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Natural Remedies
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Conditions
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We all live with daily stress, but it is
our ability to adapt to the stress which determines how it will
affect our long term health. Healthy adrenal gland function will
ensure a higher tolerance to stress and to the effects of
stress.
The adrenal gland are located just above
the kidney area and they produce the ‘stress’ hormones adrenalin
and cortisol. Our body produces these hormones in times of
stress to help us ‘adapt’ and deal with the stress. But the
ability to adapt declines when the stress is long term and
continuous.
This can leads to adrenal ‘exhaustion’
which has four phases; the longer you are under stress the more
severe the adrenal exhaustion will tend to be;
Phase 1: Stressed and Wired where common symptoms
include: anxiety, nervousness, insomnia, panic attacks, PMT,
trembling, rapid shifts in body temperature, pressure, decreased
appetite, diarrhea, palpitations and shortness of breath.
Phase 2 Tired, then Wired which includes an increased
risk of depression, anxiety, insomnia and fatigue; decrease
resistance to infections including aggravating allergic
reactions, depletion of sex hormones and libido, decreasing
thyroid function, obesity and insulin resistance. Common
symptoms can include intense anxiety, melancholy depression,
insomnia, poor appetite, allergies.
Phase 3 Stressed & Tired which includes symptoms of
(apathetic) depression, increased daytime sleep, and tiredness,
weight gain, lethargy, fibromyalgia, rheumatoid arthritis,
multiple allergies and chemical sensitivities. Fibromyalgia is a
disorder in this stage. Energy levels are extremely low and
manifest as muscle weakness and pain.
Phase 4 Exhaustion; this stage is usually after a period
of the above stages and is often associated with post viral
syndrome or chronic fatigue syndrome (as immune system if often
compromised). These symptoms are mild fevers, sore throat and
increased infections, painful lymph nodes, muscle weakness,
headaches, painful joints, depression and sleeping disturbances.
The treatment in this stage is similar to stage 3, but with more
emphasis on repairing damaged nervous tissue and adrenal glands.
The level of adrenal exhaustion will direct
effect the severity of menopausal symptoms, hence it is
important to improve adrenal gland’s adaptation & tolerance to
your daily stress to ensure an easier transition in peri-menopause
and menopause.
Natural Remedies for Healthy Adrenals
To improve adrenal gland exhaustion you
need to consider all lifestyle facts to help improve your
tolerance/resistance to daily stress. Regular exercise and
relaxation techniques like meditation, yoga, tai chi with the
use of adrenal tonic herbal medicines can be helpful.
Herbal Treatment For Adrenal Exhaustion
The commonly used herbs are;
Withania, Siberian Ginseng, Panax ginseng,
Rhodiola, Licorice and Rehmannia
For adrenal tonic herbs that support the
adrenal gland function Licorice and Rehmannia are commonly used
(for all four phases)
Poor concentration and memory Rhodiola is
specific and has an immediate effect on improving concentration.
Adaptogenic herbs are herbs wihich increase
your tolerance/resistance to stress the three lead herbs are
Withania, Siberian ginseng and Rhodiola.
For exhaustion, stimulating herbs are used
like Panax ginseng (note not to be used in phase 1 or phase 2 as
it is too stimulating). Both Ginseng’s can be too stimulating
in many people hence it is best prescribed by a qualified
herbalist. A better choice is often Withania which has a
relaxing effect.
(In some people nervine herbs (which work
on the nervous system) and/or immune herbs especially in phase 3
or 4 of adrenal exhaustion need to also be considered.
Diet & lifestyle factors to improve adrenal function;
Relaxation techniques like yoga, tai chi,
mediation & regular exercise.
Remove sugar, high GI carbohydrate food and
stimulants like coffee/caffeine from the diet.
An insulin zone diet to correct any blood
sugar imbalances is also important to help correct imbalances in
adrenal gland function.
Supplements with Vitamin C, B complex with
extra B5 & B6 and Magnesium are also important to improve
adrenal function.
There are many herbs to choose from and it
is important to take not only the correct herbs for your
individual needs but also that the quality and the dosage of
these herbs is correct. If you are considering taking herbs
please see a qualified herbalist.
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Menopause &
Peri-menopause
A natural
therapies
approach to
menopause is
to help the
body adjust
to lower
hormonal
levels. How
easily the
body becomes
accustomed
to these
changes,
reflects how
severe or
troublesome
the symptoms
of menopause
are for each
woman.
