Hot flashes, headaches and depression are
typical symptoms of menopause that strike fear in many women who are nearing
“the change.” Hormone replacement therapy — taking a combination of estrogen
and progestin — is the treatment of choice for most physicians today because of
its ability to relieve menopausal symptoms and provide other health benefits
such as delaying osteoporosis and protecting against heart disease.
But
what if you have breast cancer? Hormone replacement therapy is not recommended
because it may increase the risk of breast cancer, although studies are
inconclusive. Or what if you just don’t want to take hormones because of the
possible side effects like bloating, blood clots and depression?
Treating
menopausal symptoms is an individual process, says Judy Lane, NP, MS, director
of women’s medicine at the Preventive Medical Center, San Rafael, Calif. “As
the degree and severity of menopausal symptoms varies enormously, so does
response to therapy, whether it be herbal or hormonal. Consequently, herbal
therapy has been of great help to some women, and totally ineffective with
others.”
Black Cohosh: Another Option
There
may be another option in the fight against hot flashes — the herb black cohosh.
Black cohosh is found predominately in the eastern United States and was
traditionally used by Native Americans to treat women’s health issues from
irregular menstruation, to cramping and menopausal symptoms. Packaged herbal
supplements contain Remifemin, the standardized extract of black cohosh, which
has a low toxicity with few side effects — except in pregnant women who should
consult a physician before taking any herbal supplements.
A
randomized trial was completed recently on the effectiveness of black cohosh in
treating menopausal symptoms in women who have breast cancer. The study’s lead
author, Judith S. Jacobson, DrPH, in the division of epidemiology at the
Mailman School of Public Health, Columbia University, N.Y., discusses the
team’s motivation. “We knew that cancer patients were using many kinds of
complementary and alternative medicine (CAM), and we believe that it is
important to study the efficacy and safety of CAM.
Joel
Evans, M.D., a co-author of the study, is an obstetrician/gynecologist who has
been encouraging his patients who did not want to take hormone replacement
therapy to try black cohosh. He decided that a formal trial was needed and came
to us.”
The
study offers some insight into the herb’s effectiveness and possible dangers.
Women who have survived breast cancer often take the drug tamoxifen to treat or
prevent any recurrence of the cancer.
Unfortunately,
tamoxifen magnifies the symptoms of menopause — particularly hot flashes.
Because hormone replacement therapies are often off-limits to women with breast
cancer, they are turning to alternative medicine for help in ever-increasing
numbers. Out of 305 breast cancer patients polled at Columbia-Presbyterian
Medical Center, 37 percent reported they were using medications not prescribed
by their doctors.
These
findings prompted researchers at Columbia to do a clinical trial comparing the
effect of black cohosh on women who have breast cancer, have completed the
first phase of treatment and who suffer from frequent hot flashes. They tested
85 women for two months — 42 took black cohosh, 43 took a placebo. The results
were mixed: Both groups reported reductions in their symptoms.
Does
this mean that black cohosh is all hype? Not necessarily. The study did find
that the group taking black cohosh noted a significant decline in excess
sweating — a symptom obviously related to heat — and the placebo group did not.
Christiane
Northrup, M.D., obstetrician/gynecologist and author of the book The Wisdom of
Menopause, which follows her New York Timesbestseller, Women’s Bodies, Women’s
Wisdom, comments, “It is well-documented that placebos often work for many
menopausal symptoms. That is because stress of all kinds exacerbates menopausal
symptoms.
When a
woman is given a remedy that both she and her doctor believe in, it is far more
likely to work. And that is not ‘all in her head’ — there are direct physical
effects that result from positive expectations, such as the decrease in the
stress hormones cortisol and adrenaline.”
Jacobson
admits that the study is far from cut and dry. “Although these findings do not
tell us everything we might want to know about the potential phytoestrogenic
activity of Remifmin, they represent more information than is currently
available on other herbal agents for menopausal symptoms. I believe that
quality of life is important, and that a woman who is suffering from hot
flashes and wishes or is advised by her physician not to use hormone
replacement therapy might reasonably consider trying black cohosh.”
