Here is a video that highlights some of the same herbs that were mentionned in the article I posted below: Natural Remedies for Menopause. The video seems to have gotten cut off a bit at the end, not sure why. Hopefully we get to see most of what was said.
Saturday, July 18, 2009
Wednesday, July 15, 2009
Relieving Menopausal Symptoms Naturally
The following article on natural remedies for menopause is from LifeExtension.com. It was originally the cover story for the February 2009 issue of Life Extensions magazine. It is reprinted here in its entirety, with permission from LifeExtension.com. Get a complimentary subscription to Life Extension magazine
As women approach menopause, they become susceptible to a host of complaints, ranging from night sweats and low libido to mood disorders and insomnia. One of the main culprits in menopausal discomforts is declining levels of estrogen.
As women approach menopause (usually around age 50), they commonly experience symptoms, such as hot flashes (also called “hot flushes”), mood disorders, irritability, loss of libido, insomnia, depression, and other discomforts.
In light of this rising tide of negative data, many women have been turning back to traditional herbal remedies. While these phytoestrogens may meet the needs of some menopausal women, others find that they do not offer sufficient relief from menopausal discomforts.2 They long for one that is safe enough not to cause them health concerns, yet still strong enough to reliably suppress their hot flashes and other common discomforts and complaints.
Although the main use of hops has always been in brewing beer, it has been believed since ancient times to have certain medicinal properties, particularly as a sedative and hypnotic (sleep-inducing agent).4,11
In the first randomized, double-blind, placebo-controlled study of its kind, Belgian researchers evaluated the effects of a hops extract enriched in 8-PN for the relief of hot flashes and other menopausal discomforts in 67 naturally menopausal (ovaries not surgically removed) women, aged 45 to 60 years.5 Before treatment, the 67 participating women all reported experiencing mild-to-severe menopausal discomforts, including two to five hot flashes per day. They were randomly divided into three groups: 1) 8-PN 100 mcg/day; 2) 8‑PN 250 mcg/day; and 3) placebo. At intervals of six and 12 weeks, the researchers assessed the women’s frequency of hot flashes along with their other menopausal discomforts and complaints.
Figure 1. 8-PN at doses of 100 mcg/day and 250 mcg/day signifi cantly reduced hot fl ash frequency scores after six weeks of treatment, compared with placebo.5
Hydroxymatairesinol (HMR) is a phytoestrogen of the plant lignan class that is extracted from knots of Norway spruce trees (Picea abies).27
Plant lignans (e.g., those from flax seed, sesame seeds, rye, wheat, oat, barley, pumpkin seeds, soybeans, broccoli, beans, and some berries) have been studied most for their anticancer potential, including cancers of the breast, endometrium, colon, and prostate.21-25,28 Evidence indicates that plant lignans acquire their anticancer properties only after being ingested and converted by intestinal bacteria to mammalian lignans, particularly enterolactone and enterodiol.29
The above article on natural remedies for menopause is from LifeExtension.com. It was originally the cover story for the February 2009 issue of Life Extensions magazine. It is reprinted here in its entirety, with permission from LifeExtension.com. Get a complimentary subscription to Life Extension magazine
Relieving Menopausal Symptoms Naturally
As women approach menopause, they become susceptible to a host of complaints, ranging from night sweats and low libido to mood disorders and insomnia. One of the main culprits in menopausal discomforts is declining levels of estrogen.Ever since the Women’s Health Initiative revealed potentially dangerous side effects of estrogen drugs like Premarin®, women have been seeking comparative but safer methods to relieve menopausal concerns. Plant-based phytoestrogens are among the most promising of these natural menopause solutions that capture the benefits of estrogen without its side effects.
Now, scientists have discovered that the hops plant contains the most powerful phytoestrogen ever identified. Human studies show that this potent compound—known as 8-prenylnaringenin or 8-PN—effectively combats menopausal complaints and shows promise in protecting against bone loss and heart disease. For added protection, the estrogenic properties of 8-PN may also be complemented by the Norway spruce-derived phytoestrogen hydroxymatairesinol (HMR).
Together, this combination of phytonutrients promises to naturally and safely restore well-being to women during their menopausal years and beyond.
The Challenges of Menopause
As women approach menopause (usually around age 50), they commonly experience symptoms, such as hot flashes (also called “hot flushes”), mood disorders, irritability, loss of libido, insomnia, depression, and other discomforts. Hot flashes typically begin a year or two before women reach menopause (defined officially as 12 consecutive months with no menstruation) and may last from just a few months up to five years or longer. For some fortunate women, the sudden and intense warmth and sweating of hot flashes and its associated discomforts may occur just a few times a week, but for others, they can strike several times a day, making it hard for them to work, to spend time with friends and family, and even to go out in public. Hot flashes that occur overnight, known as “night sweats,” can make it difficult to get a good night’s sleep.1
The physiologic mechanisms that trigger and control menopausal symptoms are not completely understood, but one thing is eminently clear: they result from the pre-programmed shutdown of a woman’s ovaries and the resulting deficiency of the ovaries’ primary hormonal product, estrogen.
The Search for Solutions
Since ancient times, women have tried to ease their way through the menopausal passage by using various plant-based remedies, such as soy, red clover, flaxseed, black cohosh, and chaste tree berry. Thanks to modern science, we now know that many of the effects of these herbal medicines are due to their constituents known as phytoestrogens, plant-based estrogen-like substances.2 Since phytoestrogens resemble estradiol in their chemical structure and function, they can help substitute for a woman’s declining ovarian estrogen, and thus prevent, or at least modulate, many menopausal symptoms.
For several decades, the pharmaceutical industry’s answer to menopause has been estrogens derived from horse urine (Premarin®) and 100% estradiol products, which they have marketed—with enormous success—as menopausal “hormone replacement therapy” (HRT). Although the highly potent estrogens in these products are quite capable of inhibiting hot flashes and some other symptoms, they carry the risk of potentially serious adverse health consequences—including increased risks of breast cancer and cardiovascular disease—as confirmed in recent years by the results of the Women’s Health Initiative (WHI)3 and other important clinical trials.
In light of this rising tide of negative data, many women have been turning back to traditional herbal remedies. While these phytoestrogens may meet the needs of some menopausal women, others find that they do not offer sufficient relief from menopausal discomforts.2 They long for one that is safe enough not to cause them health concerns, yet still strong enough to reliably suppress their hot flashes and other common discomforts and complaints.Now, that phytoestrogen may finally be at hand. It’s been identified as an extract of the female flower of the hops plant (Humulus lupulus L.). Yes, that’s right, hops, the very same plant used since the Middle Ages to help process and flavor beer, has been found to contain a constituent that is, without question, the most potent phytoestrogen ever tested.4 So effective is this hops extract—now known as 8-prenylnaringenin (8-PN)—that controlled clinical research has shown that most menopausal women who take it experience a rapid and significant reduction in hot flashes and other discomforts.5 And this may just be the beginning of its health benefits. It may also be helpful against osteoporosis and heart disease—with no sign of HRT-like risks.6-8
Moreover, a compelling theory suggests that 8-PN’s anti-hot flash action, as well as its other health benefits, may be magnified when it is combined with another type of common phytoestrogen from a lignan, that is, 7-hydroxymatairesinol (HMR), extracted from Norway spruce trees.9,10 For women approaching menopause or for those already distressed by its symptoms, the combined actions of 8-PN and HMR may be the best news in centuries.
The Estrogenic Effects of Hops
Although the main use of hops has always been in brewing beer, it has been believed since ancient times to have certain medicinal properties, particularly as a sedative and hypnotic (sleep-inducing agent).4,11 Research by German investigators beginning in the 1950s found that crude hops extracts possessed estrogenic activity. In fact, this activity, as tested in animal studies, was many times stronger than that found in any other phytoestrogenic plants.4 In common phytoestrogenic plants, like soy beans, clover, and legumes, the estrogenic activity has long been linked to the presence of high concentrations of chemicals known as isoflavones, especially daidzein and genistein. In nuts and oilseeds (e.g., flaxseed), as well as some cereals, fruits, and vegetables known to have estrogenic properties, a different class of chemicals, known as lignans, was deemed responsible.
Modern scientists from Japan,12,13 Belgium,4 and the UK14 found that the most estrogenically potent compound in the hops cone—and consequently, the most potent phytoestrogen ever isolated—was 8‑prenylnaringenin (8‑PN), a member of a previously unknown class of nonsteroidal phytoestrogens known as prenylflavonoids. Lab studies indicated that the estrogenic actions of 8-PN are several times more potent than daidzein and genistein, but still significantly less estrogenic than estradiol14—in other words, the near ideal blend of power and safety that menopausal women have been craving.
Animal Studies Confirm Estrogenic Effect
Declining levels of estrogen with menopause can result in atrophy of the vaginal epithelium, which is associated with symptoms such as dryness, itching, and burning. Research in ovariectomized rats (ovaries surgically removed) indicates that 8-PN produces mild estrogen-like functions in vaginal and uterine epithelial tissues.15 After three months of treatment with either estradiol or 8-PN, both in low and high doses, examination of the animals’ uteri and vaginas showed that high and low doses of estradiol, and the high dose of 8-PN, caused typical estrogen-related growth in the epithelial tissue of these organs. These results suggest that 8-PN shares many of the typical estrogenic functions of estradiol, but in general, 8-PN is less potent, and may thus be safer.
The first clear indication that 8-PN might be useful for helping suppress hot flashes came from a British study of ovariectomized rats. Just as removing ovarian estrogen is a sure-fire way to trigger hot flashes in women, ovariectomy in rats causes their tail skin temperature to rise. Using a telemetric device to measure the animals’ tail skin temperature, the researchers fed one group of rats a diet that included estradiol and a second group a diet containing 8‑PN. A third control group consumed a normal estrogen-free diet. The results showed that, compared with their pretreatment baselines, both estradiol and 8‑PN significantly lowered the rats’ mean tail skin temperature.16 Dietary phytoestrogens, such as soy isoflavones, have also been shown to suppress elevated tail skin temperature levels in ovariectomized rats, although those effects were less intense than those produced by 8-PN.17
What You Need to Know: Relieving Menopausal Symptoms Naturally
- Hot flashes and other menopausal symptoms are a consequence of the pre-programmed shutdown of the ovaries and the subsequent decline in their primary hormone, estrogen.
- Hormone replacement therapies such as pharmaceutical HRT products made from horse estrogens or 100% estradiol, as well as natural remedies made from phytoestrogens (e.g., isoflavones) are designed to provide the body with estrogen substitutes that ideally prevent menopausal symptoms. Unfortunately, pharmaceutical HRT products can be potentially dangerous, whereas natural remedies may be too mild to produce desired effects in some women.
- Recently, an extract of the hops cone has been found to contain a previously unknown class of nonsteroidal phytoestrogens (prenylflavonoids), of which 8-PN is the most potent. Lab studies show 8-PN to be significantly more potent than the isoflavones daidzein and genistein, but significantly less estrogenic than estradiol, thus making for a near ideal balance of potency and safety.
- Clinical studies in postmenopausal women show that daily doses of 8-PN significantly suppress hot flashes, while also reducing associated insomnia, irritability, and heart palpitations. Lab studies suggest that 8-PN may one day provide valuable protection for menopausal women against osteoporosis, heart disease, and breast cancer.
- Research suggests that the lignan phytoestrogen HMR significantly reduces hot flashes by about 50%. Since 8-PN and HMR appear to work via different mechanisms of action, the combination of both phytoestrogens in a single product promises menopausal women the possibility of the most potent and complete natural relief available.
8-PN Suppresses Menopausal Discomforts in Women
In the first randomized, double-blind, placebo-controlled study of its kind, Belgian researchers evaluated the effects of a hops extract enriched in 8-PN for the relief of hot flashes and other menopausal discomforts in 67 naturally menopausal (ovaries not surgically removed) women, aged 45 to 60 years.5 Before treatment, the 67 participating women all reported experiencing mild-to-severe menopausal discomforts, including two to five hot flashes per day. They were randomly divided into three groups: 1) 8-PN 100 mcg/day; 2) 8‑PN 250 mcg/day; and 3) placebo. At intervals of six and 12 weeks, the researchers assessed the women’s frequency of hot flashes along with their other menopausal discomforts and complaints. The results (In Figure 1 below) show that both doses of 8-PN were about equally effective in significantly reducing the average frequency of hot flashes after six and 12 weeks of treatment, compared with placebo. Beyond hot flashes, 8-PN was also superior to placebo in improving total menopausal discomfort score, which included not only hot flashes, but also insomnia, irritability, and heart palpitations as assessed by the women themselves.5
Osteoporosis Protection From 8-PN
Figure 1. 8-PN at doses of 100 mcg/day and 250 mcg/day signifi cantly reduced hot fl ash frequency scores after six weeks of treatment, compared with placebo.58-PN might also help women keep their bones strong after menopause. Since ovarian estrogen helps maintain bone strength, it is common for women to develop the bone-thinning disease osteoporosis as their estrogen levels decline after menopause. Using an established animal model of human hormone-dependent osteoporosis, a team of European researchers assessed bone strength by measuring bone mineral density in ovariectomized rats.8 They found that daily injections of 8-PN inhibited subsequent bone loss compared with control injections without 8-PN; the higher the dose of 8-PN, the better the bone was protected. In fact, the highest dose of 8-PN (18 mg/kg/day) completely prevented bone loss. Another study showed that 8-PN’s bone-health benefits can be achieved through oral supplementation.