The
menopausal
transition
can take
several
years and
the duration
of every
woman's
menopause is
very
individual.
It is in
accordance
to her
general
level of
health and
primarily
her adrenal
health which
can
influence
the length
of
menopause.
Adrenal
health, or
in many
cases
‘adrenal
exhaustion’,
in the years
leading up
to menopause
is a key
factor in
determining
the severity
of the symptoms
of
menopause.
The modern
day approach
is to only
consider the
lower
hormonal
level as the
cause for
menopausal
symptoms. By
replacing
hormones
(with HRT)
that the
body is no
longer
producing,
this will
help
alleviate
the symptoms
of menopause
but it is
only
delaying the
process. It
does not
address the
underlying
causes of
why some
women
experience
severe
problems
during
menopause.
The common
menopausal
symptoms
include; hot
flushes (70%
of women),
depression
(40% of
women),
sweating,
fatigue,
irregular
menstruation,
cessation of
menstruation,
sleep
problems/insomnia
(up to 40%
of
perimenopausal
women).
The aim of
holistic
menopausal
support is
to assist
the
adjustment
of these
important
changes; to
provide
symptomatic
alleviation
of the
effects of
hormonal
withdrawal;
to improve
the overall
health of
the
individual
especially
supporting
adrenal
gland
health. It
is not
simply
taking herbs
to replace
or increase
hormonal
levels as
the approach
with HRT
(hormonal
replacement
therapy).
Holistic
treatment
should not
be used
indefinitely.
Most people
approach
herbal
treatment
for
menopause
the same way
they do HRT,
which herb
will
increase the
hormonal
level? But
that is not
the main aim
of holistic
treatment.
It is not
aimed at
DELAYING
menopause by
simply
replacing
hormones.
Natural
Remedies for
menopause &
peri-menopause
An
easier
menopausal
transition
needs to be
approached
by firstly
improving
your overall
health and
wellbeing
including
diet and
lifestyle
factors.
The best
time to
start
holistic
treatment
for
menopause is
in the
peri-menopausal
phase i.e.
when the
length of
periods are
starting to
change. As
this is the
best time to
ensure
healthy
adrenal
function and
general
health, to
help create
a healthier
and easier
transition
in menopause
with
hormonal
balancing
herbs and
natural
remedies.
Holistic
treatment
varies from
six to 18
months but
in some
case’s
treatments
may be
necessary
for years.
The
healthier
the
patient’s
adrenal
status, the
shorter the
duration of
treatment
required.
Healthy
adrenal
function can
make a
healthy
amount of
progesterone.
Recent
concerns
with the use
of HRT has
prompted
increased
interest in
what
holistic
treatments
can offer
women in
menopause.
Many herbal
and
homoeopathic
medicines
can help
alleviate
menopausal
symptoms
without
increasing
the level of
oestrogen.
There are
three
choices for
treatment in
menopause;
1. HRT which
uses
synthetic
hormones to
replace what
your body is
not
producing.
(for more
information
on HRT
alternative
click
here
2. Natural
hormones
which are
still
replacing
hormones BUT
they are
chemically
the SAME as
the hormones
you produce
in the body.
I would tend
to recommend
these
hormones
over the
synthetic
hormones
3. Holistic
treatment:
to assist
the body to
make the
adjustments
more easily
and improve
the woman’s
overall
health and
adrenal
function.
Note :most
doctors do
not
prescribe
natural
hormones,
these
hormones
have to be
made up in a
compounding
chemist (the
closest is
Lismore or
Bondi in
Sydney) and
must be
prescribed
by a doctor.
Which
natural
remedies
really work?
Herbal and
homoeopathic
medicine
needs to be
individualized
to each
person for
it to be the
most
effective
treatment
for that
individual
woman. No
one herb or
one group
herbs/homoeopathic
medicine
will always
work in
every case.
The two main
reasons why
natural
remedies
fail
to be
effective in
the
treatment of
menopause
are; 1.poor
quality of
products
especially
of herbal
products and
2. trying to
use natural
remedies the
same way
they use
orthodox
drugs
without
addressing
other health
issues
(especially
adrenal
exhaustion)
which are
directly
contributing
to a
difficult
transition
in
menopause.
