The Women’s Health Initiative (WHI) was a 15-year-long research program designed as a set of clinical trials and observational studies, with the original study enrolled between 1993 and 1998, and follow-up through to January 2010. One of the main components of this Initiative was Hormone Therapy Trials (HT). As explained on the WHI website, these trials “were designed to test the effects of postmenopausal hormone therapy on women’s risk for coronary heart disease ... and on hip and other fractures and breast cancer.” Due to adverse side-effects, the Hormone Therapy (Premarin, Provera, and PremPro) Trials were stopped early. The first was stopped in July 2002, and the second in March 2004.
Follow-up analyses after five years demonstrated that Estrogen combined with Progestin was associated with a 24% overall increased risk of coronary heart disease (CHD), and an 81% increase in the first year after taking the combined hormones. As for breast cancer, the subsequent risk nearly doubled each year after using this combination for more than five years. Furthermore, the overall increase in breast cancer risk associated with the combination of Estrogen plus Progestin was 24%. Lastly, the increased risk of stroke after this period was shown to be as high as 31% with the combination of hormones.
Another study involving more than a million women in the United Kingdom, results of which were reported in the Lancet (August 8, 2003), came up with evidence that conventional HRT is associated with a substantially greater risk of breast cancer and a greater risk of dying from it. The study found that all types of HRT, including estrogen and progestin combinations, and estrogen alone, increased the risk of breast cancer.
Women nowadays are in a big dilemma. They are scared to go on conventional HRT because of its side effects, but at the same time are suffering from hot flashes, night sweats, occasional sleeplessness, mild mood changes, weight gain, decreased libido, changes in hair and skin, vaginal dryness and more.
Both conventional and complementary medicine have the same goal: to relieve a woman’s discomfort during the transitional years of menopause and help her achieve optimal health into her later years of life. The difference lies in their approaches. Conventional medicine often considers menopause as a hormone-deficiency disorder and attempts to correct the imbalances that develop within a woman’s hormonal system during and after menopause. One of the disturbing aspects of the conventional approach is that any woman over the age of 50 who complains about anything remotely related to menopause is put on HRT. This is a one-dose-fits-all mindset that can lead to side effects.
The complementary medical approach focuses on strengthening the female body by encouraging it to balance, regulate, and normalize itself during the transition to menopause. So alternative treatments during menopause usually favour non-drug therapies.
Internet resources, Suzanne Somers’ books (Breakthrough and The Sexy Years), along with Oprah’s programs and interviews have been increasingly educating women on Bio-identical Hormone Replacement Therapy (BHRT). Not surprisingly, the demand for BHRT is increasing.
Unfortunately, Canadian women are often unable to find health professionals who are well trained and legally qualified to deal with Bio-identical Hormone Replacement. This can result in self-medication which sometimes leads to major hormonal imbalances if not tested and monitored properly.
AN INTEGRATIVE APPROACH TO HORMONAL BALANCE
An integrative approach that combines the alternative therapies with some natural or bio-available hormones is the ideal way to go. However, there are various rules to follow to ensure the best outcome:
1) Measuring and Monitoring body hormone levels: Saliva testing is far superior to serum or urine testing in measuring bio-available hormone levels. The “free” active portion (non-protein-bound) hormones diffuse easily from blood capillaries into the saliva gland and then into saliva. Protein-bound (non-bioavailable) hormones do not pass into or through the saliva gland.
Another very important tool is to measure all the hormones that are involved in regulating a woman’s health. Some practitioners deal only with estrogen and progesterone while ignoring the great role of adrenal hormones such as Cortisol and DHEA, Thyroid hormones and Insulin. This leads to the great level of frustration that we see daily in patients who have been receiving progesterone replacement only, based on very limited testing, and are still suffering from severe symptoms.
2) Use of natural or Bio-identical hormones: These should be used only if the patient needs it and only to bring her to a normal physiological level that corresponds to her age. The ‘bio-identical’ estrogens and progesterone (prepared from a plant extract or compounded at a pharmacy) are labelled as such because they are identical to the ones made by a woman’s body. On the other hand, synthetic hormones (made in the lab or obtained from horses) are different from those made by the body, and thus are associated with cancer and other side effects.