When ovariectomized rats received chow containing 8-PN, they demonstrated increased bone mineral density as well as improvements in bone bio-mechanical properties. Genistein-supplemented chow produced smaller benefits for the animals’ bone biomechanical strength.18
These results are very exciting on several fronts. First, this phytoestrogen has been shown to provide a significant anti-osteoporotic benefit. Second, if a dose of estradiol were extrapolated to provide a comparable amount of bone protection in women as 8-PN provided in these rats, it would almost certainly also stimulate excess growth in the endometrium (the lining of the uterus), thus raising the risk of endometrial cancer. Yet, the 8-PN dose that completely prevented osteoporosis in rats stimulated uterine growth at a rate at least 10 times lower than the comparable dose of estradiol, a reassuring sign of 8-PN’s safety. The researchers believe such an extrapolation of 8-PN’s tissue selectivity from rats to humans is valid, because the most important pharmacokinetic parameters (absorption, distribution, metabolism, and excretion) for 8‑PN are largely the same for both species.19 Clearly, though, long-term trials in postmenopausal women are needed to confirm such bone-protective benefits of 8-PN.
Cancer Protection Benefits of 8-PN
Numerous studies have shown that some isoflavones and lignans may have significant cancer-fighting capabilities, especially in the colon, endometrium (uterus), and breast, all important sites of estrogen activity.20-25 Now in vitro research suggests that 8-PN can also be added to this list of possible natural breast cancer inhibitors. Using human MCF-7 cells, an extensively studied model for breast cancer, Italian investigators found that high concentrations of 8-PN slowed the growth of estrogen-sensitive MCF-7 cells by inhibiting their proliferation and inducing their programmed death (apoptosis).7 This promising preliminary finding suggests that 8-PN could one day find applications in breast cancer management strategies. Until human studies are done, women with pre-existing breast cancer may want to avoid using even this natural phytoestrogen (8-PN).
8-PN and Cardiovascular Health
Data from the world-famous Framingham Heart Study have shown that higher dietary consumption of phytoestrogens—primarily isoflavones and lignans—may favorably modulate cardiovascular risk factors, which may lower women’s risk of suffering a heart attack or stroke.26
A recent study in ovariectomized rats suggests that 8‑PN may also have cardiovascular benefits and, in fact, may be superior to natural estradiol in normalizing cardiovascular risk factors. While both estradiol and 8-PN lowered cholesterol and low-density lipo-protein (LDL), estradiol produced the unwanted effects of increasing triglycerides and lowering high-density lipoprotein (HDL). In contrast, 8-PN did not alter triglycerides, and low-dose 8-PN increased levels of beneficial HDL.6 Noted the authors, “taken together, 8-PN displays an anti-atherosclerotic profile that appears to be even more beneficial than the one displayed by [estradiol], and thus might demonstrate a remarkable potential for the prevention of [cardiovascular disease] associated with estrogen deficiency.”
HMR Boosts Postmenopausal Benefits
Hydroxymatairesinol (HMR) is a phytoestrogen of the plant lignan class that is extracted from knots of Norway spruce trees (Picea abies).27
Plant lignans (e.g., those from flax seed, sesame seeds, rye, wheat, oat, barley, pumpkin seeds, soybeans, broccoli, beans, and some berries) have been studied most for their anticancer potential, including cancers of the breast, endometrium, colon, and prostate.21-25,28 Evidence indicates that plant lignans acquire their anticancer properties only after being ingested and converted by intestinal bacteria to mammalian lignans, particularly enterolactone and enterodiol.29 In a study from Finland, HMR was fed to rats pretreated with a chemical that induces mammary tumors. After 51 days of HMR treatment, the researchers found decreased numbers of growing tumors and an increased proportion of regressing and stabilized tumors.9 A Finnish clinical study found a significant association between higher serum human enterolactone levels—attributed to dietary intake of plant lignans—and lower risk of breast cancer among both pre- and postmenopausal women.30
A new study of HMR in postmenopausal women found that eight weeks of treatment with daily doses of 50 mg was very effective, reducing the frequency of hot flashes by 53% compared with baseline. From a mean of about four hot flashes per day before treatment, HMR reduced the rate to about two per day.10
Together, these findings suggest that HMR may offer relief from the discomforts of menopause while providing a rich source of cancer-preventive lignans.
Summary
The hops extract 8-PN has recently been identified as a potent phytoestrogen for alleviating the misery of hot flashes and other symptoms related to the menopausal decline in estrogen levels. 8-PN is significantly more potent than soy isoflavones, the most common phytoestrogens used for alleviating menopausal symptoms naturally, yet it is significantly less estrogenic than estradiol, thus making for a near ideal balance of potency and safety for a natural phytoestrogen. Both animal and clinical studies confirm that 8-PN relieves common menopausal symptoms, and preliminary lab studies suggest that 8-PN may provide protection for postmenopausal women against osteoporosis, breast cancer, and cardiovascular disease. Combining 8-PN with the lignan HMR may magnify these benefits even more. Since HMR and 8-PN appear to relieve menopausal symptoms via different mechanisms, the combination of these two phytoestrogens offers menopausal women the possibility of natural relief available today.
Note: Postmenopausal women seeking to optimize hormone balance should also consider using a natural progesterone cream (not a synthetic progestin) to maintain youthful progesterone levels.
If you have any questions on the scientific content of this article, please call a Life Extension Health Advisor at 1-800-226-2370.
References
1. Shanafelt TD, Barton DL, Adjei AA, Loprinzi CL. Pathophysiology and treatment of hot flashes. Mayo Clin Proc. 2002 Nov;77(11):1207-18.
2. Lethaby AE, Brown J, Marjoribanks J, Kronenberg F, Roberts H, Eden J. Phytoestrogens for vasomotor menopausal symptoms. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD001395.
3. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33.
4. De Keukeleire D, De Cooman L, Rong H, Heyerick A, Kalita J, Milligan SR. Functional properties of hop polyphenols. Basic Life Sci. 1999;66:739-60.
5. Heyerick A, Vervarcke S, Depypere H, Bracke M, De KD. A first prospective, randomized, double-blind, placebo-controlled study on the use of a standardized hop extract to alleviate menopausal discomforts. Maturitas. 2006 May 20;54(2):164-75.
6. Bottner M, Christoffel J, Wuttke W. Effects of long-term treatment with 8-prenylnaringenin and oral estradiol on the GH-IGF-1 axis and lipid metabolism in rats. J Endocrinol. 2008 Aug;198(2):395-401.
7. Brunelli E, Minassi A, Appendino G, Moro L. 8-Prenylnaringenin, inhibits estrogen receptor-alpha mediated cell growth and induces apoptosis in MCF-7 breast cancer cells. J Steroid Biochem Mol Biol. 2007 Nov;107(3-5):140-8.
8. Humpel M, Isaksson P, Schaefer O, et al. Tissue specificity of 8-prenylnaringenin: protection from ovariectomy induced bone loss with minimal trophic effects on the uterus. J Steroid Biochem Mol Biol. 2005 Nov;97(3):299-305.
9. Saarinen NM, Warri A, Makela SI, et al. Hydroxymatairesinol, a novel enterolactone precursor with antitumor properties from coniferous tree (Picea abies). Nutr Cancer. 2000;36(2):207-16.
10. Available at: http://www.hmrlignan.com/images/HotFlash.pdf. Accessed November 18, 2008.
11. No authors listed. Humulus lupus. Monograph. Altern Med Rev. 2003 May;8(2):190-2.
12. De KD, De CL, Rong H, et al. Functional properties of hop polyphenols. Basic Life Sci. 1999;66:739-60.
13. Kitaoka M, Kadokawa H, Sugano M, et al. Prenylflavonoids: a new class of non-steroidal phytoestrogen (Part 1). Isolation of 8-isopentenylnaringenin and an initial study on its structure-activity relationship. Planta Med. 1998 Aug;64(6):511-5.
14. Miyamoto M, Matsushita Y, Kiyokawa A, et al. Prenylflavonoids: a new class of non-steroidal phytoestrogen (Part 2). Estrogenic effects of 8-isopentenylnaringenin on bone metabolism. Planta Med. 1998 Aug;64(6):516-9.
15. Rimoldi G, Christoffel J, Wuttke W. Morphologic changes induced by oral long-term treatment with 8-prenylnaringenin in the uterus, vagina, and mammary gland of castrated rats. Menopause. 2006 Jul;13(4):669-77.
16. Bowe J, Li XF, Kinsey-Jones J, et al. The hop phytoestrogen, 8-prenylnaringenin, reverses the ovariectomy-induced rise in skin temperature in an animal model of menopausal hot flushes. J Endocrinol. 2006 Nov;191(2):399-405.
17. Pan Y, Anthony MS, Binns M, Clarkson TB. A comparison of oral micronized estradiol with soy phytoestrogen effects on tail skin temperatures of ovariectomized rats. Menopause. 2001 May-Jun;8(3):171-4.
18. Sehmisch S, Hammer F, Christoffel J, et al. Comparison of the phytohormones genistein, resveratrol and 8-prenylnaringenin as agents for preventing osteoporosis. Planta Med. 2008 Jun;74(8):794-801.
19. Rad M, Humpel M, Schaefer O, et al. Pharmacokinetics and systemic endocrine effects of the phyto-oestrogen 8-prenylnaringenin after single oral doses to postmenopausal women. Br J Clin Pharmacol. 2006 Sep;62(3):288-96.
20. Branca F, Lorenzetti S. Health effects of phytoestrogens. Forum Nutr. 2005;(57):100-11.
21. Horn-Ross PL, John EM, Canchola AJ, Stewart SL, Lee MM. Phytoestrogen intake and endometrial cancer risk. J Natl Cancer Inst. 2003 Aug 6;95(15):1158-64.
22. Jenab M, Thompson LU. The influence of flaxseed and lignans on colon carcinogenesis and beta-glucuronidase activity. Carcinogenesis. 1996 Jun;17(6):1343-8.
23. McCann SE, Muti P, Vito D, et al. Dietary lignan intakes and risk of pre- and postmenopausal breast cancer. Int J Cancer. 2004 Sep 1;111(3):440-3.
24. Serraino M, Thompson LU. Flaxseed supplementation and early markers of colon carcinogenesis. Cancer Lett. 1992 Apr 15;63(2):159-65.
25. Sung MK, Lautens M, Thompson LU. Mammalian lignans inhibit the growth of estrogen-independent human colon tumor cells. Anticancer Res. 1998 May;18(3A):1405-8.
26. de Kleijn MJ, van der Schouw YT, Wilson PW, Grobbee DE, Jacques PF. Dietary intake of phytoestrogens is associated with a favorable metabolic cardiovascular risk profile in postmenopausal U.S.women: the Framingham study. J Nutr. 2002 Feb;132(2):276-82.
27. Cosentino M, Marino F, Ferrari M, et al. Estrogenic activity of 7-hydroxymatairesinol potassium acetate (HMR/lignan) from Norway spruce (Picea abies) knots and of its active metabolite enterolactone in MCF-7 cells. Pharmacol Res. 2007 Aug;56(2):140-7.
28. Bylund A, Saarinen N, Zhang JX, et al. Anticancer effects of a plant lignan 7-hydroxymatairesinol on a prostate cancer model in vivo. Exp Biol Med (Maywood). 2005 Mar;230(3):217-23.
29. Borriello SP, Setchell KD, Axelson M, Lawson AM. Production and metabolism of lignans by the human faecal flora. J Appl Bacteriol. 1985 Jan;58(1):37-43.
30. Pietinen P, Stumpf K, Mannisto S, et al. Serum enterolactone and risk of breast cancer: a case-control study in eastern Finland. Cancer Epidemiol Biomarkers Prev. 2001 Apr;10(4):339-44.
The above article on natural remedies for menopause is from LifeExtension.com. It was originally the cover story for the February 2009 issue of Life Extensions magazine. It is reprinted here in its entirety, with permission from LifeExtension.com. Get a complimentary subscription to Life Extension magazine
Tuesday, July 14, 2009
Natural Remedies for Menopause Article
The following article on natural remedies for menopause is from LifeExtension.com. It was originally the cover story for the April 2006 issue of LEF magazine. It is reprinted here in its entirety, with permission from LifeExtension.com. Get a complimentary subscription to Life Extension magazine
A Natural Approach to Menopause
By Dale Kiefer
For the last few decades, doctors have had a simple solution for menopause: writing prescriptions for estrogen drugs. With millions of women taking estrogen, all seemed to be going well, until data revealed that estrogen drug use resulted in significant increases in lethal diseases ranging from breast cancer to stroke.This development left both the medical profession and menopausal women paralyzed, with no direction and no answers as to how best to relieve the debilitating symptoms of menopause.Clearly overlooked is the fact that menopause is a complex, multifactorial health condition. Addressing menopause requires a diverse approach that both restores normal hormone balance and protects against the multitude of diseases that can arise during this period in a woman’s life. The onset of menopause triggers profound changes in cardiac health, mental states, bone strength, and cell proliferation, all of which combine to greatly elevate a woman’s risk for contracting heart disease, osteoporosis, and certain cancers.
These health issues are not easy to correct, especially when they occur simultaneously. The ideal approach to addressing menopause would be comprehensive and holistic, providing fast-acting, short-term symptomatic relief as well as longer-term benefits that support women’s health as their body chemistry changes. While declining levels of estrogen are what gives rise to the difficulties of menopause, both nutritional and hormonal support are required to address and ameliorate the physiological symptoms and other changes that accompany menopause.