Remember,
herbs and
homoeopathic
medicines do
not work the
same way as
drugs, they
are treating
your whole
health,
improve your
own body’s
response.
Hence when
you stop
natural
treatment
your body
stays
healthier
and in
balance.
If you are
on HRT
and
would like
to come off
it, it is
better to
start
holistic
treatment
while you
are still on
HRT, then
slowly
increasing
the natural
remedies as
you reduce
the HRT over
8-12weeks.
If you are
on (or have
been
recently)
HRT
to reduce
the
side-effects
of HRT
supplements
with
isoflavones,
estrofactor
from
metagenics,
tumeric,
rosemary,
methylation
factors (folate,
trimethglycine,
B6, B12), st
mary’s
thistle,
grapeseed
and green
tea all help
the correct
metabolism
of oestrogen
into a less
harmful
form.
This above
treatment is
also
important
for women
who have or
have had
hormonal
problems
characterized
by estrogen
dominance. A
salvia
hormonal
test is the
best way to
assess this.
Note on poor
quality
products;
Please do
not buy your
herbs or
homoeopathic
medicines
off-the-shelf.
See a
qualified
practitioner
(and not a
5-10min
consult in a
shop) who
should spend
no less than
45 minutes
in your
first
consultation
assessing
not only
your
menopausal
or peri-menopausal
symptoms but
also your
overall
health,
especially
your adrenal
health,
stress
levels and
lifestyle
factors and
others. This
is the only
way they can
prescribe
correctly
and
individualise
your herbal
and
homoeopathic
treatment
that will
work for
you.
Dietary
Changes for
Peri-menopause
Consider
diet
modification
guidelines
suggested
in
research
studies
to
reduce
symptoms
of
peri-menopause
and
prevent
risk
of CVD,
osteoporosis,
and
endometrial
and
breast
cancer:*
Herbal
Remedies for
menopause
and peri-menopause
Herbal
remedies in
menopause;
what really
works?
There are
many
different
herbal
products on
the market
for
menopause
and peri-menopause
and the
difficulty
is to
knowing
which ones
really will
work in
which one’s
are simply a
waste of
money.
Many herbal
companies in
Australia do
not really
do the full
range of
testing that
I would
consider to
be required
on the
herbal
product's to
ensure
quality of
the herb
i.e.
contains the
correct
active
constituents
in the
correct
level to be
effective.
The two
brands that
I use are
Mediherbs
and
Phytomedicine,
these are
practitioner
only
products.
It is
always best
to have a
qualified
naturopath
or herbalist
prescribe
for your
individual
symptoms.
The Four
clinically
tested
herbal
medicines
for
menopause
are;
These for
herbs
contains
substances
called
steroidal
saponins.
This
substance
reduces
symptoms of
menopause
via a
negative
feedback on
the brain
and NOT by
increasing
estrogen.
Shatavari
Has been
traditionally
been used as
a general
tonic and
female
reproductive
tonic it is
a
rejuvenating
tonic for
women;
promoting
oestrogen
balance, the
tonic the
general
debility,
for fatigue
and low
libido and
for most of
the
menopausal
symptoms. It
is
adaptogenic,
meaning it
increases
the body's
tolerance to
stress.
Shatavari
does not
increase
oestrogen
but helps
the body's
response
(via the
pituitary
gland in the
brain) and
adjustment
to the lower
level of
oestrogen.
(It is
believed
that hot
flushes are
not caused
directly by
the lower
oestrogen
levels but
from higher
levels of
FSH, the
hormone
released
from the
pituitary
gland in the
brain to try
to make the
ovaries
produced
more
oestrogen).
Tribulus
Is one of
the best
researched
herbal
medicine for
menopause
and is
popular in
Europe of
the
treatment of
menopausal
symptoms.
It is not
significantly
change
hormonal
levels,
although FSH
tends to be
lower.
The quality
and type of
Tribulus is
very
important,
as it is
only the
Bulgarian
Tribulus
which has
the active
constituents
(not the
Chinese or
Indian
Tribulus)
and it is
only the
leaves and
stems which
are used (
and not the
fruit).
Many
products on
the market
use
incorrect
type of
Tribulus
which has
been mostly
due to the
interest
from
bodybuilders.
Wild yam
Confusion
over Wild
yam creams
and natural
progesterone
creams
Any cream
containing
extracts of
wild yam and
claims
progesterone
effects are
unproven.
