (see below). Getting long-term stress issues under control has shown to be extremely important. Regulating the body’s cooling mechanism through regular exercise is imperative.
Nutritional Advise
Food as medicine has been used for centuries to treat a wide variety of disorders. Used for prevention as well as treating symptoms, the healing power of food and herbs has been documented for centuries. Eating a healthy diet, maintaining a healthy weight, exercising regularly and quitting smoking if you smoke, can help protect against heart disease, osteoporosis and some types of cancer.
Eating food rich in plant estrogens (phytoestrogens) can be helpful for many women.
A plant-based diet rich in phytoestrogens has been shown to decrease symptoms of hot flashes and night sweats. Phytoestrogens are naturally occurring, non-steroidal plants. They are sometimes referred to as “dietary estrogens” as they are plant based “foods” with a similar chemical structure to estradiol. As they mildly mimic or sometimes act as antagonists to estrogen. These would include:
-black current seed oil
-dates
-flaxseed (crushed)
-pomegranates
-primrose oil
-miso
-soy milk
-soy beans
-tempeh
-tofu
Western herbs such as anise, black cohosh, fennel, raspberry, sarsaparilla, squaw vine, unicorn root, and wild yam root are natural estrogen (precursors) promoters. Gotu kola and danq gui can be used to relieve hot flashes, depression and vaginal dryness. These herbs are best balanced in Eastern herbal formulas that are specific to particular patterns (group of symptoms). (See below)
Consider vitamin E, emulsified, mixed tocopherols, (400 – 800 iu) daily as this can reduce hot flashes, assist in lubrication, tissue repair and improves circulation.
Vitamin B complex (mixed B’s) assist in improving circulation and cellular function, improving adrenal function, minimizing water retention and maintains the health of nerves, hair, skin, eyes, liver and gastrointestinal functions.
Lecithin granules (1 tbs 3 times daily before meals) or capsules (1200 mg 3 times daily) before meals, acts as an important emulsifier for Vitamin E to help reduce hot flashes.
Foods to Avoid
Dairy products and meat products are foods that can irritate the heat mechanism in the body triggering and/or aggravating hot flashes. Limit your dairy consumption to low fat yogurt and/or buttermilk. Other aggravators include sugar, spicy foods, hot beverages, caffeine and alcohol.
A Differential Diagnosis of Symptoms
The Eastern approach to treating any disorder is by treating the root of the problem. Branch treatments (treating just the symptoms one sees) are the equivalent to putting a band-aid on a broken bone. Treating perimenopause and menopause requires an in depth look at signs and symptoms, past medical history, family medical history and every symptom or sign, even if it does not seem related to the current problem.
Symptoms of more blood/body/essence fluid deficiency:
Dizziness, exhaustion, tinnitus, malar flush, night sweats, hot flashes, mental restlessness, heat in palms and feet, sore weak lower back and/or knees, dry mouth, dry throat, dry hair, dry skin, itching, constipation, anxiety, irritability, headaches or cold feet. Premature graying of hair, low sperm count in males, decreased menstrual flow in women, infertility in women or heel pain. The tongue often presents as a red tongue body with little or no coat or peeling coat. The pulse can feel empty or fine, deep or weak. It may also appear to be overflowing or in excess closest to the wrist.
Symptoms of more energetic deficiency
Hot flashes, but cold hands and feet (extremities), night sweating (early morning), pale face, depression, chilliness, backache, edema of the ankles. Pale or dark complexion, listless spirit, an aversion to cold, low sex drive, weak or cold low back, frequent urination or clear and profuse, clear vaginal discharge and/or edema. The tongue is pale tender, sometimes with tooth marks, and a white and/or slippery tongue coat with a fine deep pulse.
Symptoms of both an energetic as well as blood/body fluid deficiency
Hot flashes, but cold hands and feet, (especially fingers and toes) nightsweats, frequent urination, which tends to look pale, flushing around the neck, when talking, slight agitation, chilliness, dry throat, dizziness, tinnitus, backache, poor memory or vivid dreams and insomnia.. Tongue can be pale or red depends on predominate deficiency. Pulse feels empty or very fine and rapid.
When differentiating such symptoms, it is important to realize which are the most dominant set of symptoms and which are secondary. Not everyone would have all symptoms in one category. They may have a few in one category and a few in another. The more dominant or most symptoms from one category is usually the predominant deficiency. Once you can identify the more predominant deficiency then it is easier to pinpoint remedy-specific formulations to treat and tonify the situation.
Additional underlying patterns that aggravate the above symptoms include Dampness (being overweight, difficulty getting out of bed in the morning, a feeling of heaviness in the body) Vital Energy Stagnation (tiredness, fatigue, listless speech…) or Blood Stasis (sharp stabbing pains anywhere in the body, poor circulation…)
The Controversy Around “Bio-Identical” Hormones
Bioidentical hormones are supposedly chemically identical to those made by the human body and are often described as "natural." Many of those available today are custom-mixed or "compounded," in compound pharmacies. The term "bioidentical" is more of a marketing term than a medical one. Different groups define the term differently.
The FDA has warned seven pharmacies that sell these compounded "bioidentical" hormones against making misleading claims about safety and efficacy of their products. The FDA stated that the compounded products were no safer than conventional forms of hormone replacement therapy (HRT). Premarin and most other FDA-approved hormone therapy contain synthetic hormones. Misleading claims by some pharmacies were made about their compounded hormones stating that they could prevent or treat such diseases as Alzheimer's, stroke, and some cancers, and yet could not show any credible evidence to supports those claims. However, the agency stopped short of prohibiting the pharmacies from filling doctors' prescriptions for these products.
Wyeth, the manufacturer of Premarin and Prempro, petitioned the FDA in 2005 to restrict the availability of compounded "bio-identical" hormones. According to the Wall Street Journal, sales of Premarin and Prempro have dropped by about half since 2002 when two big government-sponsored studies from the The Women's Health Initiative (WHI) found that the drugs raised the risks of breast cancer, stroke, and heart attack.
Several FDA-approved bioidentical hormone products are available by prescription and are federally regulated and tested for purity, potency, efficacy, and safety, including 17-beta-estradiol (Estrace, Climara), estrone (Ortho-Est, Ogen), and micronized progesterone (Prometrium, Prochieve 4%). The term is used mainly for hormones made from a prescription by one of these compounding pharmacists, such as Triest (estriol, estradiol, and estrone), or Biest (estriol and estradiol), which are not approved by the FDA. [1.]
The North American Menopause Society and the American College of Obstetricians and Gynecologists have raised concerns about the “bioidentical” hormones dispensed by compounding pharmacies. Both groups have questioned whether the hormones have been adequately tested and maintain that there is no evidence showing that compounded hormones are better or safer than the pharmaceutical drugs. In fact, they have the same risks as synthetic hormones like Premarin and Prempro, but better side effect panels.
I feel the bioidentical controversy will go on and on primarily because advertising and marketing agency have now latched on to a “marketing concept” and are truly running with it. I do not condone this practice while advocating “false hope and false claims”. Antidotal evidence is important as it can lead to an accumulative base of knowledge that can encourage more studies to be done. The fact that advertisers and companies are stating claims that are misleading to the public, just demoralizes the entire industry and undermines the foundation and direction in which these therapies need to go.
This is where a safer alternative for “bio-identical’ formulas comes in. An herb or herbal combination are not hormones, but work as a precursor, which in turn, stimulates your body’s own metabolism, works in conjunction with endocrine system’s mechanism of action in order to bring your own system back into balance.
Formulations of Eastern Medicinals
The majority of the world’s population since has used herbal treatments as front line medicine before recorded history, and is still the most widely utilized medical system in the world today.
Herbs are the medicinals in holistic medicine. Chinese herbs are specifically used to create decoctions or “teas” and are a very powerful part of healing dis-ease. Herbal decoctions can also be given in "tea pills", tinctures, and granules or as an external patch, compress or bath. Chinese herbal medicine uses several hundred substances, mostly of plant origin (roots, seeds, flowers, twigs, crystals, bones and barks). These are hardly ever prescribed singly. They are combined into a formula, which usually contains between 8 and 12 ingredients. It is the "herbal synergy" that seems to be the strength behind Chinese herbal formulas. The exact combination is adjusted to suit the patient's individual condition, and is likely to be altered as the treatment progresses to take account of changes that have occurred. It is therefore a very flexible system, which can be closely developed to the needs of the patient. Adverse reactions to herbs are extremely rare and are negligible when compared to those commonly produced by pharmaceutical drugs.