Fortunately, researchers have identified natural approaches that may safely relieve hot flashes, breast pain, insomnia, irritability, and other menopausal symptoms. Unlike estrogen-progestin drugs, the use of these natural agents is correlated with reduced risks of certain cancers, along with improved bone and cardiovascular health.
Scientists have known for years that women who consume certain plant-based nutrients are less likely to develop hot flashes, heart disease, osteoporosis, and breast cancer.2-5 In response to the health debacle arising from the use of estrogen drugs, researchers have begun digging deeper into the botanical medicine chest, critically evaluating the efficacy of various traditional herbal products that safely stimulate estrogen receptors and create estrogen-like responses.
Mounting scientific evidence indicates that menopausal women may safely benefit from inexpensive, readily available botanical extracts that do not require a prescription.6-18 This article reviews the latest research findings concerning menopause-related health conditions—ranging from depression and hot flashes to osteoporosis and heart disease—and how women may benefit from highly researched botanicals. Taken together, these findings suggest a new approach to safely and effectively managing menopause.
Why Lignans Are So Important
For women approaching meno-pause, plant lignans offer important protection against cancer, cognitive decline, and hypertension. These fibrous compounds are present in large quantities in foods such as flaxseed, whole grains, and vegetables. In the digestive tract, they are converted to beneficial estrogenic compounds by resident bacteria. Two of these metabolic byproducts, enterolactone and enterodiol, are believed to play an important role in cancer prevention in mammals.19-22
A recent study published in the Journal of Hypertension concluded that dietary lignans, even in small amounts, are likely to normalize blood pressure and reduce hypertension, thereby lowering the risk of cardiovascular disease.23
Research from Korea indicates that high enterolactone levels also are associated with greater bone mineral density in postmenopausal women. Furthermore, scientists have found that women with low levels of enterolactone are more likely to suffer from osteoporosis.5 Scientists in the Netherlands recently reported that “higher dietary intake of lignans is associated with better cognitive function in postmenopausal women.”24
Surprisingly, the evergreen tree is an excellent source of potent lignans. Scandinavian researchers recently discovered that the knotwood of these majestic trees contains highly concentrated amounts of a lignan known as hydroxymatairesinol, or HMR. Numerous studies have shown that HMR is a potent antioxidant that may promote health and help protect against diseases such as cancer. In laboratory models of uterine, breast, colon, and other carcinomas, HMR lignan has demonstrated efficacy in reducing the volume and growth of existing tumors and preventing the formation of new tumors.22,25-29
Bioavailability—that is, the ease with which HMR lignan is converted directly to enterolactone and absorbed into the bloodstream—is what sets HMR apart from other plant lignans. Its unique chemical composition allows natural gut bacteria to convert HMR directly to the beneficial enterolactone and enterodiol lignans. This contrasts with other plant lignans, which must undergo further metabolism.29 Although flaxseed has long been recognized as one of the most concentrated sources of plant lignans, it takes far more flaxseed than HMR lignan to deliver an equivalent amount of beneficial enterolactone into the bloodstream. While one would have to eat about four tablespoons (20-30 grams) of unrefined flaxseed to get a beneficial dose of lignans, just 10-30 milligrams of HMR lignan (about 1,000 times less) provide an equivalent amount of enterolactone in the body.28
Protective Effects of Pomegranate
One of the more devastating long-term effects of menopause is an increase in both cancer and heart disease risk. Doctors initially thought that estrogen drugs would reduce cardiovascular risk, but these drugs instead dramatically increased a woman’s risk of contracting these lethal diseases. Fortunately, scientists are now discovering that natural agents can help protect aging women from these diseases.
Long venerated for its health-promoting properties, the fruit of the pomegranate tree is drawing new attention as a source of beneficial compounds that provide powerful protection against heart disease and cancer. Among these compounds are unique antioxidants that may dramatically improve cardiovascular health. A recent study conducted in Israel, for example, examined the effects of consuming pomegranate juice on the cardiovascular status of patients with atherosclerosis. Although some patients were followed for three years, dramatic differences were noted after just one year. Patients receiving the juice experienced a 30% improvement in atherosclerosis as measured by blood flow capacity through the carotid artery. In control patients who did not receive the juice, the same parameter of cardiovascular health actually worsened by 9%. Systolic blood pressure was reduced by 21% and total serum antioxidant status increased by 130% in the pomegranate-supplemented patients.30
These dramatic improvements were achieved within one year of treatment. Subsequent years yielded no further improvements, except in low-density lipoprotein (LDL) oxidation, which continued to decrease with continued consumption of pomegranate juice.30 More recent research confirms that pomegranate juice fights cardiovascular disease by preventing LDL peroxidation and by significantly suppressing the synthesis of new cholesterol by macrophages.31 In fact, punicalagin, the major antioxidant polyphenol ingredient in pomegranate juice, is found nowhere else in nature. But pomegranate also contains ellagic acid, the compound that makes berries the health-promoting powerhouses of the produce aisle. A recent analysis of the abilities of various components of pomegranate juice to fight cancer and quench free radicals found that pomegranate’s many compounds work synergistically and in a variety of ways to stop cancer.8
New research indicates that pomegranate may be particularly indicated in the prevention of breast cancer, one of the most common cancers threatening women after menopause. The most powerful estrogen in the body, 17-beta-estradiol, plays an important role in the genesis and development of breast cancers, most of which are hormone dependent in their early stages.32 Pomegranate-derived polyphenol compounds inhibit 17-beta-hydroxysteroid dehydrogenase type I, the enzyme that converts the weak estrogen estrone into its most potent metabolite, 17-beta-estradiol.33 High expression of 17-beta-hydroxysteroid dehydrogenase type I can be an indicator of adverse prognosis in women with estrogen-receptor-positive breast tumors.32 Based on these findings, scientists hope to conduct clinical trials assessing the preventive and therapeutic applications of pomegranate in human breast cancer.
Hormonal Effects of Soy
Phytoestrogens are plant-derived compounds that closely mimic the natural estrogens women produce in abundance before menopause. In the body, phytoestrogens have been shown to modulate the effects that estrogen exerts on cells in a way that could reduce the risk of contracting various diseases. It was long ago established that natural estrogens play a role in the healthy function of bones, heart muscle, and blood vessel linings. Estrogens also contribute to learning and memory.34
Aging women need to counter the depletion of beneficial natural hormones that occurs upon meno-pause. Soy contains genistein and daidzein, which are among the most extensively studied phytoestrogens. Epidemiological evidence shows that cancer and heart disease are less prevalent in populations that consume large amounts of soy.35 Moreover, scientists have demonstrated in laboratory studies that genistein inhibits the proliferation of breast cancer cells.36-39
Rates of cardiovascular disease and hormone-dependent cancers are lower among Asian women who consume soy.4 Epidemiological evidence shows that North American women who consume the greatest amounts of phytoestrogens enjoy significantly better cardiovascular risk profiles than women who consume the least phytoestrogens.40 Such epidemiological evidence suggests that dietary rather than genetic differences account for Asians’ better health.
Numerous studies have shown that increased consumption of phytoestrogens, including genistein and daidzein, is associated with a reduced risk of breast and other hormone-dependent cancers, such as endometrial cancer.19,41-44 Scientists have also determined that phyto-estrogens confer protection against lung cancer.45 Recent studies have documented significant improvements in long- and short-term memory, mental flexibility, and attention with increased phytoestrogen consumption.46-49
Phytoestrogens from soy have also been shown to reduce the loss of bone density in postmenopausal women.50 The findings from a recent prospective study suggested that postmenopausal women who consume more soy products experience a decreased risk of bone fracture compared to those who consume little soy. This association was most pronounced in the years immediately following menopause.51
Asian women experience hot flashes less frequently than do Western women. Less than one fifth of menopausal Chinese women, for example, complained of hot flashes in one such study.3 By contrast, more than three fourths of menopausal North American and European women suffer from hot flashes. Numerous studies have demonstrated that isoflavone-rich soy extracts decrease both the frequency and severity of hot flashes in postmenopausal women.52 In one study, 80% of women using a soy extract experienced a significant decrease, averaging 48%, in the number of daily hot flashes. These women also reported statistically significant improvements in other menopausal symptoms, including sleep disorder, anxiety, depression, vaginal dryness, loss of libido, and bone pain.53
In response to these findings, scientists conducted clinical trials using soy extracts in an attempt to relieve menopausal miseries. Because these studies produced inconclusive results, many mainstream medical doctors lost confidence in soy’s ability to relieve menopausal symptoms. This is regrettable considering the many diseases associated with normal aging and menopause that soy-derived phytoestrogens have been shown to prevent. While soy phyto-estrogens by themselves may not be equal to potent estrogen drugs in alleviating menopausal symptoms, their estrogen-modulating effects merit including soy in a comprehensive approach to both reducing disease risk and relieving the symptoms of menopause.
Benefits of Black Cohosh
Black cohosh (Cimicifuga racemosa) is a North American perennial herb that has been used to treat gynecological complaints for centuries. Native American healers and American physicians alike have prescribed black cohosh for relief from hot flashes and other menopausal symptoms.54 Listed as an official drug in the U.S. Pharmacopoeia from 1820 to 1926, black cohosh has been rediscovered by research scientists and menopausal women.18,55 Several recent clinical trials of exacting randomized, double-blind, placebo-controlled design have shown that black cohosh is indeed effective in reducing the severity, duration, and incidence of hot flashes and night sweats.6,16,17,56
A recent study at the Mayo Clinic in Scottsdale, AZ, examined the safety and effectiveness of black cohosh in reducing hot flashes. Weekly hot flash scores were reduced by 56% among women receiving black cohosh. Researchers noted that previous studies reported relatively high placebo effects in tests of treatments for hot flashes, but in this trial, placebo effects ranged from only 20% to 30%. “The efficacy found in this trial seems to be more than would be expected by a placebo effect,” according to the researchers. Women taking black cohosh in this study also reported less trouble sleeping, less fatigue, and less sweating.57
Another recently published study compared the efficacy and safety of black cohosh extract to a standard hormone replacement regimen (low-dose estradiol administered by skin patch). The researchers concluded that the two treatments were equally effective in reducing hot flashes. Both treatments significantly lowered LDL, but only black cohosh raised beneficial HDL. In addition, both patient groups experienced significant improvements in menopause-associated symptoms of anxiety and depression. Effects were noted within the first month of treatment and continued unabated for the three-month duration of the study. Neither treatment affected liver function or altered levels of follicle stimulating hormone, luteinizing hormone, or cortisol. The estradiol treatment, but not black cohosh, slightly increased levels of the hormone prolactin.58
Because of the potential estrogenic activity of black cohosh, scientists have carefully evaluated whether it is capable of influencing the growth of hormone-dependent cancers. Researchers at Northwestern Medical School who performed a series of sophisticated laboratory analyses of the extract concluded, “Black cohosh extracts did not demonstrate estrogenic activity in any of these assay systems.”59 However, German researchers found that black cohosh appears to exert estrogenic effects elsewhere in the body. They concluded that the botanical product demonstrated “no action in the uterus, but beneficial effects in . . . bone.”60
In practical terms, this means that black cohosh, like estradiol, prevented bone loss in laboratory animals after their ovaries had been removed. Unlike estradiol, black cohosh did not appear to exert any influence on the uterus, which may account for its superior safety profile compared to hormone replacement therapy. Thus, black cohosh not only reduces hot flashes, anxiety, and depression in menopausal women, but also appears to prevent some of the bone loss associated with the natural decline in estrogens, without the risk of stimulating uterine or breast cancer.60
In 2004, the North American Menopause Society added its stamp of approval to the use of black cohosh. In fact, it recommended black cohosh as a first-line approach. Its position statement reads, in part: “In women who need relief for mild [hot flashes and night sweats], NAMS recommends first considering lifestyle changes, either alone or combined with a nonprescription remedy, such as dietary isoflavones, black cohosh, or vitamin E.”61,62
Soothing Properties of Chasteberry
Chasteberry (Vitex agnus castus), also known as monk’s pepper, has served humankind for thousands of years. To be more precise, the berries of this deciduous shrub have benefited womankind for many years. In the ancient world, chasteberry was used to treat various gynecological complaints. For the past half century, chasteberry has been used to treat premenstrual syndrome (PMS), breast tenderness, and other gynecological conditions. In Europe, it is approved for the treatment of menstrual cycle irregularities, PMS, and breast discomfort by the German Commission E, which serves as a governmental regulatory agency for herbal medicines.15,63
Studies have shown that chasteberry acts in the brain to affect the neurotransmitter dopamine, which in turn indirectly affects the release of prolactin. Oscillating prolactin levels are thought to contribute to the breast tenderness and discomfort associated with PMS. Chasteberry has been shown to beneficially regulate several hormones including progesterone.15
Clinical trials of chasteberry for the treatment of PMS have demonstrated that it reduces a number of symptoms, especially breast pain or tenderness, headache, water retention, constipation, irritability, depressed mood, and even anger.13,15,64-70 Many small limited studies have confirmed these effects.15 Recently, a more rigorously designed study added further credence to these findings. This randomized, double-blind, placebo- controlled study of 170 women with PMS found significant improvement in self- and physician-assessed symptoms of irritability, mood change, anger, headache, breast fullness, and bloating. Symptoms decreased by 50% or more for more than half of the women taking chasteberry compared to placebo. Side effects were few and mild.13 Another double-blind, placebo-controlled trial examined chasteberry’s effects on at least three menstrual cycles in 104 women. Women in the treatment group showed significant improvement in cyclical breast discomfort.71
An intriguing study conducted in 2003 found that chasteberry was at least as effective as the popular antidepressant fluoxetine (Prozac®) in relieving premenstrual dysphoric disorder, a severe form of PMS characterized by extreme emotional and physical distress. Fluoxetine was somewhat better at improving psychological symptoms, but chasteberry did a better job of diminishing physical complaints.72 Last year, Italian researchers published a comprehensive review of all the relevant clinical data and concluded, “the data available seem to indicate that [chasteberry] is a safe herbal medicine.”63 Although no drug interactions have been reported, chasteberry might interfere with dopaminergic antagonist drugs. It should also be avoided during pregnancy or lactation, according to the Italian researchers.