3) Xenoestrogens and Estrogen Dominance: Several symptoms that women suffer from are due to a relative progesterone deficiency compared to estrogen. This is mainly caused by xenoestrogens, which we are exposed to through pesticides, plastics, industrial pollutants and toxic beauty products. These estrogen-like compounds compete with progesterone receptors in our bodies, thus producing an apparent estrogen dominance. The best way to detoxify our bodies from the effect of xenoestrogens is through enhancing liver function, the use of antioxidants, infrared sauna detoxification (sweating), chelation therapy, and so on.
Another common cause of relative estrogen dominance is adrenal fatigue. If cortisol is low, pregnenolone is shifted towards producing more cortisol, causing a relative deficiency in progesterone, and thus creating estrogen dominance-like symptoms. So supporting adrenal function is helpful in managing these symptoms.
4) Body healing and Balance: This is done through eating a healthy diet, nutritional herbs and supplements, along with homeopathic remedies that have been shown to be effective. For example, plant phytoestrogens are gaining popularity as a nutritious way to deal with menopausal symptoms. According to Tammy Southin, editor of bellaonline.com: “When phytoestrogens are consumed they are converted into compounds that act very much like the estrogen compounds found in the body. Phytoestrogens perform the same tasks as regular estrogen, but on a much weaker scale. This is why some women prefer to take natural remedies that contain phytoestrogens. Women get the benefits of estrogen without the potential for side-effects that come from the stronger versions of estrogen in [conventional] hormone replacement therapy options.”
· Foods high in phytoestrogens include flaxseed and flaxseed oil. According to Southin, “A recent study conducted at the University of Toronto showed that women with breast cancer who consumed 25 grams of flaxseed a day experienced a reduction in the growth of cancerous tumors. At the Mayo Clinic in 2007, women suffering from hot flashes were given flaxseed in place of traditional estrogen. These women wanted to avoid taking estrogen due to the side effect of increased risk for developing breast cancer. When these women took flaxseed, they reported that the severity and frequency of their hot flashes diminished after a few weeks.”
Soy is also identified as a phytoestrogenic food, however it is controversial and should be used with caution because most soy on the market is genetically modified, and allergies to soy are common. The safest and most easily digested types of soy are organic tempeh and miso.
· Phytoestrogenic herbs include Black Cohosh (Cimicifuga racemosa), Dong Quai (Angelica sinensis), Chaste Tree Berry (Vitex agnus castus), Wild Yam (Dioscorea villosa), Licorice Root (Glcyrrhiza glabra), Sage (Salvia officinalis), North American Ginseng, and Red Clover.
In addition to phytoestrogens, other substances that are important in easing the symptoms of menopause include:
· Indole-3-Carbinol, an antioxidant found in the cell walls of cruciferous vegetables, such as broccoli, cauliflower, cabbage and Brussels sprouts, can also be found in supplement form. It is especially helpful in the metabolism of estrogens and in protecting hormone sensitive organs such as breast and uterine tissue by inhibiting its receptors.
· Glucaric acid enhances glucuronidation, a process by which the body rids itself of potentially dangerous toxins – carcinogens, metabolites and other harmful chemicals, including estradiol – by inhibiting their intestinal re-uptake.
· Essential fatty acids, especially Omega 3’s, work to help regulate metabolism and burn body fat, lower blood pressure and cholesterol, and enhance tissue health and bone density. In fact, Dr. Nicholas Perricone, MD, called essential fatty acids one of the top 10 superfoods that help one look younger and live longer.
As well, lifestyle factors that include stress reduction techniques such as yoga and meditation are very helpful. Quantum biofeedback therapy is also an excellent tool to help the patient achieve balance.
In conclusion, some general measures could be sufficient on their own to manage the patient’s symptoms, but by combining hormone balancing with correction of other environmental and lifestyle factors, and appropriate clinical monitoring, we hope to treat the real cause of a patient’s symptoms and reduce her risk of developing breast cancer, stroke and heart attacks. The important message is that there is no one-dose-fits-all therapy. Treating every patient on an individual basis is the key to success.
THE GOOD NEWS
Women do not have to put up with being told that there are no other options than synthetic HRT, or that their symptoms are merely psychological. They should be able to feel more energetic and enjoy their menopausal phase, which is nature’s way of helping them reaching their spiritual peak after bringing their children into this world and taking care of them until adulthood. Now it’s their turn.