The methodology behind an herb's function, indication, contraindication, preparation and use are numerous. Herbs are categorized according to their properties, taste, temperature and their "herbal synergy" is created by using a dominant (chief herb) with a deputy, assistants and envoy herbs in a combination to produce a better effect on one particular organ or condition. The chief herb "rules" the prescription and has the primary effect on the disease condition. The deputy and assistant herbs help to synergistically increase the effect of the chief herb, to treat an illness, as well as, "supervise" the function of other herbs.
The methodology behind an herb's function, indication, contraindication, preparation and use are numerous. Herbs are categorized according to their properties. By doing this, it allows an herbologist to more efficiently utilize the power behind an herb to its fullest.
Herbs are categorized by:
1. Temperature
Hot, cold, (sligthly) warm, (slightly cool), or neutral.
2. Taste
Acrid- Disperses and moves (lung channel/organ) (see *Aromatic)
Sweet- Harmonizes, tonifies, moistens (spleen channel/organ)
Bland- Leaches dampness, promotes urination (urinary bladder channel/organ)
Bitter- Drains and dry (heart channel/organ) (see **3 Aspects)
Sour- Prevents/stops abnormal leakage of fluids(liver channel/organ)(see ***Astringent)
Salty- Purge and softens (kidney channel)
*Aromatic is an aspect of Acrid (spicy). Aromatic is considered a taste and not only disperses and moves, but also penetrates turbidity and dampness, opens orifices. (Often used on Middle Jao)
**3 Aspects of drain and dry are that they, 1. Move through a bowel movement, 2. Move downward, 3. Drain fire (inflammation).
***Astringent can be an aspect of Sour. Astringent alone prevents/soaks up fluids. Astringent and sour together can generate fluids.
3. Directional Tendencies
1. Rise/ascend- moves upward and outward
2. Floating- keeps organs from collapsing
(acrid, sweet warm, hot herbs)
3. Fall/descending- moving downward
4. Sink- keeps organs anchored
(bitter, sour, salty, astringent cool, cold herbs)
This is why the "herbal synergy" that seems to be the strength behind Chinese herbal formulas, is the major difference behind any other form of herbal medicine. The exact combination of herbs can constantly be adjusted to suit the patient's individual condition, and is likely to be altered as the treatment progresses to take into account the changes that have occurred.
Here are ways herbs are used:
*Pills, Capsules, Granules: is the most popular form. These are herbs ground into powder then rolled into "teapills", or put into capsules or given in granule form. Herbal formulas tend to be created for a single problem or nest of related problems and their specific pattern of disharmony.
*Tinctures: Herbal remedies are also prescribed in tincture form and are the previously fresh herb in well-preserved, highly concentrated form. These liquid, as well as, concentrated forms of extracted herbs are preserved in their freshest form.
*Essence: Steam distillation or cold pressing results in herbs as essential oils.
*Poultice: are macerated or chopped herbs that are placed directly on the skin and a hot, moist bandage is applied.
*Infusions: are used when you are working with the most delicate part of the herb-the leaves flowers, fruits and seeds. Infusion time can be approximately 3-5 minutes.
*Decoctions: are used to extract the tougher part of the herb-bark, berries and roots. Decoction time can be between 45 minutes to 90 minutes.
Herb and Drug Interactions
Recent concerns over the past few years about herb and drug interactions have come to light. The reality of many of these situations has to do more with the abuse, overdosing and inappropriate use than anything else. The nature of herb-drug interactions is not a chemical interaction between a drug and an herb producing toxicity, it is the interactions of an herbal component causing either an increase or decrease in the amount of a drug in the blood stream.
A decrease in the amount of drug could occur by herb components binding up the drug and preventing it from getting into the blood or by stimulating the production and activity of enzymes that lower the active ingredients in a drug making the drug ineffective; an increase in drug dosage could make it reach levels that produce side effects.
In Eastern medicine, it is sometimes useful for herbs to be combined with drugs. These combinations are based on theories or evidence about using particular herbs with certain drugs. There are several studies from prominent Chinese hospitals, which show how certain herbs reduce the side effects of drugs and help them to perform their function better; in turn, drugs will make an herb formula work more strongly and quickly. Since these combinations are up to the professional, it is to prove a point that drug and herbal combinations are not always a detriment. That great benefit can come from this research.
For the consumer, taking herbs internally can have fantastic benefits, especially when prescribed under the guide of a licensed herbalist. If you are prescribed herbs while taking Western medication, the following guidelines apply below.
As a general rule, if you are prescribed herbs while taking other than the Western medication mentioned below, you should take your herbs two hours before or two hours after your Western medication. This window allows for a safe and effective time frame, where no interactions would occur. This is due to the gastro-emptying time in the digestive tract.
Taking Herbs Internally
Herbal medicine is a natural and healing form of therapy that can be very beneficial, long term. There is common sense precautions that must be take when using herbal medicine internally.
*Never take herbal medicine internally if you are nursing or pregnant.
*If unusual symptoms occur, stop taking the formula and usually symptoms will disappear rather quickly.
*When also on prescribed Western drugs, great care should be taken. Anti-inflammatory drugs and antibiotics can upset the stomach and irritate the intestinal tract. Herbal formulas can tax the digestive tract. Do not take herbal medicine and anti- inflammatories/antibiotics together at the same time.
*Blood thinners prevent clots from forming in the blood vessels. These are very strong western drugs that must be monitored carefully. Drugs used to thin the blood, often interfere with herbs for trauma, since they both have the same action. The combination can interfere with western drugs and may cause dizziness or fainting. Do not take blood thinning herbal medicine with western blood thinners.
* Heart medications and herbs used for trauma both effect the circulation of blood. Although these herbs have a different method of action, in conjunction with heart medication, there can be unwanted side effects.
*Seizure medications work on brain function and in conjunction with Chinese herbs, should not be taken at the same time and should only be done under supervision.
The Safety of Herbs
There are many excellent companies that subject their herbs to testing more rigorous than the FDA requires. Many of the best known pharmacies and herbal companies work with CMA Testing, an independent, internationally accredited (HOKLAS certified) laboratory to test herbs for heavy metals such as Arsenic, Lead, Mercury, and Cadmium, as well as pesticide residues such as DDT, and Hexochlorobenzene (HCB) related compounds. In addition to meeting international standards, 34 international accrediting bodies, including the American Association for Laboratory Accreditation (A2LA), recognize HOKLAS certification. Through voluntary testing, the best in the industry are helping to raise the industry standard, and ensuring that patients receive only the finest quality herbs. Patented formulations from such reputable companies as Stork Brand, Kan, Crane, Golden Flower… are just a few of these reputable companies who manufactured in an internationally certified GMP. Each formulation is batch tested at the manufacturer for heavy metal contents, microbial count, and pesticides. Further, independent testing is done by an internationally recognized laboratory to verify results. All testing standards exceed USP standards in the United States. There is no reason for reservation when seeing a professional herbalist, acupuncture or licensed naturopath who uses reputable sources.
In conclusion
Hormone replacement therapy is an important decision every woman needs to make. It is imperative to way the risks over the benefits. It is critical to scrutinize your past medical history, lifestyle and symptomology. It is also important to understand the difference between natural, synthetic and “bioidentical” hormones.
Lifestyle plays a major role in how a woman experiences peri/menopause. Lifestyle factors include situations that occur during our lifetime based on our choices, such as smoking, chemical dependency, obesity, type 2 diabetes and dietary choices. Of course it is never just one factor that is an indicator of this change, but a host of factors accumulating over time.
A safer alternative to hormone replacement therapy and “bio-identicasl’ are herbal formulations prepared by a licensed professional practitioner of Eastern medicine.
It is the "herbal synergy" that seems to be the strength behind Chinese herbal formulas. The exact combination is adjusted to suit the patient's individual condition, and is likely to be altered as the treatment progresses to take account of changes that have occurred. It is therefore a very flexible system, which can be closely developed to the needs of the patient.