Protective Action of Licorice Root
Licorice (Glycyrrhiza glabra) is native to the Mediterranean, where it has been used medicinally for thousands of years. Today, women may benefit from this sweet and fragrant root in a number of ways. Recent data indicate, for instance, that extracts of a Glycyrrhiza species exhibit estrogenic activity and put the brakes on breast cancer cells in the laboratory.73 Specifically, the licorice extract induced apoptosis, or programmed suicide, in a line of human breast cancer cells.
Remarkably, this flavorful herb also exhibits activities that may ameliorate other common menopausal maladies, including depression, osteoporosis, and cardiovascular disease. In 2003, Israeli scientists reported that certain flavonoids extracted from licorice root inhibit the re-uptake of serotonin, much as estradiol does. Serotonin is a neuro- transmitter that is thought to play an important role in regulating mood. Modern antidepressant drugs such as sertraline (Zoloft®) and fluoxetine (Prozac®) act in precisely this manner to alleviate depression. “This study showed that several isoflavans are unique phytoestrogens,” wrote the researchers, “and, thus, potentially may be beneficial for mild to moderate depression in pre-and post-menopausal women.”74Noting that postmenopausal women are at greater risk of cardiovascular disease, possibly due to declining estrogen levels, another team of Israeli researchers investigated licorice root’s effects on blood vessels. Because it has estrogen-like properties, licorice extract stimulated DNA synthesis in human endothelial cells and affected the production of human vascular smooth muscle cells. “We suggest the use of glabrene [extracted from licorice root] with or without estradiol as a new agent for modulation of vascular injury and atherogenesis for the prevention of cardiovascular disease in postmenopausal women,” the scientists concluded.75
Finally, Korean researchers recently determined that glabridin, a biochemical extracted from licorice root, exerted powerful influences on bone precursor cells known as osteoblasts in the laboratory. The extract acted in several ways to promote the growth and health of these crucial bone cells. According to the researchers, “Our data indicate that the enhancement of osteoblast function by glabridin may result in the prevention of osteoporosis and inflammatory bone disease.”76 Scientists at Israel’s Tel-Aviv University have also demonstrated an osteoporosis-fighting effect of licorice components.77
A Chinese Remedy for Menopause
Dong quai (Angelica sinensis) is a traditional Chinese medicinal herb that has long been used to manage gynecological conditions. Few clinical trials of sufficient size and rigor have been conducted, so Western scientists tend toward skepticism regarding the use of this time-honored botanical for the relief of menopause symptoms. However, tantalizing research indicates that dong quai root contains a number of bioactive compounds that may help reduce menopause-related hot flashes, prevent cancer, boost immune function, and improve bone health.78-82
Not surprisingly, Chinese re-searchers have taken it upon themselves to validate claims for dong quai’s potential healing properties. Although one randomized, controlled clinical trial failed to find a significant difference between dong quai and placebo in relieving hot flashes,83 it should be noted that Chinese healers never prescribe dong quai alone. It is always administered in combination with one or more other herbs. In fact, a Chinese study of one such traditional herbal combination that included dong quai, among other botanicals, concluded that hot flashes and other menopausal complaints were reduced by 70%.80,84
Another recent study examined the effects of a combination of dong quai and chamomile in treating menopausal symptoms. This randomized, placebo-controlled study of 55 women found a significant difference in relief of hot flashes, insomnia, and fatigue between the treatment and placebo groups. Effects materialized in the treatment group within the first month of taking the herbs. “Treatment . . . seems to be effective for menopausal symptoms without apparent major adverse effects,” according to the researchers.85
A recent study of dong quai’s purported anxiety-relieving effects found that the essential oil of this Asian herb was about as effective as the prescription anti-anxiety drug diazepam (Valium®) in stress tests performed on laboratory mice.86 Another recent experiment showed that dong quai extract significantly halted replication of cancer cells in the laboratory, and induced apoptosis (programmed suicide) in the cells.81
In Chinese medicine, dong quai is often used in combination with other herbs to treat bone injuries. Seeking to understand how it affects bone health, scientists in Pennsylvania cultured human bone precursor cells with varying amounts of dong quai extract. They found that the extract stimulated proliferation of bone cells, while enhancing protein, collagen synthesis, and the activity of an enzyme associated with bone building.82
COMPREHENSIVE HORMONE MODULATION
While plant-derived compounds such as phytoestrogens and lignans successfully counter menopausal symptoms in many women, others may need additional therapeutics to achieve optimal relief.
Bioidentical hormone replacement is an option for managing the uncomfortable effects of menopause. This method involves first assessing hormone levels with blood testing and then correcting deficiencies using hormones that are identical to those found naturally in the body. By restoring estrogens (using only natural forms), progesterone, DHEA, pregnenolone, and testosterone to the levels found in healthy women in their twenties, bioidentical hormone replacement therapy helps to relieve menopausal symptoms and enhance well-being. Supplementation with phytoestrogens, lignans, and cruciferous vegetable extracts may help protect against the increased cancer risk that even some natural estrogen drugs may induce.
Cancer-Preventive Cruciferous Vegetables
Epidemiological evidence strongly suggests that abundant consumption of cruciferous vegetables such as broccoli, from the Brassica genus, correlates with lower breast cancer incidence. A recent study in China concluded: “Greater Brassica vegetable consumption . . . was associated with significantly reduced breast cancer risk among Chinese women.”87
The bioactive chemicals in cruciferous vegetables that are responsible for cancer protection derive from a family of chemicals called gluco-sinolates. When consumed, gluco-sinolates are converted to highly beneficial compounds, including sulforaphane and indole-3-carbinol (I3C). These compounds are believed to inhibit numerous types of cancers, including breast and cervical cancers, by a variety of mechanisms.88,89 In a recent article published in the Journal of Nutritional Biochemistry, scientists noted: “Mounting preclinical and clinical evidence indicates that indole-3-carbinol (I3C), a key bioactive food component in cruciferous vegetables, has multiple anticarcinogenic and anti-tumorigenic properties.”90
IMG src="http://www.lef.org/magazine/mag2006/images/apr2006_cover_menopause_06.jpg" border="0">
I3C appears especially effective in protecting against hormone-dependent cancers such as breast, cervical, and prostate cancers, due to its favorable influence on the body’s balance of estrogens.91-95 I3C further affects health by undergoing a natural conversion in the body to yet another potent anti-cancer compound, diindolylmethane (DIM). In addition to stopping hormone-dependent cancer cells in their tracks, DIM inhibits breast cancer cells that are not hormone dependent, through a number of mechanisms.
For example, scientists at the University of California, Berkeley, recently discovered that DIM causes breast cancer cells to boost production of interferon gamma, an immune system component that plays an important role in preventing the development of primary and transplanted tumors.96 This finding is only the latest in a long line of discoveries regarding the healing properties of cruciferous vegetables. It is likely that researchers will continue to unravel the many ways in which cruciferous vegetable compounds work to prevent and destroy different types of cancer.
HORMONES USED IN MENOPAUSE MANAGEMENT
Estrogens. Estriol is the main component of bioidentical estrogen replacement therapy, often used with smaller proportions of estradiol and estrone. Estriol offers many of the benefits of more conventional estrogen-replacement therapies, without the harsh side effects or long-term dangers associated with conventional hormone replacement therapy.97
Some popular prescription estrogen formulas are BiEst and TriEst. BiEst consists of estradiol and estriol, while TriEst contains all three estrogens.98
Progesterone is important to hormone replacement, serving as a counterpoint to estrogen. One of progesterone’s most valuable benefits may be its ability to fight cancer. Studies have shown that progesterone has anti-proliferative effects on at least two different types of breast cancer cells.99 Natural progesterone has also demonstrated neuroprotective properties.100 Progesterone deficiency has been linked to migraine.101
Most natural progesterone products are derived from soybeans and yams, and can be purchased over the counter. A common form of natural progesterone is dispensed in a cream that is applied topically to the skin.102,103 Many physicians recommend using progesterone therapy only during the last half of the month to simulate a young, healthy progesterone cycle.
DHEA is a hormone secreted by the adrenal gland, the gonads, and the brain.104 Although women usually have less DHEA than men, both sexes lose DHEA at about the same rate, suggesting that its decline is related to aging.105,106 Decreased levels of DHEA are associated with cancer, diabetes, lupus, and psychiatric illness.107,108
DHEA has been shown to improve mood, neurological functions, immune function, energy, and feelings of well-being, and to maintain muscle and bone mass.109-111 One study demonstrated DHEA and pregnenolone help enhance memory.112 DHEA may also improve insulin sensitivity and lower triglyceride levels.113
Testosterone levels gradually decrease with age.114 Loss of testosterone adversely affects libido, bone and muscle mass, vasomotor symptoms, cardiovascular health, mood, and well-being.115,116 Testosterone therapy, combined with estrogen therapy, has been shown to improve quality of life, vigor, mood, ability to concentrate, bone mineralization, libido, and sexual satisfaction.117-120 This combination therapy also produces improvements in hot flashes, sleep disturbances, night sweats, and vaginal dryness. In women, DHEA often converts to testosterone, thereby making it possible to raise testosterone levels using DHEA supplements.114,119
Pregnenolone levels likewise decline with age, decreasing significantly in women after the age of 30.121 Reduced pregnenolone levels result in decreased amounts of all other hormones, and pregnenolone deficiencies have been associated with diminished brain function and dementia.122,123
Conclusion
Menopause marks an important life transition for women, one potentially fraught with challenges to health and quality of life.
While many women wish to avoid the risks associated with estrogen drugs, they are keenly interested in finding relief from hot flashes, depression, irritability, insomnia, breast pain, and possible declines in cognition and bone and cardiovascular health.
Fortunately, the wisdom of ancient folk medicine combined with the objective application of modern science may now help women obtain effective, reliable relief from these menopausal conditions, without significant side effects.
HORMONE REPLACEMENT THERAPY, THEN AND NOW
For decades, hormone replacement therapy was essentially the standard treatment for menopausal complaints. This changed abruptly in 2002, when the National Institutes of Health announced that it had halted a comprehensive study of the effects of hormone replacement therapy on various aspects of women’s long-term health.
Alarmed by emerging findings, researchers cancelled the massive trial, known as the Women’s Health Initiative, before it was completed. Although the combination of estrogen and progestin improved healthy menopausal women’s bone health compared to placebo, it was also clearly associated with significant increases in heart disease, stroke, blood clots, and breast cancer. Hormone replacement therapy increased the incidence of breast cancer alone by as much as 26%, while increasing heart attack incidence by nearly 30%.1
Accordingly, menopausal women were encouraged to discontinue hormone replacement therapy, and millions of women complied.124 Although hormone replacement therapy offers slight improvements in osteoporosis risk and incidence of colon cancer, NIH officials noted, “The balance of harm versus benefit does not justify any woman beginning or continuing to take estrogen plus progestin.” While the use of hormone replacement therapy has dropped precipitously, the health problems associated with menopause remain. What to do about the erosion of quality of life, sleeplessness, irritability, hot flashes, and brittle bones that accompany menopause? Data indicate that women have been reluctant to turn to traditional herbal remedies such as black cohosh and soy.124
However, mounting evidence suggests that women should embrace these time-honored remedies, as science makes progress in proving what traditional healers have long known: botanicals work. Indeed, nature seems to know best, offering all the benefits of hormone replacement therapy with few, if any, of the side effects. Herbal remedies in use for centuries are gradually regaining acceptance in the wake of hormone replacement therapy’s fall from grace.
1. Available at: www.nhlbi.nih.gov/new/ press/02-07-09.html. Accessed February 2, 2006.
2. Wietrzyk J, Grynkiewicz G, Opolski A. Phytoestrogens in cancer prevention and therapy—mechanisms of their biological activity. Anticancer Res. 2005 May;25(3c):2357-66.
3. Tang GW. The climacteric of Chinese factory workers. Maturitas. 1994 Oct;19(3):177-82.
4. Lissin LW, Cooke JP. Phytoestrogens and cardiovascular health. J Am Coll Cardiol. 2000 May;35(6):1403-10.
5. Kim MK, Chung BC, Yu VY, et al. Relationships of urinary phyto-oestrogen excretion to BMD in postmenopausal women. Clin Endocrinol (Oxf). 2002 Mar;56(3):321-8.
6. Fugate SE, Church CO. Nonestrogen treatment modalities for vasomotor symptoms associated with menopause. Ann Pharmacother. 2004 Sep;38(9):1482-99.
7. Geller SE, Studee L. Botanical and dietary supplements for menopausal symptoms: what works, what does not. J Womens Health (Larchmt.). 2005 Sep;14(7):634-49.