The
substance in
Wild yam in
can be
converted
into
progesterone,
but this
only happens
in the
digestive
tract by the
bowel flora
chemically
changing it
and then it
is absorbed
into the
body.
Rubbing wild
yam cream on
the skin
your body
cannot
convert the
substance
into
progesterone.
Progesterone
creams as in
natural
progesterone
creams which
are made
from a
compound
chemist,
(and must be
prescribed
by a
doctor).
These creams
are made
from wild
yam (or
other
natural
substances)
which is
chemically
changed in
the
laboratory
into natural
progesterone
(that is the
same
progesterone
your body
produces
hence called
“natural”,
as opposed
to HRT which
contains
synthetic
progesterone
which is
slightly
different
chemically
to the
produced
train your
body
produces).
This natural
progesterone
cream when
rubbed onto
the skin
gives the
body a dose
of natural
progesterone.
As a herbal
product,
Wild yam
needs to be
taken orally
to be
effective.
It contains
the
steroidal
saponins
which work
via a
negative
feedback on
the
hypothalamus.
Black cohosh
This herb
has become
known as the
alternative
to HRT, for
reducing
menopausal
symptoms.
It has been
used in
Europe over
40 years so
has a long
track with
record in
menopause,
peri-menopause
and
premenstrual
syndrome.
Other herbs
Sage
Has
traditionally
been used
for sweats
and hot
flushes.
St. John's
wort
Has
traditionally
being used
the
depression
during
menopause
(long before
the current
use for
depression
in general).
Chase tree
Often use
for erratic
periods, for
peri-menopausal
stages where
there is an
worsening of
PMT, and the
sleep
disturbances
(it
increases
the
production
of
melatonin).
The most
commonly
used herbal
medicines
for the
following
(note which
of the group
you will
need depends
on your
other
symptoms)
Hot flushes;
Shatavari,
Black cohosh,
Wild yam,
Tribulus,
Zizphus,
Sage.
Low memory
and
concentration
in menopause
or
perimenopause;
Rhodiola
plus adrenal
herbs.
Sleep
disturbance
in menopause
in
perimenopause;
Chase tree,
Zizphus.
Fatigue/Tiredness
in
menopausal
or
premenopause;
ginseng
Siberian and
Panax,
Withania,
Rhodiola.
Often
required
other
adrenal
supportive
herbs
Depression
during
menopausal
perimenopause;
St. John's
wort,
Damiana plus
adrenal
herbs.
Anxiety
during
menopause or
perimenopause;
Zizphus,
Black cohosh.
Plus adrenal
herbs
Vaginally
dryness
in menopause
or
premenopause;
Codonopsis,
Shatavari
Other
important
areas your
herbalist
may
prescribe
for to
improve
menopausal
symptoms are
adrenal
tonic herbs
and herbs to
improve
detoxification.
Peri-menopause
–
begins
in
most
women
after
40
years
of
age
Menopausal
transition
–
cessation
of
regular
menstrual
bleeding
Post-Menopause
–
menstrual
bleeding
has
ceased
for
at
least
one
year
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Possible
Associated
Signs
&
Symptoms
- Hot flashes
- Headache
- Vertigo
- Heart palpitations
- Ringing in ears
- Nervousness, irritability
- Sleep disturbances, night sweats
- Depression, mood swings
- Joint pain, tingling in extremities
- Loss of concentration, memory lapses
- Loss of libido
- Vaginal dryness
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Long-term
Health
Risks
- Osteoporosis
- Cardiovascular Disease (CVD)
- Breast Cancer
|
Consider
diet
modification
guidelines
suggested
in
research
studies
to
reduce
symptoms
of
peri-menopause
and
prevent
risk
of CVD,
osteoporosis,
and
endometrial
and
breast
cancer:*
- Maintain healthy weight and include a regular exercise program.
- Limit the intake of refined breads and cereal dishes, saturated fat, alcohol, and spicy food. Replace with whole grain products, high quality seeds, oils, fish, and raw, organically grown vegetables.
- Limit the intake of well-done meat to reduce breast cancer risk.
- Increase intake of isoflavones and lignans to provide modulation of estrogen activities, antioxidant effects, and promotion of bone health.
- Increase intake of cruciferous vegetable family to support healthy estrogen metabolism.
- Include phytonutrients that act synergistically with isoflavones, such as curcumin.