All women, regardless of their choice to use HRT or not, should:
1. See their healthcare professional for recommended visits for breast, cervical, colon, and skin cancer screening, and undergo laboratory tests for evaluating bone density, lipids, glucose, thyroid, and other tests according to their personal and family history. Blood pressure, height, and weight are also important measurements to evaluate.
2. Stop smoking.
3. Maintain or achieve healthy weight through exercise
4. Pay attention to what and how you are eating. Be conscious of the foods that trigger hot flashes, make you feel bad after you eat or do not make you feel your most optimum.
5. Stay active, including regular weight-bearing exercise.
6. Limit alcohol intake.
7. Try to eliminate stresses and conflicts that decrease overall well being.
8. Have something to look forward to, whether a vacation, a new interest, or family events like the birth of a grandchild.
9. Follow the recommendations of their healthcare professional with regard to ways to prevent diseases like heart disease and stroke or the complications of diseases such as diabetes and osteoporosis.
10. Recognize that happiness and long-term health cannot be manufactured or found in an herb or other product, but found through a variety of strategies that are different for every woman.
Seek out a licensed alternative health care professional who understands how to treat peri/menopause. They should be willing to explore with you all aspects of healing mind, body and spirit. Your practitioner should be certified in treating with herbal medicine, preferably one who is well versed in Eastern formulations. They should be able to help you set up a regime or course of action in your attempt to make your transition as smooth as possible.
About the Author:
Andrew Pacholyk, MS, L.Ac. has obtained a Four-Year Masters of Science in Traditional Oriental Medicine (M.S.T.O.M.) degree from Pacific College of Oriental Medicine in New York City. He is a Licensed Acupuncturist (NY) and is a board certified Diplomate in Oriental Medicine from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). He is certified by the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM) in Clean Needle Technique. Andrew has a board certification in Chinese herbology. Andrew is a graduate of New York State University, College at New Paltz.
Andrew specializes in rejuvenating naturopathic therapies based in the ancient Chinese Medical approach to Endocrinology, Gynecology and Pain Management. By improving circulation and an increase in metabolism, Andrew treats hormonal imbalance, infertility, menopause and menstrual disorders, as well as increasing blood flow and vital energy in order to decrease pain, trauma and its associated symptoms. Andrew, through his New York City clinic, ProAcuMed, his many classes, private teachings, cross country lectures, health community and his website, has helped thousands of thoughtful people with his diagnostics and natural prescriptives.
References
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31. Pharmacokinetics of Estradiol Valerate 2mg + Dienogest 2mg (Climodien (Reg.) 2/2) After Single and Repeated Oral Administration in Healthy Postmenopausal Women
H. Zimmerman, Jenapharm GmbH & Co. KG, Jena, Germany; J.J. Thebault, T. Duvauchelle, A. Mignot, A. Renoux, V. Gualano, ASTER-CEPHAC, Paris and Saint Benoît, France
Published: 08/01/2000
32. Metabolic, Inflammatory and Haemostatic Effects of a Low-Dose Continuous Combined HRT in Women With Diabetes: Potentially Safer With Respect to Vascular Risk? Joyce McKenzie; Alan J. Jaap; Stephen Gallacher; Anne Kelly; Lynne Crawford; Ian A. Greer; Ann Rumley; John R. Petrie; Gordon D. Lowe; Kenneth Paterson; Naveed Sattar
33. Salpeter SR, Walsh JME, Greyber E, et al. Brief report: Coronary heart disease events associated with hormone therapy in younger and older women. A meta-analysis. J Gen Intern Med 2006; 21:363-366. Salpeter SRR, Walsh JME, Ormiston TM, et al. Meta-analysis: effect of hormone replacement therapy on components of the metabolic system in postmenopausal women. Diabetes Obes Metab 2005; DOI:10.1111/j.1463-1326.2005.00545. Available at:http://www.blackwell-synergy.com
34. Early HRT Use Linked to Reduced Risk of Alzheimer's Disease, All-Cause Dementia
Caroline Cassels American Academy of Neurology 59th Annual Meeting: Abstract S31.004. April 28 – May 5, 2007.
35. Changes in Bone Density After Stopping HRT Published: 01/16/2003 Gallagher JC et al. Effect of discontinuation of estrogen, calcitriol, and the combination of both on bone density and bone markers. J Clin Endocrinol Metab 2002 Nov; 87:4914-23.
36. Measuring Estradiol Levels Recommended for Women Treated With HRT Mindy Hung J Womens Health. 2003;12(8):757-768 Reviewed by Gary D. Vogin, MD
Our lives are filled with transitions. From birth to death, women tend to go through a major transition cycle every seven years, with men it is every eight years. So looking at our lives in cycles helps us to map out in our mind or better understand our transitions and how to approach them.
For women, the seventh cycle in her life is related to menopause. Menopause is the progression and natural change a women's body goes through when she is reaching the end of her child-bearing cycle. This change signals a decrease in the production of estrogen and progesterone in the ovaries. Often, women are aware that they are nearing menopause once their menstrual periods start changing. The cessation of the menstrual cycle for a period of one full year is considered the medical diagnosis of menopause. There is menopause that occurs naturally and there is also menopause that may be induced by surgery. This medical “diagnosis” is not considered a disease but simply an upgrade from reproductive to non-reproductive years. It is simply a name given to this passing phase. This reduction in ovary function, follicles, hormonal changes and blood circulation does not happen overnight. This process or change often takes place over a span of 3-6 years prior to a diagnosis of menopause. This is considered peri-menopause.
Although the median age for women reaching menopause is age 50, worldwide, remaining unchanged for centuries, variations in this process occur based on constitutional factors and lifestyle. Constitutional factors are considered situations we are born out of based on family traits, genes and heredity. Lifestyle factors include situations that occur during our lifetime based on our choices, such as smoking, chemical dependency, obesity, type 2 diabetes and dietary choices. Of course it is never just one factor that is an indicator of this change, but a host of factors accumulating over a lifetime.
The severities of problems or symptoms, which can occur during peri-menopause or menopause, are the culmination of several factors brought together over time. For some women, no outward physiological symptoms are experienced. But on the other hand, many women will experience one or several of such symptoms as hot flashes, sweating, vaginal dryness, headaches, irritability, insomnia, anxiety, depression, fatigue or lack of concentration.
A Look At Hormones
Progesterone and estrogen hormone levels are the driving force during the reproductive years. These hormones then start fluctuating during menopause. Estrogen is the dominant hormone during the 3rd-13th day of the cycle. Progesterone is the dominant hormone in the 14th-28th day of the cycle. During the onset of menopause, a woman's body will not produce sufficient amounts of estrogen and progesterone during the cycle, which causes symptoms of menopause.
The endocrine system is the least understood of the body’s physiological processes. When the brain is called the “greatest sex organ in the body” it is for good reason. The master controller of all processes is the pituitary-hypothalamus-axis. This is the cross roads of a complex series of feedback interactions and influences within the hypothalamus, the pituitary gland and the adrenal glands. The ovaries are the main source of estrogen during the reproductive years. This form of estrogen is known as estrodiol. During the course of perimenopause, women can begin having less than regular menstruation. Estrogen may be high (dominant) at the beginning of perimenopause or estrogen may cease to produce. This can often explain why women in their 40’s experience symptoms and then the symptoms stop. Indicators of perimenopause can begin manifesting as symptoms such as irregular menstrual cycles, with scanty infrequent bleeding, heavy bleeding and/or clotting or skipped periods. These indicators are the body showing it’s hormonal imbalances. These symptoms can also be indicators of other disorders; therefore the past history can differentiate.
As a great regulator, the pituitary-hypothalamus-axis helps to control hormones. As a woman’s body starts entering here seventh life cycle, the kidneys (her constitution source of life) and better yet, the adrenal glands start producing more of the hormone, androstenedione. This hormone starts converting into an estrogen called estrone. Estrone becomes the dominant estrogen instead of estrodial, after menopause. The conversion of androstenedione to estrone is most prevalent in women due to the amount of adipose (fat) tissue she may have. Therefore, a woman who is overweight to obese will convert a much larger percentage of androstenedione to estrone (between 5-7%) were a thinner woman may only convert a smaller percentage (between 1-2%). Again, this shows how lifestyle can play a major part in how a woman experiences menopause.