China’s Remedy: Dong Quai
There
are many other herbs that are frequently used to treat the long list of
menopausal ailments. But women must be patient, says Northrup. “Herbs do not
work as fast as hormones and may not be appropriate for a woman who is
suffering from something like severe insomnia from hot flashes, or severe
vaginal dryness.”
Dong
quai is one of the most popular. A Chinese herb, dong quai is used for
menopausal complaints, irregular menstruation and abdominal pain. Janet Zand,
LAc, OMD, a naturopathic physician in Austin, Texas, and author of Smart
Medicine for Healthier Living, explains, “Dong quai, also spelled tang kuei or
angelica sinensis has been used for over 2,000 years throughout Asia in the
treatment of many gynecological problems.
As for
menopause, it is known to treat hot flashes as well as painful and abnormal
menstruation. It is believed that the efficacy of dong quai is due to its
phytoestrogens as well as its ability to help stabilize blood vessels.”
However,
a study was conducted on 71 postmenopausal women using dong quai and a placebo.
Dong quai failed to live up to its reputation as a menopausal cure-all — both
the placebo group and the group taking the herb reported the same results.
However,
Lane reports that there is more than one way of interpreting studies. “The most
widely accepted study on dong quai in Western medicine was published in
Fertility and Sterility and was a double-blind, placebo controlled trial that
showed no benefit to using the herb. However, in Chinese medicine, dong quai is
generally never given as a single herb, but in combination, and this was one of
the criticisms of the study.”
Natural Hormones
Using
natural hormones is another option. Cynthia M. Watson, M.D., family
practitioner in private practice in Santa Monica, Calif., recommends a
combination of maca root and natural progesterone. “Maca root is probably one
of the number one things I use for women with perimenopausal and menopausal
symptoms who don’t want to go on estrogen, and I use it with natural
progesterone.
I have
very good results with symptoms like hot flashes and vaginal dryness. I think
natural progesterone is far underutilized in conventional medicine. I have been
on natural progesterone myself for almost 10 years. It has saved me many times
and has prolonged my menstruating years.”
Zand is
a proponent of plant estrogen. “Natural plant estrogens, orphytoestrogens,
provide a useful form of estrogenic like supplementation for women who are
unable or who choose not take conventional estrogen replacement therapy. There
are over 300 different plants that contain estrogenic-like substances.”
However,
there are potential drawbacks to natural hormones. Watson explains, “The issue
is, do herbs and natural hormonal treatment protect the bones, the heart and
the brain? We don’t know the answer to that question yet. Synthetic hormone
replacement does that.
I
believe the power is in the individual and in her own ability to educate
herself and to be a part of her own healthcare, but you do need to be careful
because it would be a shame for a woman to be on plant estrogen for 15 years
and find out that she’s developed osteoporosis.”
Northrup
says, ”My favorite alternative menopause remedy is high dose whole soy food,
either as soy food itself, e.g. soy milk, edemame, etc, or as a powdered drink.
Usually 100-180mg of soy isoflavones per day will improve hot flashes, vaginal
dryness, skin dryness, and mood swings. Research has shown that soy tends to
enhance the effects of estrogen, giving better results at lower doses. It is also very useful in those women who
cannot take estrogen because of a history of breast cancer, uterine cancer, or
ovarian cancer.”
Frustrated?
Without a multitude of in-depth research projects, randomized trials, and
clinical studies to scientifically back up the benefits of herb and natural
hormone use in treating menopausal symptoms, it is difficult to make any
grandiose claims or sweeping criticisms.
Jacobson
offers some hope. “Many studies of herbal agents are in progress. Dr. Fredi
Kronenberg at Columbia’s Rosenthal Center is currently conducting a clinical trial
of black cohosh in a different formulation, at a different dose, over one year
of use in healthy women with hot flashes. That trial should give us much more
detailed information about efficacy and safety than we now have.”
On the
positive side, black cohosh, dong quai and maca root have few or no adverse
side effects, so trying them may be an option for many women. Your physician
can advise you on any possible interactions if you are taking other
medications.
Also
ask about hormone replacement therapy and natural hormones — one may be the
right choice for you. As Lane says, “The only given about treating menopausal
symptoms is there is no ‘one size fits all.”
MEDICAL
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