Herbal remedies can be used as a safe and natural alternatives to hormone replacement.
For most healthy women, menopause is a normal part of aging. As a biological rite of passage, it marks the transition into the post-reproductive phase of life. Menopause heralds the emergence of a new lifestyle, one of liberation from the responsibilities of the childbearing years. But it wasn’t that long ago that this transition was seen as the beginning of the end. Consider that up until the late nineteenth century, the average woman’s lifespan was only forty-nine years. Consequently, the time after menopause was short and often spent in declining health. But the longevity revolution has dramatically changed that scenario. The average lifespan has now increased to seventy-five years, meaning that in this country alone, tens of millions of women will spend at least a third of their lives after menopause. It is reasonable for these women to expect that, if they maintain salutary habits, they will be able to enjoy continued physical vitality throughout much of that time.
However, along with the potential opportunities it provides, menopause can also bring many undesirable symptoms. These include hot flashes, night sweats, heart palpitations, vaginal dryness, loss of libido, irritability, mood swings, and depression. In addition, menopause is associated with the development of several chronic diseases. As a result of decreasing production of estrogen by the ovaries, there is an accelerated loss of calcium, leading to osteoporosis and bone fractures. Lower estrogen levels also are associated with an increased risk of coronary artery disease and have been implicated in age-related memory impairment and Alzheimer’s disease. Natural alternatives to hormone replacement can be used as a safe treatment for menopausal symptoms.
The conventional medical solution to menopause has been to narrowly define it as a deficiency syndrome that should be corrected by hormone replacement. This practice began roughly forty years ago, with the isolation of a commercial source of estrogens from the urine of pregnant horses. In 1966, the popular book Feminine Forever by Robert Wilson, M.D., touted the virtues of estrogen therapy as the answer to menopause and the “problem” of aging. Millions of women heeded Wilson’s advice. Over the next decade, Premarin, a mixture of equine estrogens, became one of the top-selling prescription drugs in the United States. The armamentarium was later expanded to include Provera (a type of progesterone) and testosterone. Various forms of these three drugs are now the mainstays of hormone replacement therapy (HRT).
Ten years after the drugs’ introduction, researchers discovered a significant downside to HRT. It was found that when estrogen was taken by women who had an intact uterus, the risk of endometrial cancer increased dramatically. After this connection was established, more than 15,000 cases of endometrial cancer were attributed to the use of unopposed estrogen during the years 1971 to 1975 alone. (This amounts to one of the largest physician-caused epidemics on record.) The risk appears to decrease significantly when progesterone is added; however, a recent study showed that the combination of estrogen and progestin (synthetic progesterone) may increase the risk of breast cancer. Estrogen should also be avoided by women with clotting disorders, migraines, gallbladder disease, hypertension, or liver cancer.
HRT can be highly effective for women who have undergone premature menopause, such as after surgical removal of the ovaries or chemotherapy and/or radiation for cancer. In premature menopause, the dramatic drop in hormone production at an early age causes much more intense symptoms and a greater risk for heart disease and osteoporosis. For women whose symptoms are not as severe, the choice is less clear. In this case, it is important to consider all of the pros and cons for HRT so that an informed decision can be made.
Concerns about the potential health risks of HRT have led increasing numbers of women to seek out alternative therapies, such as dietary changes, functional foods, botanical medicines, and nutritional supplements. Although some conventional practitioners dismiss these therapies as unproven, many of the therapies have been used effectively for hundreds of years. These approaches have the added advantage of being safe and relatively inexpensive. Because they are available without a prescription, using them can also help reduce medical costs and relieve the pressure on an overburdened health-care delivery system. The following are some of the best-researched of these alternatives.
Soy (Glycine max). Tofu, tempeh, miso, and other foods derived from soybeans have long been staples of the Asian diet. Women from cultures in which these foods are consumed on a regular basis rarely have menopausal symptoms and are much less likely to suffer from hip fractures, breast and endometrial cancer, or heart disease. For example, fewer than 25 percent of Japanese women complain of hot flashes, compared to 85 percent of American women. And Japanese women have one-quarter the incidence of breast cancer as Americans.
The ingredient responsible for these effects appears to be a group of compounds called isoflavones. After soy products are eaten, the intestinal bacteria convert isoflavones into substances called phytoestrogens, which are then absorbed into the bloodstream. These substances appear to have several beneficial effects in the body to help relieve menopausal symptoms.
For example, in one published study, fifty-one women were given 60 g per day of a dietary soy supplement and the participants’ responses were compared to another group of fifty-three women who were given a placebo. After twelve weeks, the women taking the soy reported a significant reduction in hot flashes. Numerous studies have also shown that supplementing the diet with 17 to 25 g of isoflavone-rich soy protein daily can lower the “bad” LDL cholesterol by up to 13 percent and serum triglycerides by 10 percent, without affecting the “good” HDL cholesterol. Other studies strongly suggest that ingestion of soy products can help maintain bone density.
Even though soy isoflavones are called phytoestrogens, it is important to clarify that they are not true estrogens. Instead, they balance the effects of estrogen in the body, enhancing estrogen when it’s low but blocking estrogen’s stimulating effects when the levels are high. Despite the warnings of some critics, there has not been a single human study showing that eating soy products increases the risk of breast—or any other—cancer or enhances the growth of existing cancers. In fact, phytoestrogens, which are found to some degree in almost all plants, are excellent cancer-preventive agents. This makes soy supplementation ideal for women who choose to pursue HRT.