The Symptoms of Menopause
Woman may not experience any symptoms during this transition or may only have one or more of the following. Many woman, on the other hand can experience:
-hot flashes
-night sweats
-depression
-anxiety
-insomnia
-poor memory
-poor concentration
-vaginal dryness and/or atrophy
During menopause, women are at higher risk for:
-coronary artery disease
-artheriosclerosis
-osteoperosis
-thinning skin
-slow healing
-itching
-vaginal dryness
-atrophy
Hormone Replacement Approach To Menopause
The Western medical paradigm has been treating menopausal symptoms in women with the replacing of hormones or hormone replacement therapy (HRT). From the Western viewpoint, menopausal symptoms are only hot flashes and vaginal dryness; both solely considered an estrogen deficiency problem. Therefore, HRT is considered the cure.
The Women's Health Initiative (WHI) is a set of studies conducted by the National Institutes of Health, a division of the U.S. Department of Health and Human Services. Through these studies, WHI researchers gathered information about the health of women who have gone through menopause. In the HRT trial, researchers were studying the effects of HRT on the health of postmenopausal women. Researchers were trying to determine whether using HRT affects a woman's chances of developing breast and colorectal cancers, heart disease and osteoporosis after she has gone through menopause.
Two groups of women were involved in the HRT trial. In one group, women who had undergone hysterectomy (surgical removal of the uterus) took either estrogen or a placebo (sugar pill). Women in the other group were also postmenopausal but they had not undergone hysterectomy. These women took either combination HRT (both estrogen and progestin) or a placebo. The specific brand of combination medicine used in this group was Prempro. There are other brands of combination-therapy HRT available, but only Prempro was used in this study.
The HRT trial was scheduled to end in 2005. However, researchers decided to stop the combination-therapy part of the study in 2002 because they could see that the risks associated with combination HRT outweighed the benefits. Specifically, it was found that long-term use (5 years or more) of combination HRT resulted in an increase in a woman's risk of breast cancer, blood clots, heart attacks and strokes. For each of these problems, the increased risk was about 8 more events per 10,000 women per year, compared to women who did not use HRT.
The European Heart Journal, Europe's leading cardiology journal, published the largest study to look at the effects of HRT since the Women's Health Initiative trial was stopped early after finding that HRT increased the risk of women developing a range of conditions including breast cancer and thromboembolism. The research is an observational study of 698,098 healthy Danish women, aged 51-69, who were followed between 1995-2001. It has found that overall there was no increased risk of heart attacks in current users of HRT compared to women who had never taken it.
The results did find that in women (aged 51-54) who were taking HRT during the period of the study, their risk of heart attacks was about a quarter (24%) more than in women who had never taken HRT. In addition, in younger women there was an increasing risk with longer duration of HRT, which was not seen in the older age groups.
The study also found that the type of HRT and the way that the women took it made a difference to the risk of heart attacks. Continuous HRT (a continuous combination of estrogen and progesterone) carried a 35% increased risk of heart attacks compared with women who had never used HRT. But if HRT was taken on a cyclical basis (estrogen, followed by a combination of estrogen and progesterone) there was a tendency for these women to have a reduced risk of heart attacks compared to women who had never used HRT, and this was also seen if a synthetic hormone, tibolone, was used. If the method of taking the estrogen was via a patch or gel on the skin or in the vagina, the risk of heart attack reduced by more than a third (38% and 44% respectively).
The New England Journal of Medicine, in 1995 confirmed the link between estrogen therapy and breast cancer. Also, long-term use of estrogen may increase the risk of ovarian cancer.
The Brigham Multipurpose Arthritis and Muskuloskeletal Disease of Boston analyzed a recent report indicating a possible connection between long-term estrogen use and lupus.
HRT therapy is given to regulate a hormone called FSH (follicular stimulating hormone), which, during per/menopause, is running high through the blood stream. This surge in FSH is in response to the decreasing unresponsive follicles during ovulation. HRT therapy increases the estrogen in the body, causing the pituitary to think that ovulation and estrogen production are continuing. The therapy decreases the FSH levels and therefore symptoms of hot flashes and dryness decrease. HRT therapy therefore, “tricks” the pituitary gland into thinking it is getting what it needs, artificially. It appears to the body ovulation and estrogen production are continuing, decreasing FSH levels and therefore, decreases such symptoms as hot flashes, anxiety and dryness. Stopping the estrogen causes the body to revert back to its initial state.
The Western medicine approach to HRT is given in several forms. They can be given in a combination of several estrogens (estradiol, estrone and estriol). They can be given as a conjugated equine estrogen or a synthetic estrogen. Synthetic estrogen is manufactured in laboratories and therefore not easily broken down in the body and because of this, tend to accumulate in the body. Dangerous metabolic changes can occur with synthetic estrogen resulting in increased incidents of high blood pressure, blood clots and fluid retention. Natural estrogens too are manufactured in laboratories, one of the most popular types being equine estrogen, manufactured from the urine of pregnant mares. These are sold under the name of Premarin and Estratab. As this is an extremely potent form of estrogen, it too can create metabolic changes in the liver. This form of estrogen is not recommended for women who are extremely over weight to obese, who currently smoke, have high blood pressure, high cholesterol or varicose veins. The other natural form of estrogen is estradiol sold under the names Estraderm, Emcyt and Estrace. These forms are more easily metabolized by the body and should be taken in the smallest dose possible, taken orally and every other day.
HRT can also be prescribed as a combination of estrogen along with progesterone. It was often given to neutralize such potential carcinogenic effects of the breasts and endometrium. Two classes of progestin are used, which include a progesterone and 17 hydroxyprogesterone combination or synthetic progestins. There has been an ever-growing body of research around replacing progesterone instead of estrogen. Natural progesterone cream is sometime recommended. There are two reasons to be cautious with this protocol. Often creams that say they are natural are actual synthetic ingredients, which make it no safer than synthetic progestins. The other reason is that women start feeling good on progesterone and do not regulate their dosage properly. Adverse effects of improper progesterone use include break through bleeding, changes in cervical erosion and secretion, breast tenderness, weight gain and edema.
Potential adverse effects of HRT:
-endometrial hyperplasia
-cancer
-thromboembolism
-stroke
-hypertension
-breast cancer
-gallbladder dysfunction
-nausea
-vomiting
-headaches
-water retention
HRT Therapy is contraindicated for any woman who ever had:
-breast cancer
-breast lumps of unknown origin
-active liver cancer
-a history of thromboembolism
-hypertension that is untreated
-vaginal bleeding of unknown origin
It is crucial to analyze your medical history. Women with a history of breast, uterine or ovarian cancer, fibroid tumors, breast cyst that have been diagnosed as atypical hyperplasia, or have liver or gallbladder disease, should not take estrogen replacement therapy.
In conclusion, HRT not only failed to provide the heart and bone health benefits promised, the research showed that these synthetic hormones would promote breast, ovarian and uterine cancer, as well as, cause blood clots, stroke and high blood pressure.
Estrogen therapy alone was shown to increase risk of endometrial cancer if not taken with progestin in woman with a uterus. It also increases the risk of stroke, developing gallstones and urinary incontinence.
Progestin therapy alone such as medroxy-progesterone, was shown not to relieve vaginal dryness and may increase the risk of atherosclerosis as well as negative effects on cholesterol. The effects such as coronary artery disease, stroke, breast cancer, blood clots and breast cancer are yet unknown. However, micronized progesterone appears to have fewer side effects and may not adversely affect cholesterol.
Combination therapy (estrogen plus progestin) was shown to increase the risk of coronary artery disease, stroke, breast cancer blood clots dementia and urinary incontinence.
There are other drugs that have been recommended to woman for treating symptoms of per-menopause and menopausal symptoms. Selective Estrogen Receptor Modulators (SERMs) function like estrogen in certain parts of the body and as an anti-estrogen in other areas. The drug Raloxifene, has been given to prevent and treat osteoporosis. Like estrogen, it helps with bone loss. Recently, it has shown to decrease the risk of breast cancer in postmenopausal women. However, it has been shown to increase the risk of blood clots, increase hot flashes in 1 out of 10 women and can cause leg cramps.