8. Seeram NP, Adams LS, Henning SM, et al. In vitro antiproliferative, apoptotic and antioxidant activities of punicalagin, ellagic acid and a total pomegranate tannin extract are enhanced in combination with other polyphenols as found in pomegranate juice. J Nutr Biochem. 2005 Jun;16(6):360-7.
9. Kim ND, Mehta R, Yu W, et al. Chemopreventive and adjuvant therapeutic potential of pomegranate (Punica granatum) for human breast cancer. Breast Cancer Res Treat. 2002 Feb;71(3):203-17.
10. Mehta R, Lansky EP. Breast cancer chemopreventive properties of pomegranate (Punica granatum) fruit extracts in a mouse mammary organ culture. Eur J Cancer Prev. 2004 Aug;13(4):345-8.
11. Chidambara Murthy KN, Jayaprakasha GK, Singh RP. Studies on antioxidant activity of pomegranate (Punica granatum) peel extract using in vivo models. J Agric Food Chem. 2002 Aug 14;50(17):4791-5.
12. Sudheesh S, Vijayalakshmi NR. Flavonoids from Punica granatum—potential antiperoxidative agents. Fitoterapia. 2005 Mar;76(2):181-6.
13. Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ. 2001 Jan 20;322(7279):134-7.
14. Wuttke W, Jarry H, Christoffel V, Spengler B, Seidlova-Wuttke D. Chaste tree (Vitex agnus-castus)—pharmacology and clinical indications. Phytomedicine. 2003 May;10(4):348-57.
15. Roemheld-Hamm B. Chasteberry. Am Fam Physician. 2005 Sep 1;72(5):821-4.
16. Frei-Kleiner S, Schaffner W, Rahlfs VW, Bodmer C, Birkhauser M. Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial. Maturitas. 2005 Aug 16;51(4):397-404.
17. Osmers R, Friede M, Liske E, et al. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol. 2005 May;105(5 Pt 1):1074-83.
18. Branca F, Lorenzetti S. Health effects of phytoestrogens. Forum Nutr. 2005;(57):100-11.
19. Linseisen J, Piller R, Hermann S, Chang-Claude J. Dietary phytoestrogen intake and premenopausal breast cancer risk in a German case-control study. Int J Cancer. 2004 Jun 10;110(2):284-90.
20. McCann SE, Muti P, Vito D, et al. Dietary lignan intakes and risk of pre- and postmenopausal breast cancer. Int J Cancer. 2004 Sep 1;111(3):440-3.
21. Saleem M, Kim HJ, Ali MS, Lee YS. An update on bioactive plant lignans. Nat Prod Rep. 2005 Dec;22(6):696-716.
22. Wang LQ. Mammalian phytoestrogens: enterodiol and enterolactone. J Chromatogr B Analyt Technol Biomed Life Sci . 2002 Sep 25;777(1-2):289-309.
23. Kreijkamp-Kaspers S, Kok L, Bots ML, Grobbee DE, van der Schouw YT. Dietary phytoestrogens and vascular function in postmenopausal women: a cross-sectional study. J Hypertens. 2004 Jul;22(7):1381-8.
24. Franco OH, Burger H, Lebrun CE, et al. Higher dietary intake of lignans is associated with better cognitive performance in postmenopausal women. J Nutr. 2005 May;135(5):1190-5.
25. Saarinen NM, Huovinen R, Warri A, et al. Uptake and metabolism of hydroxymatairesinol in relation to its anticarcinogenicity in DMBA-induced rat mammary carcinoma model. Nutr Cancer. 2001;41(1-2):82-90.
26. Saarinen NM, Penttinen PE, Smeds AI, Hurmerinta TT, Makela SI. Structural determinants of plant lignans for growth of mammary tumors and hormonal responses in vivo. J Steroid Biochem Mol Biol. 2005 Feb;93(2-5):209-19.
27. Katsuda S, Yoshida M, Saarinen N, et al. Chemopreventive effects of hydroxymatairesinol on uterine carcinogenesis in Donryu rats. Exp Biol Med (Maywood). 2004 May;229(5):417-24.
28. Kangas L, Saarinen N, Mutanen M, et al. Antioxidant and antitumor effects of hydroxymatairesinol (HM-3000, HMR), a lignan isolated from the knots of spruce. Eur J Cancer Prev. 2002 Aug;11 Suppl 2S48-S57.
29. Saarinen NM, Warri A, Makela SI, et al. Hydroxymatairesinol, a novel enterolactone precursor with antitumor properties from coniferous tree (Picea abies). Nutr Cancer. 2000;36(2):207-16.
30. Aviram M, Rosenblat M, Gaitini D, et al. Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation. Clin Nutr. 2004 Jun;23(3):423-33.
31. Fuhrman B, Volkova N, Aviram M. Pomegranate juice inhibits oxidized LDL uptake and cholesterol biosynthesis in macrophages. J Nutr Biochem. 2005 Sep;16(9):570-6.
32. Pasqualini JR, Chetrite GS. Recent insight on the control of enzymes involved in estrogen formation and transformation in human breast cancer. J Steroid Biochem Mol Biol. 2005 Feb;93(2-5):221-36.
33. Kim ND, Mehta R, Yu W, et al. Chemopreventive and adjuvant therapeutic potential of pomegranate (Punica granatum) for human breast cancer. Breast Cancer Res Treat. 2002 Feb;71(3):203-17.
34. Cornwell T, Cohick W, Raskin I. Dietary phytoestrogens and health. Phytochemistry. 2004 Apr;65(8):995-1016.
35. Holzbeierlein JM, McIntosh J, Thrasher JB. The role of soy phytoestrogens in prostate cancer. Curr Opin Urol. 2005 Jan;15(1):17-22.
36. Singeltary KW, Frey RS, Li JY. Differential effects of genistein cell proliferation, cyclin B1, and p34cdc2 in transformed and nontransformed human breast cells. Pharm Biol. 2002;40:35-42.
37. Jeune MA, Kumi-Diaka J, Brown J. Anticancer activities of pomegranate extracts and genistein in human breast cancer cells. J Med Food. 2005;8(4):469-75.
38. Frey RS, Li J, Singletary KW. Effects of genistein on cell proliferation and cell cycle arrest in nonneoplastic human mammary epithelial cells: involvement of Cdc2, p21(waf/cip1), p27(kip1), and Cdc25C expression. Biochem Pharmacol. 2001 Apr 15;61(8):979-89.
39. Rowell C, Carpenter DM, Lamartiniere CA. Chemoprevention of breast cancer, proteomic discovery of genistein action in the rat mammary gland. J Nutr. 2005 Dec;135(12 Suppl):2953S-9S.
40. de Kleijn MJ, van der Schouw YT, Wilson PW, Grobbee DE, Jacques PF. Dietary intake of phytoestrogens is associated with a favorable metabolic cardiovascular risk profile in postmenopausal US women: the Framingham study. J Nutr. 2002 Feb;132(2):276-82.
41. Hedelin M, Klint A, Chang ET, et al. Dietary phytoestrogen, serum enterolactone and risk of prostate cancer: the cancer prostate sweden study (sweden). Cancer Causes Control. 2006 Mar;17(2):169-80.
42. Xu WH, Zheng W, Xiang YB, et al. Soya food intake and risk of endometrial cancer among Chinese women in Shanghai: population based case-control study. BMJ. 2004 May 29;328(7451):1285.
43. Sarkar FH, Li Y. Cell signaling pathways altered by natural chemopreventive agents. Mutat Res. 2004 Nov 2;555(1-2):53-64.
44. Sarkar FH, Li Y. The role of isoflavones in cancer chemoprevention. Front Biosci. 2004 Sep 1;9:2714-24.
45. Schabath MB, Hernandez LM, Wu X, Pillow PC, Spitz MR. Dietary phytoestrogens and lung cancer risk. JAMA. 2005 Sep 28;294(12):1493-504.
46. Hogervorst E, Williams J, Budge M, Riedel W, Jolles J. The nature of the effect of female gonadal hormone replacement therapy on cognitive function in post-menopausal women: a meta-analysis. Neuroscience. 2000;101(3):485-512.
47. File SE, Jarrett N, Fluck E, et al. Eating soya improves human memory. Psychopharmacology (Berl). 2001 Oct;157(4):430-6.
48. Duffy R, Wiseman H, File SE. Improved cognitive function in postmenopausal women after 12 weeks of consumption of a soya extract containing isoflavones. Pharmacol Biochem Behav. 2003 Jun;75(3):721-9.
49. Lee YB, Lee HJ, Sohn HS. Soy isoflavones and cognitive function. J Nutr Biochem. 2005 Nov;16(11):641-9.
50. Lydeking-Olsen E, Beck-Jensen JE, Setchell KD, Holm-Jensen T. Soymilk or progesterone for prevention of bone loss—a 2 year randomized, placebo-controlled trial. Eur J Nutr. 2004 Aug;43(4):246-57.
51. Zhang X, Shu XO, Li H, et al. Prospective cohort study of soy food consumption and risk of bone fracture among postmenopausal women. Arch Intern Med. 2005 Sep 12;165(16):1890-5.
52. Upmalis DH, Lobo R, Bradley L, Warren M, Cone FL, Lamia CA. Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study. Menopause. 2000 Jul-Aug;7(4):236-42.
53. Albert A, Altabre C, Baro F, et al. Efficacy and safety of a phytoestrogen preparation derived from Glycine max (L.) Merr in climacteric symptomatology: a multicentric, open, prospective and non-randomized trial. Phytomedicine. 2002 Mar;9(2):85-92.
54. Mahady GB, Fabricant D, Chadwick LR, Dietz B. Black cohosh: an alternative therapy for menopause? Nutr Clin Care. 2002 Nov;5(6):283-9.
55. Anon. Cimicifuga racemosa. Monograph. Altern Med Rev. 2003 May;8(2):186-9.
56. Mahady GB. Black cohosh (Actaea/Cimicifuga racemosa): review of the clinical data for safety and efficacy in menopausal symptoms. Treat Endocrinol. 2005;4(3):177-84.
57. Pockaj BA, Loprinzi CL, Sloan JA, et al. Pilot evaluation of black cohosh for the treatment of hot flashes in women. Cancer Invest. 2004;22(4):515-21.
58. Nappi RE, Malavasi B, Brundu B, Facchinetti F. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol. 2005 Jan;20(1):30-5.
59. Lupu R, Mehmi I, Atlas E, et al. Black cohosh, a menopausal remedy, does not have estrogenic activity and does not promote breast cancer cell growth. Int J Oncol. 2003 Nov;23(5):1407-12.
60. Seidlova-Wuttke D, Hesse O, Jarry H, et al. Evidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta. Eur J Endocrinol. 2003 Oct;149(4):351-62.
61. Neff MJ. NAMS releases position statement on the treatment of vasomotor symptoms associated with menopause. Am Fam Physician. 2004 Jul 15;70(2):393-4, 396, 399.
62. Anon. Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause. 2004 Jan;11(1):11-33.
63. Daniele C, Thompson CJ, Pittler MH, Ernst E. Vitex agnus castus: a systematic review of adverse events. Drug Saf. 2005;28(4):319-32.
64. Blumenthal M. German Federal Institute for Drugs and Medical Devices. Commission E. Herbal Medicine: expanded Commission E monographs. 1st ed. Newton, MA: Integrative Medicine Communications; 2000.
65. Gorkow C, Wuttke W, Marz RW. Effectiveness of Vitex agnus-castus preparations. Wien Med Wochenschr. 2002;152(15-16):364-72.
66. Lauritzen C, Reuter HD, Repges R, Bohnert KJ, Schmidt U. Treatment of premenstrual tension syndrome with Vitex agnus castus. Controlled, double-blind study versus pyridoxine. Phytomedicine. 1997;4:183-9.
67. Berger D, Schaffner W, Schrader E, Meier B, Brattstrom A. Efficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome (PMS). Arch Gynecol Obstet. 2000 Nov;264(3):150-3.
68. Loch EG, Selle H, Boblitz N. Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus castus. J Womens Health Gend Based Med. 2000 Apr;9(3):315-20.
69. Turner S, Mills S. A double-blind clinical trial on herbal remedy for premenstrual syndrome: a case study. Complement Ther Med. 1993;1:73-7.
70. Halaska M, Raus K, Beles P, Martan A, Paithner KG. Treatment of cyclical mastodynia using an extract of Vitex agnus castus: results of a double-blind comparison with a placebo. Ceska Gynekol. 1998 Oct;63(5):388-92.
71. Wuttke W, Splitt G, Gorkow C, et al. Treatment of cyclical mastalgia: results of a randomized, placebo-controlled, double-blind study (in Czech). Ceska Gynekol. 1998;63:988-92.
72. Atmaca M, Kumru S, Tezcan E. Fluoxetine versus Vitex agnus castus extract in the treatment of premenstrual dysphoric disorder. Hum Psychopharmacol. 2003 Apr; 18(3):191-5.
73. Jo EH, Kim SH, Ra JC, et al. Chemopreventive properties of the ethanol extract of chinese licorice (Glycyrrhiza uralensis) root: induction of apoptosis and G1 cell cycle arrest in MCF-7 human breast cancer cells. Cancer Lett. 2005 Dec 18;230(2):239-47.
74. Ofir R, Tamir S, Khatib S, Vaya J. Inhibition of serotonin re-uptake by licorice constituents. J Mol Neurosci. 2003 Apr;20(2):135-40.
75. Somjen D, Knoll E, Vaya J, Stern N, Tamir S. Estrogen-like activity of licorice root constituents: glabridin and glabrene, in vascular tissues in vitro and in vivo. J Steroid Biochem Mol Biol. 2004 Jul;91(3):147-55.