- Increase intake of calcium, vitamin D, vitamin K, magnesium and trace minerals to promote bone health.
- Promote a healthy methylation pathway and manage homocysteine levels with folate, vitamin B12, and vitamin B6
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| While hormone replacement therapy (HRT) has proven to be effective in relieving many of the uncomfortable symptoms of menopause, its use remains highly controversial. Recently, numerous studies have demonstrated the potential health risks surrounding HRT. Of foremost concern is the possibility that women on HRT are particularly susceptible to blood clots, heart attack, stroke, gallbladder disease, and breast and ovarian cancers. Based on these concerns and scientific evidence, healthcare providers are often apprehensive about recommending HRT to their patients. Similarly, menopausal women are often confused over whether or not the benefits of HRT outweigh the risks, and if there are any alternatives. The following question and answer guide will help to clarify the facts about HRT and the role of natural substances in balancing estrogens.
Are there effective alternatives to HRT for managing menopause symptoms?
Yes. Phytoestrogens such as isoflavones and lignans are some of the natural plant-based alternatives that have ability to modify estrogen functions in humans. Isoflavones-found in soy, red clover, and kudzu-include genistein, daidzein, and puerarin. Numerous placebo-controlled clinical trials have shown that isoflavones significantly reduce hot flushes compared to placebo.1-4 Human clinical data also suggest that isoflavones support bone health, provide antioxidant support, protect against lipid peroxidation, and promote healthy cholesterol levels.5-8 Isoflavones have a similar structure to estradiol and can bind to estrogen receptors (ERs) and have been shown to have estrogenic activity in vitro.
In addition, herbs such as black cohosh (Actaea racemosa) have a long history of traditional use as a natural approach to reduce menopausal discomforts. Today, black cohosh is widely used throughout Europe and the U.S. and appears to be a safe and effective alternative to HRT.9
It is important to note that a woman's experience during perimenopause is individual. Some studies suggest that not all women will see a reduction in the frequency of hot flushes from soy alone,10,11 and that a combination of nutritional support and a variety of isoflavone sources may be more beneficial. Other menopausal discomforts are influenced by many factors-not just the absolute presence or absence of estrogen. Studies suggest that physical exercise, maintenance of appropriate weight, and healthy diet can provide many of the perceived benefits of HRT.12 Diet, in particular, can dramatically alter how estrogen is metabolized, which may influence the symptoms a woman experiences, as well as her response to isoflavones.
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Can isoflavones protect against breast cancer?
Isoflavones appear to promote some estrogenic activities, as well as to inhibit other estrogenic functions, such as estrogen-dependent proliferation of cells. Because of this, isoflavones are suggested to protect against hormone-dependent cancers.13 This ability to modulate estrogen activity is thought to be due to the differential binding of isoflavones to the two forms of the ER, alpha and beta, that have been identified. Isoflavones bind more readily to the ER-beta than to the ER-alpha-and are thus called selective estrogen receptor modulators (SERMs). In contrast, estradiol (the most potent estrogen) binds similarly to both ERs. Because the ER-alpha and ER-beta differ in tissue distribution and biological function, the differential binding of isoflavones may be one reason for their ability to behave like estrogen in some tissues but block its action in others.
Epidemiological and diet-intervention studies overwhelmingly support the role of isoflavones in reducing the risk of breast cancer. Furthermore, various phytonutrients have shown synergistic effects with isoflavones. Curcumin, in particular, is synergistic with genistein in inhibiting the growth of estrogen-dependent and -independent breast cancer cells. Similar to isoflavones, the phytonutrient resveratrol has also been shown to have estrogen-modulating effects.
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So is estrogen good or bad?
Estrogens play an important role not only in reproduction but in bone formation and maintenance, behavior and mood, and cardiovascular health. However, metabolism of estrogen within the body is very complex and yields a variety of estrogen metabolites. Because these metabolites vary greatly in biological activity, the ultimate biologic effect of estrogen depends on how it is metabolized. Data suggests that promotion of estrogen metabolism to yield the 2-hydroxyestrogen may reduce the risk of estrogen-related conditions.14,15 Since the 2-hydroxyestrogen is the least estrogenic of the metabolites, this may also improve symptoms associated with perimenopause. Rosemary extract and indole-3-carbinol are two phytonutrients that have been shown to promote 2-hydroxylation of estrogen.16
Isoflavones also promote the 2-hydroxylation pathway,17 and are associated with increased sex hormone binding globulin (SHBG), which also helps to manage healthy estrogen functions. Low SHBG is associated with higher risk of CVD, and the ability of isoflavones to increase SHBG suggests this may be one beneficial influence of these phytonutrients on heart health.18 In a clinical trial, 80 mg per day of red clover was shown to improve arterial compliance and elasticity compared to placebo.19 Moreover, isoflavones have been shown to reduce cholesterol in animals and humans.1,20 Several recent reviews provide thorough discussions of estrogen metabolism.14-16
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What are the risks associated with isoflavones? Are they really any safer?
