Natural Alternatives to Hormone Replacement

Herbal remedies can be used as a safe and natural alternatives to hormone replacement.

Natural Remedies or HRT for the Heart?

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.

Hormone Replacement Therapy

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.

Helpful Herbs and Supplements

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.

Final Thoughts on Natural Hormone Replacement

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.

Natural Alternatives to Hormone Replacement

Natural Remedies or HRT for the Heart?

Hormone Replacement Therapy

Helpful Herbs and Supplements

Final Thoughts on Natural Hormone Replacement

Suggested Reading