76. Choi EM. The licorice root derived isoflavan glabridin increases the function of osteoblastic MC3T3-E1 cells. Biochem Pharmacol. 2005 Aug 1;70(3):363-8.
77. Somjen D, Katzburg S, Vaya J, et al. Estrogenic activity of glabridin and glabrene from licorice roots on human osteoblasts and prepubertal rat skeletal tissues. J Steroid Biochem Mol Biol. 2004 Aug;91(4-5):241-6.
78. Yang T, Jia M, Mei Q. Effect of Angelica sinensis polysaccharide on lymphocyte proliferation and cytokine induction. Zhong Yao Cai. 2005 May;28(5):405-7.
79. Tsai NM, Lin SZ, Lee CC, et al. The antitumor effects of Angelica sinensis on malignant brain tumors in vitro and in vivo. Clin Cancer Res. 2005 May 1;11(9):3475-84.
80. Anon. Monograph. Angelica sinensis. Altern Med Rev. 2004 Dec;9(4):429-33.
81. Cheng YL, Chang WL, Lee SC, et al. Acetone extract of Angelica sinensis inhibits proliferation of human cancer cells via inducing cell cycle arrest and apoptosis. Life Sci. 2004 Aug 13;75(13):1579-94.
82. Yang Q, Populo SM, Zhang J, Yang G, Kodama H. Effect of Angelica sinensis on the proliferation of human bone cells. Clin Chim Acta. 2002 Oct;324(1-2):89-97.
83. Hirata JD, Swiersz LM, Zell B, Small R, Ettinger B. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril. 1997 Dec;68(6):981-6.
84. Chang HM, But PP. Pharmacology and application of chinese material medica. World Scientific. 1987;1:489-505.
85. Kupfersztain C, Rotem C, Fagot R, Kaplan B. The immediate effect of natural plant extract, Angelica sinensis and Matricaria chamomilla (Climex) for the treatment of hot flushes during menopause. A preliminary report. Clin Exp Obstet Gynecol. 2003;30(4):203-6.
86. Chen SW, Min L, Li WJ, et al. The effects of angelica essential oil in three murine tests of anxiety. Pharmacol Biochem Behav. 2004 Oct;79(2):377-82.
87. Fowke JH, Chung FL, Jin F, et al. Urinary isothiocyanate levels, brassica, and human breast cancer. Cancer Res. 2003 Jul 15;63(14):3980-6.
88. Rouzaud G, Young SA, Duncan AJ. Hydrolysis of glucosinolates to isothiocyanates after ingestion of raw or microwaved cabbage by human volunteers. Cancer Epidemiol Biomarkers Prev. 2004 Jan;13(1):125-31.
89. Anon. Indole-3-carbinol. Monograph. Altern Med Rev. 2005 Dec;10(4):337-42.
90. Kim YS, Milner JA. Targets for indole-3-carbinol in cancer prevention. J Nutr Biochem. 2005 Feb;16(2):65-73.
91. Bradlow HL, Michnovicz JJ, Halper M, et al. Long-term responses of women to indole-3-carbinol or a high fiber diet. Cancer Epidemiol Biomarkers Prev. 1994 Oct;3(7):591-5.
92. Ashok BT, Chen Y, Liu X, et al. Abrogation of estrogen-mediated cellular and biochemical effects by indole-3-carbinol. Nutr Cancer. 2001;41(1-2):180-7.
93. Ashok BT, Chen YG, Liu X, et al. Multiple molecular targets of indole-3-carbinol, a chemopreventive anti-estrogen in breast cancer. Eur J Cancer Prev. 2002 Aug;11 Suppl 2S86-S93.
94. Yuan F, Chen DZ, Liu K, et al. Anti-estrogenic activities of indole-3-carbinol in cervical cells: implication for prevention of cervical cancer. Anticancer Res. 1999 May;19(3A):1673-80.
95. Liu H, Wormke M, Safe SH, Bjeldanes LF. Indolo[3,2-b]carbazole: a dietary-derived factor that exhibits both antiestrogenic and estrogenic activity. J Natl Cancer Inst. 1994 Dec 7;86(23):1758-65.
96. Riby JE, Xue L, Chatterji U, et al. Activation and Potentiation of Interferon-{gamma} Signaling by 3,3’-Diindolylmethane in MCF-7 Breast Cancer Cells. Mol Pharmacol. 2006 Feb;69(2):430-9.
97. Head KA. Estriol: safety and efficacy. Altern Med Rev. 1998 Apr;3(2):101–13.
98. Taylor M. Unconventional estrogens: estriol, biest, and triest. Clin Obstet Gynecol. 2001 Dec;44(4):864–79.
99. Formby B, Wiley TS. Progesterone inhibits growth and induces apoptosis in breast cancer cells: inverse effects on Bcl-2 and p53. Ann Clin Lab Sci. 1998 Nov;28(6):360–9.
100. Stein DG. The case for progesterone. Ann NY Acad Sci. 2005 Jun;1053:152–69.
101. Colson NJ, Lea RA, Quinlan S, MacMillian J, Griffiths LR. Investigation of hormone receptor genes in migraine. Neurogenetics. 2005 Feb;6(1):17–23.
102. Komesaroff PA, Black CV, Cable V, Sudhir K. Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women. Climacteric. 2001 Jun;4(2):144–50.
103. Uchibayashi M. Forgotten episodes of the birth of cortisone. Yakushigaku Zasshi. 2001;36(1):70–5.
104. Williams GH, Dluhy RG. Disorders of the adrenal cortex. In: Harrison’s Principles of Internal Medicine. 15th ed. New York: McGraw-Hill; 2001.
105. Khorram O. DHEA: a hormone with multiple effects. Curr Opin Obstet Gynecol. 1996;8(5):351–4.
106. Wilder RL. Adrenal and gonadal steroid hormone deficiency in the pathogenesis of rheumatoid arthritis. J Rheumatol Suppl. 1996 Mar;44:10–2.
107. Berkman LF, Seeman TE, Albert M, et al. High, usual and impaired functioning in community-dwelling older men and women: findings from the MacArthur Foundation Research Network on Successful Aging. J Clin Epidemiol. 1993 Oct;46(10):1129–40.
108. Salek FS, Bigos KL, Kroboth PD. The influence of hormones and pharmaceutical agents on DHEA and DHEA-S concentrations: a review of clinical studies. J Clin Pharmacol. 2002 Mar;42(3):247–66.
109. Kroboth PD, Salek FS, Pittenger AL, Fabian TJ, Frye RF. DHEA and DHEA-S: a review. J Clin Pharmacol. 1999 Apr;39(4):327–48.
110. Proctor DN, Balagopal P, Nair KS. Age-related sarcopenia in humans is associated with reduced synthetic rates of specific muscle proteins. J Nutr. 1998 Feb;128(2 Suppl):351S–5S.
111. Yen SS, Morales AJ, Khorram O. Replacement of DHEA in aging men and women. Potential remedial effects. Ann NY Acad Sci. 1995 Dec 29;774:128–42.
112. Rupprecht R, Holsboer F. Neuropsychopharmacological properties of neuroactive steroids. Steroids. 1999 Jan;64(1–2):83–91.
113. Casson PR, Faquin LC, Stentz FB, et al. Replacement of dehydroepiandrosterone enhances T-lymphocyte insulin binding in postmenopausal women. Fertil Steril. 1995 May;63(5):1027–31.
114. Schneider HP. Androgens and antiandrogens. Ann NY Acad Sci. 2003 Nov; 997:292-306.
115. Burd ID, Bachmann GA. Androgen replacement in menopause. Curr Womens Health Rep. 2001 Dec;1(3):202-5.
116. Watt PJ, Hughes RB, Rettew LB, Adams R. A holistic programmatic approach to natural hormone replacement. Fam Community Health. 2003 Jan;25(1):53-63.
117. Bachmann GA. Androgen therapy in menopause: evolving benefits and challenges. Am J Obstet Gynecol. 1999 Mar;180(3 Pt 2):308-11.
118. Braunstein GD. Androgen insufficiency in women: summary of critical issues. Fertil Steril. 2002 Apr;77(Suppl 4):S94–9.
119. Cameron DR, Braunstein GD. Androgen replacement therapy in women. Fertil Steril. 2004 Aug;82(2):273-89.
120. Davis A, Gilbert K, Misiowiec P, Riegel B. Perceived effects of testosterone replacement therapy in perimenopausal and postmenopausal women: an internet pilot study. Health Care Women Int. 2003 Nov;24(9):831–48.
121. Havlikova H, Hill M, Hampl R, Starka L. Sex- and age-related changes in epitestosterone in relation to pregnenolone sulfate and testosterone in normal subjects. J Clin Endocrinol Metab. 2002 May;87(5):2225-31.
122. Maurice T, Phan VL, Urani A, Kamei H, Noda Y, Nabeshima T. Neuroactive neurosteroids as endogenous effectors for the sigma1 (sigma1) receptor: pharmacological evidence and therapeutic opportunities. Jpn J Pharmacol. 1999 Oct;81(2):125–55.
123. Yao ZX, Brown RC, Teper G, Greeson J, Papadopoulos V. 22R-Hydroxycholesterol protects neuronal cells from beta-amyloid-induced cytotoxicity by binding to beta-amyloid peptide. J Neurochem. 2002 Dec;83(5):1110–19.
124. Kelly JP, Kaufman DW, Rosenberg L, et al. Use of postmenopausal hormone therapy since the Women’s Health Initiative findings. Pharmacoepidemiol Drug Saf. 2005 Dec;14(12):837-42.
Natural Remedies for Menopause: Article on Women's Hormones
I found the following info on LifeExtension.com. It is reprinted here in its entirety, with permission from LifeExtension.com. You might think at first that this article is only about traditional, medical menopause treatments. However, it also includes info on natural remedies for menopause. If you don't want to read the entire article, you can simply scroll down to the section on Naturally Suppressing Symptoms of Menopause
From Puberty to Menopause: A Woman's Journey
Progesterone's Balancing Act
Phytoestrogens: A Natural Option
Heart Benefits of Phytoestrogens
Bioidentical Hormone Replacement
These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure, or prevent any disease. The information provided on this site is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional or any information contained on or in any product label or packaging. You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem. You should not stop taking any medication without first consulting your physician.
Few topics have attracted as much attention in recent years as hormone replacement therapy (HRT) among postmenopausal women. For decades, physicians have been prescribing HRT to combat the symptoms of menopause as well as protect patients against osteoporosis and heart disease. The rationale behind heart disease prevention was simple: during their reproductive years, women enjoy lower rates of heart disease than men do, primarily because of the protective effect of estrogen hormones. It seemed only logical that by replacing the estrogens lost at menopause, women would retain some of their protection against heart disease. To offset the increased risk of certain cancers caused by unopposed estrogen therapy, doctors frequently added progestins to the therapy (Andrade et al 2002; Formby 1998). Progestins are synthetic chemicals designed in a lab to mimic natural progesterone.
Unfortunately, the logic of conventional HRT turned out to be faulty. In 2002, the results of the Women’s Health Initiative were released early. This landmark study followed more than 16,000 women and assessed the effects of conventional HRT, including estrogen-only therapy and therapy that combined estrogen and synthetic progestin. The findings were shocking: the estrogen/progestin arm of the study was discontinued early because the hormone therapy not only failed to protect against heart disease but was shown to increase the risk of heart attack and breast cancer (La Vecchia et al 2001). Long-term conventional HRT also increases risk for uterine cancer (Hulley et al 2002; Van et al 2002). Side effects include weight gain, premenstrual symptoms such as depression and bloating, and breast tenderness (Walsh et al 2001).
In 2004, the estrogen-only arm of the study was discontinued as well because estrogen-only HRT was found to increase the risk of stroke (Azoulay 2004). Based on these side effects, conventional HRT should not be prescribed for osteoporosis and cardiovascular disease prevention (Azoulay 2004; Rapp et al 2003).
These findings had an immediate impact on the millions of women taking conventional HRT. Up to 70 percent of women taking HRT stopped, and overall, women’s trust in the medical establishment declined significantly (Schonberg et al 2005).
This situation was unfortunate—and unnecessary. This approach to conventional HRT reflects a basic and widespread misunderstanding of female hormone replacement. Among conventional physicians, menopause is considered an isolated event that occurs around age 50, when the ovaries cease to produce estrogen and progesterone. Menopause is associated with increased incidence of heart disease, osteoporosis, and various symptoms.
While this understanding of menopause is correct, it does not do justice to the finely tuned hormone system that operates throughout a woman's life. In reality, hormone levels may begin to change in the 30s, as a woman enters a period called perimenopause. In the decades leading up to menopause, small hormonal imbalances can exist, so by the time menopause sets in, a woman may have already experienced close to 20 years of hormonal imbalance.
Furthermore, it is impossible to consider estrogen and progesterone in isolation from other hormones. All steroid hormones are created from cholesterol in a hormonal cascade. The first in the chain is pregnenolone, which is converted into other hormones, including dehydroepiandrosterone (DHEA), progesterone, testosterone, and the various forms of estrogen. These hormones are interrelated, each performing a unique biological function. True hormone replacement focuses on a woman's overall hormone health and seeks to achieve an optimal balance.