The issue of safety with isoflavones has been addressed in several recent reviews.7,13,20-22 To date, no adverse effects-including negative effects on cognition-of isoflavones or isoflavone-containing soy protein extracts have been reported in short-term prospective clinical trials or long-term epidemiological studies.23 However, long-term, prospective studies have not been reported. Some in vitro data has suggested that isoflavones can promote estrogen-dependent cell proliferation. Animal and human studies, however, have not shown the same effects. These observations may be due to the nature of the cell culture systems used and not representative of in vivo effects.
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Why has it taken us so long to assess the risks of HRT?
The risks of HRT have been known for some time. The medical field, however, had accepted and implemented HRT to such a level that it required what it called "definitive proof" to question this standard of care-despite the existence of known risks that were shown in numerous studies pre-dating this latest revelation. For instance, it has been known for some time that HRT can increase the risk of breast cancer, yet it has continued to be prescribed because of the belief that it is unnatural for women to lose estrogen. Furthermore, the notion that we could turn back the clock by stemming this loss of estrogen was prevalent. Many recent articles review the possible reasons for the misconceptions of HRT and how it became the norm in medicine without clear evidence of its benefits or history of use.24,25 Clearly, women can continue to lead healthy, active lives after menopause without having to take synthetic estrogens.
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What about HRT and cardiovascular disease?
Cardiovascular disease (CVD) is the number one cause of death of postmenopausal women. The influence of HRT on CVD risk is therefore extremely important for peri- and postmenopausal women. The effect of HRT on CVD has been controversial for quite some time. Early retrospective studies suggested that HRT was associated with decreased CVD in women; however, prospective studies suggested that HRT offered no protection against CVD. In 1999, a study suggested that the patient populations contributed to this discrepancy. Authors found that women who took HRT tended to be more educated, in a higher income bracket, of lower weight and body-mass-index, healthier, and at lower risk for CVD than those who were not on HRT. This was reflective of lifestyle prior to HRT, and not of the therapy itself. Therefore, retrospective studies suggesting lower risk of CVD with HRT were due to the differences in the relative risks of the subject populations, and not to the HRT.
The Women's Health Initiative (WHI) study published July 17, 2002 in The Journal of the American Medical Association indicated that HRT does not provide effective prevention of CVD and that, moreover, it brings with it a higher risk of CVD.26 The Heart and Estrogen/Progestin Replacement Study (HERS) published earlier this year also showed that HRT did not reduce the risk of CVD, but led to an increased risk of coronary events, especially during the first year of therapy.27 In addition to these concerns, a recent study suggested that HRT is associated with insulin-resistance in postmenopausal women.28
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Will we find out down the road that plant-based alternatives have side effects similar to HRT?
Unlike HRT, plant-based alternatives have a long history of use in natural medicine. Epidemiological studies have shown that Japanese women living in Japan have less CVD than Japanese women living in the US due to the consumption of a diet high in isoflavones. Soy protein has been extensively studied for its lipid-lowering ability -- an ability partially attributed to isoflavones. Synthetic estrogens have not shown the same effects.
Isoflavone intake in Japan, China, and Indonesia ranges from 15 to 250 mg per day, with an average consumption of around 45 mg per day in Japan, and 125 mg per day in Indonesia.13 Interestingly, although it is known that the risk of breast cancer is much lower in Japan and China than in the U.S. or European countries, in which the average isoflavone intake is much lower, the incidence of breast cancer risk in Indonesia is much lower than that seen in Japan and China. These observations have been attributed to the higher intake of isoflavones in Indonesia.
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Since HRT may be helpful in preventing osteoporosis, are there any alternatives for supporting bone health?
