~ A Natural Approach to Menopause, Part 2

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

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.



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