The importance of balance cannot be overstated. Physicians are just now beginning to understand the danger of having too much estrogen, a condition referred to as "estrogen dominance" (Carr et al 2001). Estrogen dominance might explain many of the conditions that confront modern Western women, from increasingly early menstruation (as early as age 10) to fibrocystic breasts (Kubista 1990), and cancer (Ashby et al 2001; Bentrem et al 2003; Bradlow et al 1995; Ghosh et al 1999; Papaconstantinou et al 2000). Estrogen dominance can occur in any woman, but perimenopausal women, who typically experience a more rapid decline in progesterone than in estrogen, are especially at risk.
Considering the dangers of estrogen dominance, it is a wonder that it took conventional medicine so long to become alert to the dangers of traditional HRT. Traditional HRT relies on a very strong estrogen called conjugated equine estrogen (CEE), which is usually (but not always) given in combination with synthetic progestins. A typical dosage is .625 mg of CEE with 2.5 mg of progestin. As the name implies, CEE is synthesized from the urine of pregnant horses (Bhavnani 2003). The progestin component used a chemical version of progesterone that was invented in a laboratory and has a chemical structure different from natural progesterone.
We believe that women should begin to monitor and, if necessary, correct hormone imbalances long before menopause, when there is still time to reverse this imbalance by restoring youthful hormone levels. Among younger women, it may be possible to address estrogen and progesterone levels with natural hormones, such as phytoestrogens or progesterones that can be found in plants. Among menopausal and postmenopausal women, who have dramatically reduced levels of hormones, it is often necessary to turn to specially formulated hormones that are bioidentical and supplied in approximately the same ratio found in the body. These natural hormones are often taken in conjunction with supplements that have been shown to reduce the side effects of menopause.
In addition to estrogen and progesterone, it's also important to monitor levels of pregnenolone, DHEA, and testosterone. The ideal goal of HRT therapy goes beyond the suppression of side effects caused by dropping hormone levels. The real goal of Life Extension's hormone restoration program is to restore hormone levels to those of a woman aged 20 to 29. Such an approach has wide-ranging benefits throughout the body, including psychological well-being and sex drive.
What You Have Learned So Far
|
From Puberty to Menopause: A Woman's Journey
At around age 12, girls enter puberty, a time when increased estrogen production causes the start of menstruation and the development of secondary sex characteristics, such as breasts and pubic hair. For the next two decades or more, a woman's hormonal cycles ideally operate like a finely tuned machine. Each monthly cycle of menstruation is an orchestrated dance between two ovarian hormones, estrogen and progesterone. During the first half of the menstrual cycle, estrogen levels rise and the lining of the uterus builds up in preparation for a fertilized egg. In the second half of the menstrual cycle, progesterone levels rise, causing the uterine lining to be infused with a rich blood supply. If fertilization does not occur, progesterone levels fall, and the uterine lining sloughs off as the uterus prepares itself for another cycle.
This cycle helps us understand in simple terms why the proper balance between estrogen and progesterone is so important. Estrogen is a pro-growth hormone, which explains why high estrogen levels are associated with increased risk of certain cancers. Progesterone, by contrast, protects women from estrogen's growth effect, which makes clear why it is used to help prevent cancers in conventional HRT. The two hormones oppose each other in other ways as well. Estrogen, for instance, increases body fat (Mayes et al 2004), while progesterone decreases body fat.
Around age 35, many women enter perimenopause, characterized by gradually declining estrogen levels and more rapidly declining progesterone levels. These different rates of decline can result in an imbalance. Although still menstruating, a perimenopausal woman may begin to experience symptoms of hormone imbalance, including unpredictable menstrual cycles, headaches, engorged breasts, cramping, and bleeding problems.
Perimenopause is followed at around age 50 by menopause, medically defined as the cessation of menstruation for 12 successive months (McAllister 1998; Walsh et al 2001). Most women will spend about one-third of their lives in menopause or postmenopause (Damewood 1997). During this time, the ovaries fail completely, and estrogen and progesterone levels (as well as other sex hormone levels) decline rapidly. Besides uncomfortable side effects, menopause is associated with increased risk for cardiovascular disease, osteoporosis, and breast cancer in the United States and other Western countries (Lock 1994). It is also accompanied by changes in the endocrinological, psychological, musculoskeletal, neurological, and immune systems (Danilovich et al2004; Khorram 1996; Walsh et al 2001).
For most women, menopause is known chiefly through its side effects. Up to 85 percent of Western women experience menopausal symptoms, including hot flashes, night sweats, disturbed sleep, fatigue, and related psychological changes, such as depression and anxiety (Burd et al 2001; Mahady et al 2002; Philp 2003; Soares et al 2003). Physical changes include urinary tract atrophy, vaginal atrophy and dryness with discomfort during sexual intercourse (Burger 2001; Coope 1996; Griffith 2004). These uncomfortable symptoms can last up to five years, with an average duration of two to three years (Samsioe 1995). Other symptoms include the following:
- Strength, energy, muscle, and bone loss (Notelovitz 2002; Proctor et al 1998)
- Cognitive changes, such as decreased memory, lack of concentration, and decreased learning capacity (Bhavnani 2003; Duffy et al 2003; File et al 2001; Lephart et al 2002)
- Elevated cholesterol levels due to alterations in cholesterol metabolism, as well as hardening of the arteries (atherosclerosis) and increased blood pressure (Philosophe et al 1991). Estrogen deprivation is a contributing factor to cardiovascular disease, the leading cause of death of women (Brochier et al 1998). It has been hypothesized that elevated cholesterol may be connected to falling hormone levels because the body tries to compensate for lost hormones by increasing the supply of precursor cholesterol (Dzugan et al 2002).
| Causes of Estrogen Dominance Beginning in perimenopause and continuing through menopause, women’s production of progesterone tends to decline more rapidly than their estrogen production does. Between puberty and perimenopause, estrogen levels can be raised by external influences, such as birth control pills or chemicals and toxins. If the ratio between progesterone and estrogen is altered in favor of estrogen, a condition may result that is known as "estrogen dominance," which is associated with increased risk of cancer and other health risks (Kubista 1990; Ashby et al 2001). Causes of estrogen dominance include the following:
Estrogen dominance often produces the following symptoms:
|
Understanding Estrogen
To fully understand HRT, it’s important to understand the various forms of estrogen and their effects in the body. More than 20 forms of estrogen have been identified. The three major ones are estrone, estradiol, and estriol.
Estradiol is the strongest form of estrogen; it is the kind used in conventional HRT. It converts to estrone, which is produced to some extent in the ovaries but most often in other tissues. The weakest estrogen is estriol. It is the form of estrogen least associated with hormone-related cancers (Head 1998; Kano et al 2002).
These three estrogens convert into many metabolites. Estrone, for example, may convert into three different forms:
- 2-hydroxyestrone
- 4-hydroxyestrone
- 16-alpha-hydroxyestrone
Scientists have identified 2-hydroxyestrone as a “good estrogen,” while 16-alpha-hydroxyestrone and 4-hydroxyestrone have been associated with the development of cancer (Bradlow et al 1996; Muti et al 2000). The relationship between 2-hydroxyestrone and 16-alpha-hydroxyestrone is sometimes expressed as the 2:16 ratio.
By increasing the ratio of 2-hydroxyestrone to 16-alpha-hydroxyestrone, it may be possible to reduce the risk of hormone-related cancers (Bradlow et al 1986). A cancer that requires estrogen to grow and multiply is known as an estrogen receptor positive (ER+) cancer. Estrogen replacement therapy is generally discouraged in women who have estrogen positive cancers.
The most important ratio to watch, however, is the relation of the three major estrogens to each other. In a young, healthy woman, the estrogen ratio generally averages as follows:
90 percent estriol:7 percent estradiol:3 percent estrone.
While these levels vary individually, the goal of hormone restoration therapy is to recreate a more natural balance while balancing the levels of estrogen against all the other sex hormones. Again, maintaining a youthful balance is key.
One of the major problems with conventional HRT should now be clear. The average ratio of estrogens in CEE is 52 percent estrone, 4 percent estradiol, and 43 percent equilenin, a horse estrogen. Although this therapy may reduce the symptoms of menopause, it clearly is not natural.
| The Dangers of Hormone Loss By the time a woman enters menopause, she may have already experienced two decades of hormonal imbalance and estrogen dominance. After menopause, when all hormone levels decrease significantly, aging women are at increased risk of major diseases, including the following: Heart disease. Rates of heart disease in postmenopausal women gradually climb until they equal the rates typically seen among men. According to the American Heart Association, heart disease is the leading killer of American women (American Heart Association 2004). A number of negative changes in cardiovascular health are provoked by menopause, including elevations in blood pressure, low-density lipoprotein (LDL) cholesterol, total cholesterol, and triglycerides. At the same time, high-density lipoprotein (HDL) cholesterol levels drop significantly. Elevated levels of homocysteine, C-reactive protein, and interleukin-6 (an inflammatory cytokine) are all associated with estrogen deficiency (Cushman 2003; Davison et al 2003; Dijsselbloem et al 2004) Osteoporosis. Hormone deficiencies are clearly associated with bone loss and osteoporosis, beginning even in the third decade of life. By the time women reach 50, they are at significantly increased risk of an osteoporotic bone fracture. Estrogen deficiency results in increased production of pro-inflammatory cytokines, which cause increased bone breakdown and inflammation (Lian et al l2001). Estrogen and androgen therapy increases bone mineral density (BMD), and estrogen/androgen replacement therapy has been shown to increase BMD more than estrogen therapy alone (Notelovitz 2002). Alzheimer's and dementia. Loss of hormones is associated with neurodegeneration and increased risk of dementia, such as Alzheimer’s disease and Parkinson’s disease (Danilovich et al 2004; O'Suilleabhain et al 2004). Deficiencies in pregnenolone and DHEA, which are both neuroprotective hormones, are also linked to reduced memory and brain cell death associated with Alzheimer's disease (Yao et al 2002). These two hormones play an important role in regulating neurotransmitter systems that are involved in learning, stress, depression, addiction, and many other vital functions (Maurice T et al 1999). |
Progesterone's Balancing Act
Estrogen is only part of the hormone restoration picture. Equally important is progesterone. In a healthy young woman, progesterone serves as a counterpoint to estrogen. While estrogen builds up in the first half of a menstrual cycle, progesterone levels don't start rising until the middle of the cycle. Progesterone's job is to prepare the uterus for implantation with a healthy fertilized egg and to support the early pregnancy. If no implantation occurs, progesterone levels drop, and another cycle begins.
One of progesterone's most valuable functions is its ability to fight cancer. Whereas estrogen is pro-growth (causing the cells in the uterus to multiply early in a menstrual cycle), progesterone is antigrowth. Studies have shown that progesterone has antiproliferative effects on at least two different types of breast cancer cells (Formby et al 1998). Breast cancer is 5.4 times more common in women with low progesterone than in women who have favorable progesterone levels (Cowan et al 1981). Recent studies have also shown that natural progesterone does not affect breast cancer risk, but the synthetic progestins used in conventional HRT raise the risk of breast cancer (Campagnoli et al 2005).
Natural progesterone has also demonstrated neuroprotective properties. One recent study called for more attention to progesterone as a “potent neurotrophic agent that may play an important role in reducing or preventing motor, cognitive, and sensory impairments” in both men and women (Stein 2005). Progesterone deficiency has also been linked to migraine (Colson et al 2005).
Wild Mexican yam is a safe, natural source of progesterone (Bagur et al 1996; Komesaroff et al 2001; Uchibayashi 2001). Other sources of natural progesterone include thyme, oregano, turmeric, verbena, damiana, and red clover (Bagur et al 1996).
Most natural progesterone products that can be purchased over the counter use progesterone derived from soybeans and yams. A common form of natural progesterone is dispensed in a cream that is rubbed into appropriate areas of the body (Komesaroff et al 2001; Uchibayashi 2001). This route of administration bypasses the liver (where the majority of oral progesterone is metabolized) and allows more hormone delivery to where it is needed.
This method provides the closest possible approximation to the natural production of progesterone by the ovaries, provided the dosages are properly timed. Once again, it’s important that progesterone therapy mimic the natural cycle as much as possible. To accomplish this, many physicians recommend progesterone therapy be used only during the last half of the month to simulate a young, healthy progesterone cycle.
Female Hormone Restoration
Beyond Estrogen and Progesterone: The Total Hormone Picture
The final step to total hormone restoration is to look at all the hormone levels. Because the steroid hormones are all related to one another, and because many convert into other hormones, it is very important to strive for balance.
DHEA is a natural steroidal hormone secreted by the adrenal gland, the gonads, and the brain (Williams et al 2001). Although women usually have less DHEA than men, both sexes lose DHEA at about the same rate, suggesting that its decline is age related (Khorram 1996; Wilder 1996). Peak levels are typically reached when women are in their 30s, after which they begin to lose approximately 2 percent per year. Decreased levels of DHEA are associated with cancer, diabetes, lupus, and psychiatric illness (Berkman et al 1993; Salek et al 2002). Low levels of DHEA are also associated with higher levels of insomnia, pain, and disability (Morrison et al 1998).
DHEA has been shown to improve mood, neurological functions, immune system functioning, energy, feelings of well-being, and to maintain muscle and bone mass (Kroboth et al 1999; Proctor et al 1998; Yen et al 1995). A study has demonstrated memory-enhancement effects by DHEA and pregnenolone (Rupprecht et al 1999). DHEA may also improve insulin sensitivity and lower triglyceride levels (Casson et al 1995).