Flax (Linum usitatissimum) is the perfect dietary complement to soy. Flaxseeds, and to a lesser extent, flaxseed oil, are rich in chemical compounds called lignans. Similar to what happens with soy, these lignans are processed by intestinal bacteria into beneficial phytoestrogens, which can help alleviate menopausal symptoms such as hot flashes and vaginal dryness. They also can have a stabilizing effect on hormone-related mood disorders.
For example, at the 1998 annual meeting of the North American Menopause Society, it was reported that flaxseed supplementation had been observed to improve the anxiety and depressed mood associated with menopause. Flax-supplemented diets also have been shown to lower LDL cholesterol levels in at least two published human studies. The best way to supplement with flax is to eat one to two tablespoons of fresh-ground seeds per day, mixed into salads, breads, cereals, and smoothies. Because flax meal is high in fiber, it is also an excellent supplement to ensure bowel regularity.
Black cohosh (Cimicifuga racemosa) was known as “squawroot” by Native Americans, who used it for a wide range of female health problems. Traditional herbalists adopted this practice, and the herb was included in the U.S. Pharmacopoeia as far back as 1820. Black cohosh was one of the ingredients in Lydia Pinkham’s Vegetable Compound, an extremely popular patent medicine for “female complaints” in the 1920s. In the 1950s, a standardized extract of black cohosh was developed in Germany and studied in numerous clinical trials. Since then it has been taken by more than 1.5 million women and has been endorsed by the German Commission E, a panel of government-sponsored experts similar to the U.S. Food and Drug Administration.
Black cohosh has been found to reduce hot flashes, night sweats, vaginal dryness, depression, irritability, and nervousness. It also has anti-inflammatory and muscle-relaxant properties. Early research suggested that it may contain a phytoestrogen called formononetin that is responsible for these effects, but this has been difficult to confirm on repeat testing. When breast cancer cells in a test tube were exposed to a standardized black cohosh extract, no stimulation was observed—in fact, their growth was inhibited. Current thinking is that black cohosh contains a variety of active compounds that act synergistically to normalize female hormonal function.
Gamma oryzanol is a complex mixture of cholesterol-like chemicals that are commercially extracted from rice bran oil. An important antioxidant, it is also found in many whole grains, fruits, and vegetables. In Japan, gamma oryzanol has been used extensively as a natural medication since the early 1960s. It was initially used as a treatment for anxiety and later found to be effective for treating menopausal symptoms. Two published studies have shown it to alleviate hot flashes. Given in a dose of 100 mg three times daily, the first study showed a 50 percent improvement in hot flashes in about 70 percent of menopausal women. The second study showed 85 percent improvement. The mechanism by which it achieves these effects is not fully understood, but it appears to modulate the release of hormones by the pituitary—the master gland that regulates the ovaries, thyroid, and adrenals.
In addition, gamma oryzanol may help reduce the risk of heart disease. Several studies have found that gamma oryzanol, in doses of 300 to 600 mg daily, significantly lowers elevated blood cholesterol and triglycerides. It appears to do this by blocking the absorption of cholesterol in the intestines and increasing cholesterol’s elimination in the bile. Gamma oryzanol has no known side effects and has been demonstrated to be safe in both animal and human studies.
Maca (Lepidium meyenii) has been cultivated in the high Peruvian Andes for more than 2,000 years. A member of the cruciferous vegetable family, it is a relative of broccoli and Brussels sprouts. Originally grown by the ancient Incas as a nutrient-dense food, it developed a reputation among the indigenous peoples of Peru as a medicinal herb that could improve stamina, enhance fertility, and increase libido. More than a decade ago, animal studies conducted by Peruvian scientists showed that maca acted on the pituitary gland, which then regulated ovarian and adrenal function. It also appeared to amplify the effect of all of the sex hormones. Based on these studies, medical doctors in Peru began prescribing maca for treatment of the full range of menopausal symptoms, including hot flashes, vaginal dryness, depression, and osteoporosis.
Clinical reports from hundreds of patients indicate that maca can help with all of these symptoms. However, its most pronounced action is in the improvement of sexual drive, which often declines after menopause. Recent research has identified compounds called macamides and macaenes that may be responsible for these effects. Maca is now available in capsule form in the United States, where it is generally taken in a dose of 2 to 3 g daily. Some women have experienced a decrease in hot flashes after less than a week, but usually three to four weeks of regular use is necessary before its therapeutic effects are realized. Maca is free of side effects and can be taken for extended periods of time.
Even a cursory review of the natural alternatives to HRT shows that the green pharmacy of plant-based medicines provides many possibilities. The best thing about the natural approach is that it can be used in combination with HRT for women who don’t want to eschew the conventional model but are concerned about side effects. Women who wish to completely avoid HRT can find numerous options to help alleviate symptoms, reduce their risk of chronic diseases, and enjoy the new life available to them.
Robert Rountree, M.D., is a physician in private practice in Boulder, Colorado, where he practices integrative medicine. He is coauthor of Smart Medicine for a Healthier Child (Avery, 1994) and Immunotics (Putnam, 2000) and is an Herb Research Foundation advisory board member.
Greenwood, Sadja. Menopause, Naturally: Preparing for the Second Half of Life. Volcano, California: Volcano Press, 1992.
Hudson, Tori. Women’s Encyclopedia of Natural Medicine. Lincolnwood, Illinois: Keats Publishing, 1999.
Lark, Susan. The Menopause Self Help Book: A Woman’s Guide to Feeling Wonderful for the Second Half of Her Life. Collingdale, Pennsylvania: DIANE Publishing, 1996.
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