The two benefits of HRT that were not disputed in recent studies are protection against osteoporosis and decreased risk of colon cancer. While osteoporosis is a concern for many postmenopausal women, there are many alternatives to promote optimal bone health throughout life. Adequate intake of calcium, magnesium, trace minerals found in bone, and vitamins D and K, along with weight-bearing exercise, have been shown to promote bone health. Animal studies show that isoflavones can promote bone growth and decrease bone loss, and early clinical studies suggest that isoflavones promote bone sparing in postmenopausal women.7,21
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What are selective estrogen receptor modulators (SERMs)? Are natural, plant-based SERMs available?
SERMs are non-steroidal compounds that are capable of binding to and influencing the activity of ERs. Specifically, SERMs are noted as being both agonists and antagonists of estrogen activity-a duality that occurs because they do not bind as tightly or in the same way as estrogen. Through this specialized binding process, SERMs can simultaneously promote and inhibit estrogen activity depending on the type of ER (alpha or beta) found in the tissue.
Raloxifene, a SERM drug, has been shown to prevent fractures and preserve bone mass without increasing breast cancer risk. Structural analysis shows that the isoflavone, genistein, binds to the ER in the exact manner as raloxifene. Furthermore, the binding of both raloxifene and genistein is very different than that of estradiol.29,30 These observations suggest that differential binding may be one reason why isoflavones do not have the negative effects on breast and endometrium tissues that estradiol does.13 Furthermore, these biochemical observations support the fact that genistein may be a natural alternative to synthetic SERMs such as raloxifene.
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What is perimenopause and how is it related to menopause?
Menopause is defined as the time when a woman ceases menstrual periods. Perimenopause is the approximately ten years before menopause, during which time a woman's body is preparing for menopause. Most women experience menopause between the age of 45 and 55, and the average age for menopause is 52 years. If a woman is experiencing changes in her menstrual cycle, hot flushes, and symptoms of sleep disturbances, but still has a menstrual cycle occurring at least once a year, she is in perimenopause. Menopause is used to define when menstruation ceases entirely, and postmenopausal means a woman who hasn't had a menstrual cycle for at least a year.
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Why do menopausal symptoms sometimes seem like premenstrual syndrome (PMS)?
Many people think perimenopause (the ten years before actual menopause) is a time when estrogen levels either stay the same or slowly decrease, thereby preparing a woman's body for the cessation of estrogen production by the ovaries that occurs at menopause. However, this is incorrect. Instead, estrogen levels during perimenopause undergo dramatic shifts from hypo-estrogen secretion to hyper-estrogen secretion (hyper-estrogen secretion resembles estrogen dominance). Researchers who have investigated changes in estrogen levels during perimenopause have shown that women often oscillate from very low estrogen levels to hyper-estrogen secretion of as much as two to three times the normal levels.31
Upward fluctuations in estrogen levels during perimenopause can produce symptoms similar to those of premenstrual syndrome (PMS). These symptoms often include sleep disturbances, changes in mood, fatigue, water retention, weight gain, and hot flushes. Clinical studies suggest approaches that are successful for PMS may therefore also help with managing some of the symptoms of perimenopause.
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What other steps can be taken to promote menopausal health?
Peri- and postmenopausal women can take several steps to promote health and decrease symptoms of menopause. Since heart health is a primary concern to women as they age, antioxidant status should be considered. Dietary intake of vitamin E, in particular, is inversely associated with CVD and much research has shown that vitamin E inhibits LDL oxidation and protects against oxidative stress.31,32 Folate and vitamin B12 are also important considerations because they promote healthy homocysteine metabolism (homocysteine is an independent risk factor for CVD) and support healthy estrogen metabolism.
Recent literature on estrogen and cancer susceptibility has shown that 2-hydroxylated estrogens and 4-hydroxylated estrogens are readily oxidized to quinones-highly reactive compounds that can damage DNA and promote cancer development.14,15 Generation of these damaging quinones can be avoided if the estrogens are methylated, a process that requires folate and vitamin B12. Moreover, current research is now focusing on 2-methoxyestrogen since in vitro studies suggest that it may inhibit breast cancer cell proliferation, angiogenesis (the growth of new blood vessels to support tumors), and aromatase activity (an enzyme required for the conversion of androgens to estrogens).33-35 These studies indicate that it is estrogen metabolism and the influence of isoflavones and other phytonutrients-not just the presence or absence of estrogens-that promote health throughout life. |
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