Selective Serotonin Reuptake Inhibitors (SSRIs) such as Fluoxetine, Sertraline, and Paroxetine have been prescribed to relieve anxiety, depression irritability and insomnia with an “a side” for relieving hot flashes. Depending on the drug, these SSRIs can cause such side effects as sexual dysfunction, nausea, diarrhea, weight loss (short term use), weight gain (long term use), dry mouth, mental confusion, and can have effects on blood pressure.
Statins (lipid lowering drugs) are sometimes prescribed for preventing atheroslerosis and coronary artery disease. The side effects of these drugs include constipation, loose stool, abdominal pain, nausea, bloating, rash, muscle weakness, muscle inflammation, increased levels of liver enzymes and fatigue.
Antihypertensive drugs (used to treat high blood pressure), such as the drug Clonidine, have also been given to lessen hot flashes. But again, caution should be used as they can cause drowsiness, dry mouth and fatigue, abnormally slow heart rate, rebound high blood pressure when the drug is withdrawn as well as sexual dysfunction.
Testosterone (used in combination with estrogen) has been given to increase sex drive in women. It does prevent osteoporosis and may improve mood, yet it decreases HDL cholesterol (the good cholesterol) as well as having some masculinizing effects such as lowering the voice and facial hair growth. They also increase the risk of liver problems including liver cancer.
The Holistic Approach In Treating Menopause
The Eastern approach to treating menopause as a holistic therapy is connecting the relationship between the mental, emotional, physical and spiritual outlook. The Eastern medicine paradigm treats the whole person, as the belief is that nothing works independent of each other, but in conjunction with one another. This paradigm also sees symptoms as a differential factor. As an example; hot flashes and night sweats are one diagnosis where as, hot flashes, night sweats with cold hands and feet is a completely different diagnosis. The Eastern approach also looks at lifestyle concerns, environmental issues and diet, nutritional choices and exercise as a complete effort in treating menopause.
With this said, a holistic approach must have a course of action. A holistic therapy needs to address all of the above aspects (mental, emotional, physical and spiritual) in order to be “whole”. I have many women come into my practice to tell me how they have begun dabbling in alternative medicine for their situation. I do think it is wonderful that more and more patient are becoming empowered and willing to take responsibility for their health and health care. What I would love to see more of is addressing all aspects of their whole selves.
For example, I had a new patient come to me for hot flashes that are worse in the morning, with fatigue, loose stool and frequent urination. Here stress levels were extremely high and she was constantly complaining about gas and bloating. Her solution was to take Vitex (chasteberry) to address hot flashes and DHEA, because she read somewhere this could help. She was taking an over the counter remedy for here loose stool and a prescription from her doctor for the frequent urination. She did nothing to address her stress levels and was eating whatever she wanted because she was so stressed and called herself an “emotional eater”. This was here holistic approach.
Unfortunately, not only was she taking an inappropriate combination of medications and herbal supplements, she was not taking the correct doses. She was not addressing the root of her problem (menopause agitated by stress) and was sabotaging herself with what she was putting in her mouth. She was simply addressing “symptoms”, which is no better than a Western approach. Of course, symptoms must be address, but the root of the problem will continue to remain and rebound back into her life the minute her remedies for the symptoms wear off. By reaching down to the root of the problem and “rebuilding and fortifying” the foundation, she can affectively resolve so much more of her imbalances.
A holistic course of action takes into account the mental, emotional, physical and spiritual balance achieved throughout life. It is the accumulation of the whole based on our constitutional health (what we are born with/into) and the lifestyles choices we make during our stay here. Following a holistic lifestyle should be one of continuous education, exploration and self-discovery. So many, many people give their lives and bodies away to the trust of. advertisers, doctors, friends and family members.
Learn to listen to your body and your intuition. Trust only your body, as it will do its best to take care of itself. And when it does not, a health professional is a good place to get an idea as to what is happening. But… no matter who you see for your health, I encourage you to get a second and even third opinion. All health care professionals will give you their opinion, based on their expertise, signs, symptoms, physical findings or tests. Again, I stress the word opinion, as this is exactly what it is. An opinion is based on a culmination of information originating from everything including hearsay to practical means. Some practitioner’s scope is broad and far reaching. While other practitioner’s scope of practice is not so amassed or open. Regardless, listen and learn. The more responsibility you take for your health the greater your knowledge grows. This goes for what you read in books and on the Internet as well. Everyone with an opinion has a belief or set of beliefs that formulate that opinion. Sometimes, the formulation of these beliefs into an opinion may not always be the most altruistic. Discern information you receive carefully. Crosscheck this information and do more research before giving yourself and your body over freely. Formulate your opinion or belief system based on your own research as well. Be a well-informed patient, first.
A holistic course of action for peri-menopause and menopause needs to address the change in the body’s physical characteristics. The mental and emotional side of menopause is often an even larger hurdle to overcome, as our attitudes and beliefs create our mind/body structure. Elements that are seldom looked at during this seventh cycle of life include sleep patterns, bowel movements, urination, digestion and the assimilation of food in the body, body temperature in general, body temperature in specific areas, movement and exercise, food choices, situations that bring us stress and joy and mental attitudes that contribute to our spiritual growth.
In Eastern medicine the kidneys are looked at as an entire system, not just an anatomical object. The “energy” of the kidney system encompasses not only the physical traits of regulating blood, waste products and water metabolism, but dominates reproduction growth and development. The kidney system is the producer of marrow (or essence), dominates water metabolism working in conjunction with the urinary bladder and the lungs. The kidney “system” in Eastern medicine is the dominant force in our life vitality. They share a corresponding emotional connection (fear), tissues (the ears), sensory organ (bones) and element (water). As we age, the energy of the kidneys decline. Since the kidneys are associated with our essence, they are the main organs treated during menopause. Kidney disorders are generally of a cold and or deficient nature. Therefore, tonifying and moistening the kidneys is the primary approach.
The bladders along with the kidneys form an important pair. As they are anatomically connected through the ureters, the bladder not only excretes waste material but also is a temporary receptacle for vital fluid retention and transformation. The bladder functions largely at its optimum when the kidneys are normal, strong and healthy. Therefore, water is metabolized properly and the storage and excretion of waste through the bladder, is related to the general function of the kidneys.
A Look At Lifestyle
Lifestyle factors include situations that occur during our lifetime based on our choices, such as smoking, chemical dependency, obesity, type 2 diabetes and dietary choices. Of course it is never just one factor that is an indicator of this change, but a host of factors accumulating over a lifetime. Many times, the symptoms from the aging process are confused with symptoms of peri/menopause. In general, symptoms associated with the aging process include weight gain; change in sleep patterns, hearing loss, a rise in blood pressure and/or cholesterol. These changes are often confused as a direct result of peri/menopause. Often, by changing some lifestyle choices these symptoms of aging lessen or disappear all together. Regardless, if symptoms are due to peri/menopause lifestyle/aging problems, the solutions can affect both outcomes.
Not smoking, regular exercise and decreasing stress levels may help with sleep problems but will also help relieve hot flashes.
Weight gain increases body fat, which in turn affects hormone levels. By reducing the number of calories per day to 1200, a decrease in weight will occur. Increasing your exercise to 4 days will have additional benefits such as lowering cholesterol and burning more calories. In addition, weight bearing exercises (walking, weight training, jogging…) along with supplementing such as 1500mg of calcium and 400mg of vitamin D in divided doses, will not only help with sleep but will increase bone density as well.
Vaginal dryness can often be an issue as hormone levels fluctuate. Vaginal lubricants can be helpful. Staying sexually active will increase blood flow to surrounding tissue. A wonderful natural lubricant is a paste made of aloe vera gel and slippery elm powder. Use a tablespoon of pure aloe vera gel and slowly stir in the slippery elm powder to create a consistency of toothpaste. Insert a teaspoon of this paste inside the vagina at night to relive dryness. Vaginal itching can be addressed by applying a non-fragrant vitamin E cream or by opening up a vitamin E capsule and applying the oil directly.
Kegal exercises can and should be done several times daily to keep the pelvic floor tight and strong. These are wonderful exercises for bladder control due to shrinkage of urethral and vaginal membranes, which can cause incontinence.