Testosterone levels also gradually decrease with age (Schneider 2003). Loss of testosterone affects libido, bone and muscle mass, vasomotor symptoms, cardiovascular health, mood, and well-being (Burd et al 2001; Watt et al 2003). Testosterone therapy, combined with estrogen therapy, has been shown to improve quality of life, vigor and mood, ability to concentrate, bone mineralization, libido, and sexual satisfaction (Bachmann 1999; Braunstein 2002; Cameron et al 2004; Davis et al 2003; Sarrel 1999). This combination therapy also produces improvements with hot flashes, sleep disturbances, night sweats, and vaginal dryness. Because DHEA converts into testosterone, it may be possible to raise testosterone levels with DHEA supplements (Cameron et al 2004; Schneider 2003).
An observational study suggests that testosterone may protect against breast cancer (Slayden 1998). Studies also demonstrate that testosterone replacement alone may protect against breast cancer (Dimitrakakis et al 2003; Dimitrakakis et al 2004; Zhou et al 2000). In addition, testosterone is effective for the treatment of decreased libido (Davis 1999).
Pregnenolone levels also decline with age. As the primary steroid hormone in the cascade, pregnenolone is the first product of cholesterol. Like other hormones, there is a significant reduction occurring in women at about age 32 (Havlikova et al 2002). Reduced pregnenolone levels result in decreased amounts of all other hormones, and pregnenolone deficiencies have been associated with diminished brain function and dementia (Yao et al 2002; Maurice T et al 1999).
It is very important for women to check blood levels of hormones before beginning therapy, and again one and three months after initiating replacement therapy to ensure safe and adequate levels. If testosterone is still low after DHEA and pregnenolone therapy, talk to your physician about options. Always consult your physician before beginning HRT, especially if you are at high risk or have a family history of hormone-dependent cancer.
Phytoestrogens: A Natural Option
It might seem like a stark choice: face aging and hormonal decline or rely on synthetic hormones that raise the risk of heart attack and breast cancer. Fortunately, there are other options. Progressive physicians throughout the United States, Europe, and Japan have begun to rely on natural bioidentical estrogens, or plant compounds that have estrogenic properties (called phytoestrogens).
Some of the best evidence for phytoestrogens comes from Asia. In Asia, women do not experience many of the diseases and symptoms associated with menopause and the loss of estrogen (Knight et al 1996; Park et al 2005; Sarkar et al 2003). Looking for answers, researchers examined whether there was a genetic difference or another explanation.
Phytoestrogens found in soy and other plant products may help protect aging Asian women (Park et al 2005; Sarkar et al 2003).
Phytoestrogens bind to estrogen receptors (Zittermann 2003). By competing for estrogen receptors, phytoestrogens help prevent the growth and spread of several hormone-dependent cancers (Adlercreutz et al 1992). They have also been shown to decrease the risk of some degenerative diseases, including cardiovascular disease, osteoporosis, and breast and uterine cancer (Badowski et al 2001; Fletcher 2003; Magee et al 2004; Park et al 2005; Valentin-Blasini et al 2003).
Heart Benefits of Phytoestrogens
Unlike conventional HRT, which was shown to raise the risk of heart attack among postmenopausal women, phytoestrogens actually have a positive effect on the heart. In 1999, the US Food and Drug Administration authorized the use of food-label health claims connecting increased soy consumption with reduced risk of coronary artery disease (Vincent et al 2000). One study of more than 400 women demonstrated that phytoestrogens protect against arterial degeneration and atherosclerosis through their effect on the arterial walls, particularly in older women (van der Schouw et al 2002).
A survey of scientific studies on phytoestrogens found they offer the following benefits:
- Decreased blood pressure, LDL cholesterol, total cholesterol, and triglycerides (De Kleijn et al 2002; Ruiz-Larrea et al 2000).
- Increased HDL cholesterol and improved cardiovascular profile (De Kleijn et al 2002).
- Lowered the overall rate of cardiovascular disease among people with higher consumption of phytoestrogens (Ariyo et al 2002). Genistein and daidzein, two of the most extensively studied phytoestrogens, are effective at lowering lipids in people with high cholesterol (Anthony et al 1997; Teede et al 2001; Zittermann 2003). Increased levels of daidzein and genistein inhibit LDL oxidation and help reduce the risk of atherosclerosis (Exner et al 2001).
- A six-month study of more than 180 women confirmed that a soy-rich diet is as effective as conventional HRT for lipid lowering (Park et al 2005).
Furthermore, phytoestrogens have up to almost 3 times the radical scavenging activity of vitamin C and vitamin E and have protective effects on the arterial walls (Ruiz-Larrea et al 2000; van der Schouw et al 2002).
Osteoporosis and Phytoestrogens
Studies have shown that postmenopausal women with a habitually high intake of phytoestrogens have high bone mineral density of the spine and hip (Greendale et al 2002; Hanna et al 2004; Mei et al 2001). A number of studies have been conducted on phytoestrogens and bone homeostatis:
- Genistein, daidzein, and coumestrol increase bone mineralization (Clifton-Bligh et al 2001; Kanno et al 2004).
- Genistein and daidzein decrease bone resorption and inflammatory factors and increase bone-making proteins (Gao et al 1999; Gao et al 1999b; Harkness et al 2004; Jia et al 2003; Rassi et al 2002; Suh et al 2003; Yamaguchi et al 2000; Zhang et al 2004).
- An isoflavone mixture of daidzein, genistein, formononetin, and biochanin demonstrated significant increases in bone mineral density after six months of treatment. Women who took 57 mg/day of isoflavones had a 4 percent increase in bone mineral density (Clifton-Bligh et al 2001).
- A phytoestrogen preparation using daidzein, genistein, formononetin, and biochanin demonstrated protective effects on the lumbar spine (Atkinson et al 2004).
- Dietary supplementation with 54 mg/day of genistein “may be as effective as hormone replacement therapy in attenuating menopause-related bone loss without causing the associated side effects” (Cotter et al 2003).
Genistein: A Powerful Phytoestrogen
Genistein, together with daidzein, is one of the most extensively studied phytoestrogens. It has been shown to have beneficial estrogenic effects in bone, the brain and the cardiovascular system (Bang et al 2004). It is even being considered as an alternative to estrogen for the treatment of Alzheimer’s disease (Bang et al 2004).
Brain protection. Estrogen and estrogen-like compounds protect brain cells from degenerative changes due to aging and oxidative stress (Bhavnani 2003; Linford et al 2002). Genistein is a potential alternative to estrogen in the treatment of Alzheimer’s disease (Bang et al 2004).
Menopause symptoms. Several studies demonstrate that natural estrogens significantly decrease hot flashes and vaginal atrophy (Albert et al 2002; Baird et al 1995; Chiechi et al 2003; Clifton-Bligh et al 2001; Murkies et al 1995). Treatment with 54 mg/day of genistein safely decreases hot flashes up to 30 percent and should be considered as an alternative treatment for postmenopausal conditions (Crisafulli et al 2004).
Cancer. Studies demonstrate a significantly lower incidence of sex hormone–related cancer in Asian countries (Sarkar et al 2003; Vij et al 2004). This difference has been attributed to the traditionally high intake of soy isoflavones in the Asian diet because genistein has been shown to stop the growth and spread of breast cancer cells and significantly delay the progression of prostate cancer (Sarkar et al 2003; xon-Shanies et al 1999).
Daily soy isoflavone consumption is associated with decreased breast cancer risk (Lu et al 2001). A diet containing 113–202 mg/day (depending on body size) of genistein and daidzein can increase the production of the protective 2-hydroxylated estrogen, decrease estradiol and its harmful metabolites, and lower the long-term risk for breast cancer (Lu et al 2000). Genistein and daidzein also have an inhibitory effect on uterine cancer (Lian et al 2001). Most studies indicate that soy isoflavones are safe and effective.
Naturally Suppressing Symptoms of Menopause In addition to hormone restoration therapy, many supplements have been shown to suppress the symptoms of menopause and hormone loss. Folk and traditional healing therapies have successfully and safely used herbal medicines to treat gynecologic problems for more than 100 years (Hardy 2000; Mahady et al 2002). These herbal medicines include the following: Black cohosh. Native American Indians have used black cohosh as a traditional medicine for many years, and Koreans have used it to treat pain and inflammation (Huntley 2004; Kim et al 2004; McKenna et al 2001). Today, it is used primarily for the treatment of menopausal symptoms, such as hot flashes, and menopausal depression and anxiety (Kennelly et al 2002). Black cohosh has also been used to treat younger women who have surgically induced hormonal deficits due to hysterectomy or ovariectomy and for menstrual disorders (McKenna et al 2001). It is effective for reducing hot flashes, night sweats, fatigue, and insomnia (Kronenberg et al 2002; Philp 2003; Pockaj et al 2004). Black cohosh also has antiproliferative effects on breast cancer cells (Bodinet et al 2004; Einbond et al 2004; Hostanska et al 2004; Zierau et al 2002). Studies have shown it is as effective as Evista for preventing bone loss (Nisslein et al 2003). Black cohosh is so effective that an extract called Remifemin® is commonly prescribed in Europe as an alternative to HRT for menopause (McKenna et al 2001). Several clinical studies demonstrate that black cohosh should be considered as an alternative therapy, especially for women who should not take HRT (Hardy 2000; Huntley 2004; Johnson et al 2003; Lieberman 1998; Lupu et al 2003). Licorice root. Licorice root's many beneficial biological effects include estrogenic effects, body fat reduction, and reduction of testosterone (Armanini et al 2002). Similarly, licorice root has been shown to decrease serotonin reuptake by up to 60 percent, which may help alleviate menopausal depression (Ofir et al 2003). Licorice root also has the ability to lower the risk of cardiovascular disease by assisting with repair of blood vessel walls and preventing hardening of the arteries (Somjen et al 2004). For more information on the safety profile of licorice root, please see “Safety Caveats” at the end of this chapter. Dong quai. Dong quai is used in Chinese medicine to treat gynecologic conditions (Goh et al 2001; Hardy 2000). It is an effective remedy for alleviating menopausal symptoms without causing harmful changes in the uterus or vagina (Hirata et al 1997). A study demonstrated that a preparation with 60 mg of soy isoflavones, 50 mg of black cohosh, and 100 mg of dong quai reduced menstruation-related migraine headaches (Burke et al 2002). Most phytoestrogen preparations contain a small quantity of dong quai because of its various biological effects in the body. Vitex agnus-castus. Extracts from the fruit and leaves of vitex agnus-castus (vitex), also known as chasteberry, contain chemicals with diverse beneficial effects for the treatment of premenstrual and menopausal symptoms. Menopausal women report excellent symptomatic relief after using two essential oils from vitex (Chopin 2003). |
Bioidentical Hormone Replacement
Among younger women, phytoestrogens alone may be enough to correct small deficiencies. Menopausal and postmenopausal women, however, often require HRT with bioidentical estrogens and progesterone. As the name implies, these hormones have exactly the same chemical structure as biological hormones. Bioidentical hormones can be found at special pharmacies that will compound them in the correct ratio to naturally restore hormones to a youthful level. The use of bioidentical estrogens, which is gaining acceptance in the United States, has long been practiced in Europe and Japan (Kano et al 2002).
Estriol is the main component of Life Extension's recommended bioidentical estrogen replacement therapy, representing 90 percent of the content, with smaller proportions of estradiol (7 percent) and estrone (3 percent). Estriol offers many of the benefits of more conventional estrogen-replacement therapies, but without the harsh side effects or long-term dangers often encountered with conventional HRT, which has an unnatural balance of estrogens and contains almost 50 percent horse estrogen (Head 1998). This weak estrogen also slows the progression of atherosclerosis (Kano et al 2002).
Some popular prescription estrogen formulas are BiEst® and TriEst®. BiEst® consists of estradiol and estriol (Taylor 2001), while TriEst® contains all three estrogens in a ratio of 80 percent estriol to 10 percent each of estradiol and estrone (Taylor 2001). For a patient with a prescription, a compounding pharmacy can alter the proportion of each estrogen to achieve Life Extension’s recommended ratio of 90:7:3. For referrals to physicians who are willing to prescribe bioidentical estrogens, or for information on obtaining a Female Hormone Profile, call 1-800-544-4440 or go to www.lef.org.
Bioidentical estrogens will often be prescribed after blood testing shows deficiencies in estrogen and can be part of a comprehensive hormone restoration program that also includes progesterone cream or bioidentical progesterone, DHEA, pregnenolone, and perhaps testosterone.
Women should also discuss hormone cycling with their physicians. During their fertile years, women do not experience stable blood levels of estrogen and progesterone. Rather, estrogen and progesterone levels naturally rise and fall throughout the monthly cycle. Decades of this normal, natural flow of hormones has the effect of conditioning hormone receptors throughout the body to follow a rhythmic pattern.
To mimic nature and get the most benefit from hormone restoration, a woman should take estrogen in the first part of the month and taper the amount toward the end of the month, when her body is conditioned to receive less estrogen. Progesterone, on the other hand, should be taken in the latter half of the month, when her progesterone levels would be rising. Discuss this cycle with your physician because every woman's body and natural cycles are different.
| Female Hormone Safety Caveats Women who are at risk of hormone-dependent cancer should not begin hormone restoration therapy unless they are under the direct supervision of a qualified physician. An aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. These include: Black Cohosh
Daidzein
DHEA
Genistein
Glycitein
Licorice
Progesterone
Vitex (chasteberry)
For more information see the Safety Appendix |
Subscribe to:
Posts (Atom)
Natural Remedies for Menopause