Stress plays a major role in all biological and physiological functions. Exercise, meditation, yoga, relaxation techniques, massage, acupuncture, guided imagery are just a few therapies that can all help to relieve depression, anxiety, irritability, mental forgetfulness, fuzziness, over thinking and fatigue. Stress puts a great deal of burden on the adrenal glands, which, in turn, causes them to work harder. This decreases the amount of hormones needed to help reduce the effects of declining estrogen needed by the body.
Exercise, like work, eating, sleeping… must be scheduled into your day in order for you to do it! You know when to go to work, you know when to eat, and you must know when to exercise. The best way to do this is to make it apart of your day.
Treating Hot Flashes is probably the number one issue with the change from reproductive to the non-reproductive years. Nutritional recommendations must be followed (see below). Getting long-term stress issues under control has shown to be extremely important. Regulating the body’s cooling mechanism through regular exercise is imperative.
Nutritional Advise
Food as medicine has been used for centuries to treat a wide variety of disorders. Used for prevention as well as treating symptoms, the healing power of food and herbs has been documented for centuries. Eating a healthy diet, maintaining a healthy weight, exercising regularly and quitting smoking if you smoke, can help protect against heart disease, osteoporosis and some types of cancer.
Eating food rich in plant estrogens (phytoestrogens) can be helpful for many women.
A plant-based diet rich in phytoestrogens has been shown to decrease symptoms of hot flashes and night sweats. Phytoestrogens are naturally occurring, non-steroidal plants. They are sometimes referred to as “dietary estrogens” as they are plant based “foods” with a similar chemical structure to estradiol. As they mildly mimic or sometimes act as antagonists to estrogen. These would include:
-black current seed oil
-dates
-flaxseed (crushed)
-pomegranates
-primrose oil
-miso
-soy milk
-soy beans
-tempeh
-tofu
Western herbs such as anise, black cohosh, fennel, raspberry, sarsaparilla, squaw vine, unicorn root, and wild yam root are natural estrogen (precursors) promoters. Gotu kola and danq gui can be used to relieve hot flashes, depression and vaginal dryness. These herbs are best balanced in Eastern herbal formulas that are specific to particular patterns (group of symptoms). (See below)
Consider vitamin E, emulsified, mixed tocopherols, (400 – 800 iu) daily as this can reduce hot flashes, assist in lubrication, tissue repair and improves circulation.
Vitamin B complex (mixed B’s) assist in improving circulation and cellular function, improving adrenal function, minimizing water retention and maintains the health of nerves, hair, skin, eyes, liver and gastrointestinal functions.
Lecithin granules (1 tbs 3 times daily before meals) or capsules (1200 mg 3 times daily) before meals, acts as an important emulsifier for Vitamin E to help reduce hot flashes.
Foods to Avoid
Dairy products and meat products are foods that can irritate the heat mechanism in the body triggering and/or aggravating hot flashes. Limit your dairy consumption to low fat yogurt and/or buttermilk. Other aggravators include sugar, spicy foods, hot beverages, caffeine and alcohol.
A Differential Diagnosis of Symptoms
The Eastern approach to treating any disorder is by treating the root of the problem. Branch treatments (treating just the symptoms one sees) are the equivalent to putting a band-aid on a broken bone. Treating perimenopause and menopause requires an in depth look at signs and symptoms, past medical history, family medical history and every symptom or sign, even if it does not seem related to the current problem.
Symptoms of more blood/body/essence fluid deficiency:
Dizziness, exhaustion, tinnitus, malar flush, night sweats, hot flashes, mental restlessness, heat in palms and feet, sore weak lower back and/or knees, dry mouth, dry throat, dry hair, dry skin, itching, constipation, anxiety, irritability, headaches or cold feet. Premature graying of hair, low sperm count in males, decreased menstrual flow in women, infertility in women or heel pain. The tongue often presents as a red tongue body with little or no coat or peeling coat. The pulse can feel empty or fine, deep or weak. It may also appear to be overflowing or in excess closest to the wrist.
Symptoms of more energetic deficiency
Hot flashes, but cold hands and feet (extremities), night sweating (early morning), pale face, depression, chilliness, backache, edema of the ankles. Pale or dark complexion, listless spirit, an aversion to cold, low sex drive, weak or cold low back, frequent urination or clear and profuse, clear vaginal discharge and/or edema. The tongue is pale tender, sometimes with tooth marks, and a white and/or slippery tongue coat with a fine deep pulse.
Symptoms of both an energetic as well as blood/body fluid deficiency
Hot flashes, but cold hands and feet, (especially fingers and toes) nightsweats, frequent urination, which tends to look pale, flushing around the neck, when talking, slight agitation, chilliness, dry throat, dizziness, tinnitus, backache, poor memory or vivid dreams and insomnia.. Tongue can be pale or red depends on predominate deficiency. Pulse feels empty or very fine and rapid.
When differentiating such symptoms, it is important to realize which are the most dominant set of symptoms and which are secondary. Not everyone would have all symptoms in one category. They may have a few in one category and a few in another. The more dominant or most symptoms from one category is usually the predominant deficiency. Once you can identify the more predominant deficiency then it is easier to pinpoint remedy-specific formulations to treat and tonify the situation.
Additional underlying patterns that aggravate the above symptoms include Dampness (being overweight, difficulty getting out of bed in the morning, a feeling of heaviness in the body) Vital Energy Stagnation (tiredness, fatigue, listless speech…) or Blood Stasis (sharp stabbing pains anywhere in the body, poor circulation…)
The Controversy Around “Bio-Identical” Hormones
Bioidentical hormones are supposedly chemically identical to those made by the human body and are often described as "natural." Many of those available today are custom-mixed or "compounded," in compound pharmacies. The term "bioidentical" is more of a marketing term than a medical one. Different groups define the term differently.
The FDA has warned seven pharmacies that sell these compounded "bioidentical" hormones against making misleading claims about safety and efficacy of their products. The FDA stated that the compounded products were no safer than conventional forms of hormone replacement therapy (HRT). Premarin and most other FDA-approved hormone therapy contain synthetic hormones. Misleading claims by some pharmacies were made about their compounded hormones stating that they could prevent or treat such diseases as Alzheimer's, stroke, and some cancers, and yet could not show any credible evidence to supports those claims. However, the agency stopped short of prohibiting the pharmacies from filling doctors' prescriptions for these products.
Wyeth, the manufacturer of Premarin and Prempro, petitioned the FDA in 2005 to restrict the availability of compounded "bio-identical" hormones. According to the Wall Street Journal, sales of Premarin and Prempro have dropped by about half since 2002 when two big government-sponsored studies from the The Women's Health Initiative (WHI) found that the drugs raised the risks of breast cancer, stroke, and heart attack.
Several FDA-approved bioidentical hormone products are available by prescription and are federally regulated and tested for purity, potency, efficacy, and safety, including 17-beta-estradiol (Estrace, Climara), estrone (Ortho-Est, Ogen), and micronized progesterone (Prometrium, Prochieve 4%). The term is used mainly for hormones made from a prescription by one of these compounding pharmacists, such as Triest (estriol, estradiol, and estrone), or Biest (estriol and estradiol), which are not approved by the FDA. [1.]
The North American Menopause Society and the American College of Obstetricians and Gynecologists have raised concerns about the “bioidentical” hormones dispensed by compounding pharmacies. Both groups have questioned whether the hormones have been adequately tested and maintain that there is no evidence showing that compounded hormones are better or safer than the pharmaceutical drugs. In fact, they have the same risks as synthetic hormones like Premarin and Prempro, but better side effect panels.
I feel the bioidentical controversy will go on and on primarily because advertising and marketing agency have now latched on to a “marketing concept” and are truly running with it. I do not condone this practice while advocating “false hope and false claims”. Antidotal evidence is important as it can lead to an accumulative base of knowledge that can encourage more studies to be done. The fact that advertisers and companies are stating claims that are misleading to the public, just demoralizes the entire industry and undermines the foundation and direction in which these therapies need to go.
This is where a safer alternative for “bio-identical’ formulas comes in. An herb or herbal combination are not hormones, but work as a precursor, which in turn, stimulates your body’s own metabolism, works in conjunction with endocrine system’s mechanism of action in order to bring your own system back into balance.
Formulations of Eastern Medicinals
The majority of the world’s population since has used herbal treatments as front line medicine before recorded history, and is still the most widely utilized medical system in the world today.
Herbs are the medicinals in holistic medicine. Chinese herbs are specifically used to create decoctions or “teas” and are a very powerful part of healing dis-ease. Herbal decoctions can also be given in "tea pills", tinctures, and granules or as an external patch, compress or bath. Chinese herbal medicine uses several hundred substances, mostly of plant origin (roots, seeds, flowers, twigs, crystals, bones and barks). These are hardly ever prescribed singly. They are combined into a formula, which usually contains between 8 and 12 ingredients. It is the "herbal synergy" that seems to be the strength behind Chinese herbal formulas. The exact combination is adjusted to suit the patient's individual condition, and is likely to be altered as the treatment progresses to take account of changes that have occurred. It is therefore a very flexible system, which can be closely developed to the needs of the patient. Adverse reactions to herbs are extremely rare and are negligible when compared to those commonly produced by pharmaceutical drugs.
The methodology behind an herb's function, indication, contraindication, preparation and use are numerous. Herbs are categorized according to their properties, taste, temperature and their "herbal synergy" is created by using a dominant (chief herb) with a deputy, assistants and envoy herbs in a combination to produce a better effect on one particular organ or condition. The chief herb "rules" the prescription and has the primary effect on the disease condition. The deputy and assistant herbs help to synergistically increase the effect of the chief herb, to treat an illness, as well as, "supervise" the function of other herbs.
The methodology behind an herb's function, indication, contraindication, preparation and use are numerous. Herbs are categorized according to their properties. By doing this, it allows an herbologist to more efficiently utilize the power behind an herb to its fullest.
Herbs are categorized by:
1. Temperature
Hot, cold, (sligthly) warm, (slightly cool), or neutral.
2. Taste
Acrid- Disperses and moves (lung channel/organ) (see *Aromatic)
Sweet- Harmonizes, tonifies, moistens (spleen channel/organ)
Bland- Leaches dampness, promotes urination (urinary bladder channel/organ)
Bitter- Drains and dry (heart channel/organ) (see **3 Aspects)
Sour- Prevents/stops abnormal leakage of fluids(liver channel/organ)(see ***Astringent)
Salty- Purge and softens (kidney channel)
*Aromatic is an aspect of Acrid (spicy). Aromatic is considered a taste and not only disperses and moves, but also penetrates turbidity and dampness, opens orifices. (Often used on Middle Jao)
**3 Aspects of drain and dry are that they, 1. Move through a bowel movement, 2. Move downward, 3. Drain fire (inflammation).
***Astringent can be an aspect of Sour. Astringent alone prevents/soaks up fluids. Astringent and sour together can generate fluids.
3. Directional Tendencies
1. Rise/ascend- moves upward and outward
2. Floating- keeps organs from collapsing
(acrid, sweet warm, hot herbs)
3. Fall/descending- moving downward
4. Sink- keeps organs anchored
(bitter, sour, salty, astringent cool, cold herbs)
This is why the "herbal synergy" that seems to be the strength behind Chinese herbal formulas, is the major difference behind any other form of herbal medicine. The exact combination of herbs can constantly be adjusted to suit the patient's individual condition, and is likely to be altered as the treatment progresses to take into account the changes that have occurred.
Here are ways herbs are used:
*Pills, Capsules, Granules: is the most popular form. These are herbs ground into powder then rolled into "teapills", or put into capsules or given in granule form. Herbal formulas tend to be created for a single problem or nest of related problems and their specific pattern of disharmony.
*Tinctures: Herbal remedies are also prescribed in tincture form and are the previously fresh herb in well-preserved, highly concentrated form. These liquid, as well as, concentrated forms of extracted herbs are preserved in their freshest form.
*Essence: Steam distillation or cold pressing results in herbs as essential oils.
*Poultice: are macerated or chopped herbs that are placed directly on the skin and a hot, moist bandage is applied.
*Infusions: are used when you are working with the most delicate part of the herb-the leaves flowers, fruits and seeds. Infusion time can be approximately 3-5 minutes.
*Decoctions: are used to extract the tougher part of the herb-bark, berries and roots. Decoction time can be between 45 minutes to 90 minutes.
Herb and Drug Interactions
Recent concerns over the past few years about herb and drug interactions have come to light. The reality of many of these situations has to do more with the abuse, overdosing and inappropriate use than anything else. The nature of herb-drug interactions is not a chemical interaction between a drug and an herb producing toxicity, it is the interactions of an herbal component causing either an increase or decrease in the amount of a drug in the blood stream.
A decrease in the amount of drug could occur by herb components binding up the drug and preventing it from getting into the blood or by stimulating the production and activity of enzymes that lower the active ingredients in a drug making the drug ineffective; an increase in drug dosage could make it reach levels that produce side effects.
In Eastern medicine, it is sometimes useful for herbs to be combined with drugs. These combinations are based on theories or evidence about using particular herbs with certain drugs. There are several studies from prominent Chinese hospitals, which show how certain herbs reduce the side effects of drugs and help them to perform their function better; in turn, drugs will make an herb formula work more strongly and quickly. Since these combinations are up to the professional, it is to prove a point that drug and herbal combinations are not always a detriment. That great benefit can come from this research.
For the consumer, taking herbs internally can have fantastic benefits, especially when prescribed under the guide of a licensed herbalist. If you are prescribed herbs while taking Western medication, the following guidelines apply below.
As a general rule, if you are prescribed herbs while taking other than the Western medication mentioned below, you should take your herbs two hours before or two hours after your Western medication. This window allows for a safe and effective time frame, where no interactions would occur. This is due to the gastro-emptying time in the digestive tract.
Taking Herbs Internally
Herbal medicine is a natural and healing form of therapy that can be very beneficial, long term. There is common sense precautions that must be take when using herbal medicine internally.
*Never take herbal medicine internally if you are nursing or pregnant.
*If unusual symptoms occur, stop taking the formula and usually symptoms will disappear rather quickly.
*When also on prescribed Western drugs, great care should be taken. Anti-inflammatory drugs and antibiotics can upset the stomach and irritate the intestinal tract. Herbal formulas can tax the digestive tract. Do not take herbal medicine and anti- inflammatories/antibiotics together at the same time.
*Blood thinners prevent clots from forming in the blood vessels. These are very strong western drugs that must be monitored carefully. Drugs used to thin the blood, often interfere with herbs for trauma, since they both have the same action. The combination can interfere with western drugs and may cause dizziness or fainting. Do not take blood thinning herbal medicine with western blood thinners.
* Heart medications and herbs used for trauma both effect the circulation of blood. Although these herbs have a different method of action, in conjunction with heart medication, there can be unwanted side effects.
*Seizure medications work on brain function and in conjunction with Chinese herbs, should not be taken at the same time and should only be done under supervision.
The Safety of Herbs
There are many excellent companies that subject their herbs to testing more rigorous than the FDA requires. Many of the best known pharmacies and herbal companies work with CMA Testing, an independent, internationally accredited (HOKLAS certified) laboratory to test herbs for heavy metals such as Arsenic, Lead, Mercury, and Cadmium, as well as pesticide residues such as DDT, and Hexochlorobenzene (HCB) related compounds. In addition to meeting international standards, 34 international accrediting bodies, including the American Association for Laboratory Accreditation (A2LA), recognize HOKLAS certification. Through voluntary testing, the best in the industry are helping to raise the industry standard, and ensuring that patients receive only the finest quality herbs. Patented formulations from such reputable companies as Stork Brand, Kan, Crane, Golden Flower… are just a few of these reputable companies who manufactured in an internationally certified GMP. Each formulation is batch tested at the manufacturer for heavy metal contents, microbial count, and pesticides. Further, independent testing is done by an internationally recognized laboratory to verify results. All testing standards exceed USP standards in the United States. There is no reason for reservation when seeing a professional herbalist, acupuncture or licensed naturopath who uses reputable sources.
In conclusion
Hormone replacement therapy is an important decision every woman needs to make. It is imperative to way the risks over the benefits. It is critical to scrutinize your past medical history, lifestyle and symptomology. It is also important to understand the difference between natural, synthetic and “bioidentical” hormones.
Lifestyle plays a major role in how a woman experiences peri/menopause. Lifestyle factors include situations that occur during our lifetime based on our choices, such as smoking, chemical dependency, obesity, type 2 diabetes and dietary choices. Of course it is never just one factor that is an indicator of this change, but a host of factors accumulating over time.
A safer alternative to hormone replacement therapy and “bio-identicasl’ are herbal formulations prepared by a licensed professional practitioner of Eastern medicine.
It is the "herbal synergy" that seems to be the strength behind Chinese herbal formulas. The exact combination is adjusted to suit the patient's individual condition, and is likely to be altered as the treatment progresses to take account of changes that have occurred. It is therefore a very flexible system, which can be closely developed to the needs of the patient.
All women, regardless of their choice to use HRT or not, should:
1. See their healthcare professional for recommended visits for breast, cervical, colon, and skin cancer screening, and undergo laboratory tests for evaluating bone density, lipids, glucose, thyroid, and other tests according to their personal and family history. Blood pressure, height, and weight are also important measurements to evaluate.
2. Stop smoking.
3. Maintain or achieve healthy weight through exercise
4. Pay attention to what and how you are eating. Be conscious of the foods that trigger hot flashes, make you feel bad after you eat or do not make you feel your most optimum.
5. Stay active, including regular weight-bearing exercise.
6. Limit alcohol intake.
7. Try to eliminate stresses and conflicts that decrease overall well being.
8. Have something to look forward to, whether a vacation, a new interest, or family events like the birth of a grandchild.
9. Follow the recommendations of their healthcare professional with regard to ways to prevent diseases like heart disease and stroke or the complications of diseases such as diabetes and osteoporosis.
10. Recognize that happiness and long-term health cannot be manufactured or found in an herb or other product, but found through a variety of strategies that are different for every woman.
Seek out a licensed alternative health care professional who understands how to treat peri/menopause. They should be willing to explore with you all aspects of healing mind, body and spirit. Your practitioner should be certified in treating with herbal medicine, preferably one who is well versed in Eastern formulations. They should be able to help you set up a regime or course of action in your attempt to make your transition as smooth as possible.
About the Author:
Andrew Pacholyk, MS, L.Ac. has obtained a Four-Year Masters of Science in Traditional Oriental Medicine (M.S.T.O.M.) degree from Pacific College of Oriental Medicine in New York City. He is a Licensed Acupuncturist (NY) and is a board certified Diplomate in Oriental Medicine from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). He is certified by the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM) in Clean Needle Technique. Andrew has a board certification in Chinese herbology. Andrew is a graduate of New York State University, College at New Paltz.
Andrew specializes in rejuvenating naturopathic therapies based in the ancient Chinese Medical approach to Endocrinology, Gynecology and Pain Management. By improving circulation and an increase in metabolism, Andrew treats hormonal imbalance, infertility, menopause and menstrual disorders, as well as increasing blood flow and vital energy in order to decrease pain, trauma and its associated symptoms. Andrew, through his New York City clinic, ProAcuMed, his many classes, private teachings, cross country lectures, health community and his website, has helped thousands of thoughtful people with his diagnostics and natural prescriptives.
References
1. Internal Medicine Issue: January 2007 Controversy Swirls Around Bioidentical Hormone Therapy by Charles Bankhead
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8. Dewey, W.A. Practical Homeopathic Therapeutics. New Delhi, India: Jain Publising Co
9. Gibson DM. First Aid Homeopathy. The British Homeopathic Association. London, England
10. Duke, J.A. Handbook of Medicinal Herbs. Boca Raton, FL: CRC Press, 1985
11. Duke, James A. Dr., The Green Pharmacy
12. Habif TP, et al. (2001). Acne. In Skin Disease: Diagnosis and Treatment, pp. 72–83. St. Louis: Mosby
13. Hahnemann, Samuel. Organon of the Medical Art. 6th ed. Edited and annotated by Wenda B. O’Reilly. Redmond, Washington, 1996.
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16. Lawless, Julia. "The Illustrated Encyclopedia of Essential Oils". Rockport, MA: Element Books, Inc., 1995.
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19. Mindell, Earl, Earl Mindell's Herb Bible
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22. Myss, Caroline Ph.D. “Anatomy of the Spirit”, Three Rivers Press (August 26, 1997)
23. National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research.
24. Shealy, Norman C., The Illustrated Encyclopedia of Natural Remedies
25. TCM: tcm.health-info.org/
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27. Tierra, Michael, Planetary Herbology
28. Tierra, Michael, Lust, John, The Natural Remedy Bible
29. World Health Organization (WHO), http://www.who.int/en
30. 2. Li Zhongzi, A Primer of Medical Objectives 1637
31. Pharmacokinetics of Estradiol Valerate 2mg + Dienogest 2mg (Climodien (Reg.) 2/2) After Single and Repeated Oral Administration in Healthy Postmenopausal Women
H. Zimmerman, Jenapharm GmbH & Co. KG, Jena, Germany; J.J. Thebault, T. Duvauchelle, A. Mignot, A. Renoux, V. Gualano, ASTER-CEPHAC, Paris and Saint Benoît, France
Published: 08/01/2000
32. Metabolic, Inflammatory and Haemostatic Effects of a Low-Dose Continuous Combined HRT in Women With Diabetes: Potentially Safer With Respect to Vascular Risk? Joyce McKenzie; Alan J. Jaap; Stephen Gallacher; Anne Kelly; Lynne Crawford; Ian A. Greer; Ann Rumley; John R. Petrie; Gordon D. Lowe; Kenneth Paterson; Naveed Sattar
33. Salpeter SR, Walsh JME, Greyber E, et al. Brief report: Coronary heart disease events associated with hormone therapy in younger and older women. A meta-analysis. J Gen Intern Med 2006; 21:363-366. Salpeter SRR, Walsh JME, Ormiston TM, et al. Meta-analysis: effect of hormone replacement therapy on components of the metabolic system in postmenopausal women. Diabetes Obes Metab 2005; DOI:10.1111/j.1463-1326.2005.00545. Available at:http://www.blackwell-synergy.com
34. Early HRT Use Linked to Reduced Risk of Alzheimer's Disease, All-Cause Dementia
Caroline Cassels American Academy of Neurology 59th Annual Meeting: Abstract S31.004. April 28 – May 5, 2007.
35. Changes in Bone Density After Stopping HRT Published: 01/16/2003 Gallagher JC et al. Effect of discontinuation of estrogen, calcitriol, and the combination of both on bone density and bone markers. J Clin Endocrinol Metab 2002 Nov; 87:4914-23.
36. Measuring Estradiol Levels Recommended for Women Treated With HRT Mindy Hung J Womens Health. 2003;12(8):757-768 Reviewed by Gary D. Vogin, MD
7/29/2009 5:04:16 AM
Written by Andrew Pacholyk
I specialize in hormonal balancing, endocrine and gynecological abnormalities, as well as, decreasing pain, trauma, gastrointestinal issues and their associated problems.
I have obtained a Four-Year Masters of Science in Traditional Oriental Medicine (M.S.T.O.M.) degree from Pacific College of Oriental Medicine in Ne...
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Website: http://www.peacefulmind.com/
Comments
http://blue.wellness.com/blog/20543/alternative-answers-for-hrt-hormone-replacement-therapy/andrew-pacholyk
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Posted by Dante
http://blue.wellness.com/blog/20543/alternative-answers-for-hrt-hormone-replacement-therapy/andrew-pacholyk
Brillant article! I have taken the liberty of looking up Dr. Pacholyk and actually ordering his menopause formula! I have been on this for 6 months and feel fantastic! I have thrown out all my prescriptions and creams and gone the natural way! I am so grateful, I found this article and the expert knowledge of Dr. Pacholyk
Posted by supersunshine
http://blue.wellness.com/blog/20543/alternative-answers-for-hrt-hormone-replacement-therapy/andrew-pacholyk
Spoken just like a man! I have been on bioidenticals for over a year now and considering the state I was in before I had them I can assure you no amount of homeopathic remedies would have made a dent. Not to be disrespectful, but you're way off base.
Posted by SusanR
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