Hormones for Healthy Menopause: Part TwoDr. Carolyn DeMarco, MD November 1, 2002
Part Two of a Two-Part Series on HRT & Nutritional Medicine
In Part One, Dr. Demarco explored the merits of natural vs. synthetic progesterone. In this issue, she moves on to look at the estrogen debate.
There are three main types of estrogen: estrone, estriol and estradiol, and they each have a different role in the body. Estradiol is by far the strongest. Estrone is one that seems to promote breast cancer, and estriol is the weakest, appearing to protect users from breast cancer.
Synthetic estrogens are not identical to the estrogens found in the human body. For example, Premarin is derived from pregnant mares’ urine. It is the most prescribed estrogen, and contains estrone, probably the most breast cancer-causing of the three estrogens: in fact, it has been associated with a doubling of breast cancer risk if used for six years or more. It also contains other ingredients not found naturally in the female body, such as horse estrogens. It is unknown what effects these equilines and dihydroequilines have in the body, but they may cause some of the side effects of Premarin. Ogen, an estropipate, is also a synthetic estrogen, and so is not identical to the body’s own estrogen, but some women find it easier to take than Premarin.
If you are going take an estrogen, I would advise against one that is made from pregnant mare’s urine. Instead, take one that has components normally present in the body. If you decide to go off Premarin, decrease usage slowly. If you don’t have extra risk factors, such as bone loss, try Remifemin (a brand of black cohosh) as an herbal alternative to Premarin. Reduce the Premarin to a half for a couple of weeks, then a quarter for two weeks, and then go off it. Start the Remifemin at the same time as you are going off the estrogen. Start taking two twice a day.
Estraderm, an estrogen patch, contains estradiol, which is similar to the body’s own estrogen. The patch allows the prescription to bypass the liver. Estrace is an oral form of estradiol, also similar to the body’s own estrogen. It is relatively natural, but again, “natural” is an overused term. Estradiol is a very potent estrogen, 80 times stronger than estriol and 12 times stronger than estrone.
NATURAL PRESCRIPTION ESTROGENS
• TRIEST — This is a natural estrogen formula, available by prescription, containing all three estrogens. I usually reserve this prescription for patients having severe menopause, or who’ve have had early hysterectomy or are experiencing premature menopause. But it can be used for anyone who doesn’t respond to other natural treatments. The tri-estrogens or Triest was formulated by Dr. Jonathan Wright. It is 80% estriol, 10% estrone and 10% estradiol, and has to be made up in a compounding pharmacy. The usual dosage is 2.5 mg (equal to 0.625 mg of Premarin). Dr. Wright has had a very favourable response with Triest. Estriol has actually been used to treat breast cancer, so it is relatively safe and some doctors will even prescribe it for women who have had breast cancer. I personally am wary. If you had breast cancer, I would tend to prescribe only natural progesterone by itself to control menopausal symptoms.
Three new Japanese studies demonstrate that estriol will prevent bone loss. This is very exciting. It doesn’t protect the heart, but it does seem to protect the breast and uterus. The problem is there is no funding for further studies because there is no money to be made in studying estriol, which seems like a good natural alternative. Some women take estriol by itself, but it is 80 times weaker than estradiol, so you may have to adjust the dosage and or substitute with Triest until you get the desired results.
• VAGINAL ESTROGEN — Another method of taking estrogen that is effective and inexpensive is through the vagina. If you take a very low dose, the estrogen won’t enter your blood stream in any significant amount. Estriol is actually the most effective vaginal cream; it will take care of vaginal dryness immediately. There is a new vaginal ring that looks like a small diaphragm and will give out very minute amounts of estrogen, slowly over three months.
• RECEPTOR MODULATOR DRUGS — Raloxifene (or Evista). This drug is now being heavily promoted for menopause. Raloxifene (Evista) has been recently associated with possibly increasing Alzheimer’s in susceptible people. Raloxifene is a tamoxifen cousin. Tamoxifen is an anti-estrogen drug. Tamoxifen has been shown to possibly increase the incidence of breast cancer after five years of use. It appears to protect the uterus and breast, and tests have been positive on bones, but it is really too premature to promote its use. It will take five to ten years to learn the cancer potential. It is, however, being pushed by gynecologists. Selective estrogen receptor modulators such as Raloxifene (Evista) are supposed to target some estrogen receptors, and leave the others alone. Right now, however, I wouldn’t suggest taking it.
ADVANTAGES AND DISADVANTAGES OF ESTROGEN
Estrogen prevents hot flashes and night sweats, relieves vaginal dryness and atrophy and improves cholesterol profile. It relieves urethral and urinary problems, halts bone loss and reduces fracture rate, increases skin thickness and has a direct positive effect on blood vessels. All of these effects can be achieved with natural estrogens. Estrogen does halt bone loss, but it does not add anything to the bone. As soon as you go off it, bone loss accelerates. New studies have shown calcium alone will prevent bone loss. The disadvantages of estrogens are increased risk of uterine cancer (eight times), increased risk of breast cancer, fibroids, endometriosis, thrombophlebitis, lupus and gallbladder problems. One study has shown an association between estrogen and fatal ovarian cancer.
Estrogen is not a heart protective hormone. A recent study showed some women who were on estrogen had an increased incidence of heart disease. We really don’t know if the supposed benefits outweigh the risks at this point. Wilfred and Evan Shute, the great Canadian pioneers, discovered that just 100 IUs of vitamin E reduces risk of heart disease in women by 60%. Similar results have been shown in men. We also have other means for protecting the heart, like chelation therapy, and wonderful herbs like hawthorn that are tonics for the heart.
NATURAL SOLUTIONS FOR MENOPAUSAL SYMPTOMS
• DIET — You can improve symptoms a great deal just by diet alone. The main change is to eliminate sugar. And all those sugar substitutes — such as Aspartame and Nutrasweet — have a negative effect on brain function (neurotoxic) and can cause headaches. (So you’re not doing yourself any favour by substituting with diet colas or chewing gum.) Also, eat less animal fat, and eliminate caffeine, junk food, fried foods, additives, salty foods and nicotine. Drink pure water and eat a lot of fresh fruits and vegetables (organic if possible).
• PHYTOESTROGENS — The soy bean contains plant estrogens known as isoflavones. These estrogens are 100,000 times weaker than estradiol and solid research has shown that they reduce cholesterol, risk of breast cancer and menopausal complaints. They effectively alleviate hot flashes. (Ed. note: Go for the fermented organic soy products: miso, tempeh.)
• IPRIFLAVONE — One patented soy derivative known as ipriflavone has a very good safety profile, and has been approved in Italy and Japan for the treatment of osteoporosis. This is a well researched natural alternative for treatment and prevention of bone loss. You can find ipriflavone in health food stores; it should be taken twice a day. This is a good alternative because natural progesterone cream is not effective for everyone in terms of building bone.
• FLAXSEED — A diet high in soy foods provides phytoestrogens, but you can substitute flaxseed if you don’t like soy. Two tablespoons of flaxseed will equal two servings of soy per day and this is good for menopausal symptoms like hot flashes, breast cancer prevention and even bone loss. To reduce cholesterol, take 3 to 5 tbsp. of flaxseed (fresh ground). For osteoporosis, you would have to take a ton of flaxseed, or 6 to 8 servings of soy, which is hard to imagine. The real concern I have for all the soy that is being promoted is that it is made from genetically altered soy. Westbrae, Eden and a few others do have organic soy.
• VITAMINS AND MINERALS — By the time you reach menopause, you should be on a basic program of at least 500 mg of vitamin C (preferably Ester C), 400 IU vitamin E and 30,000 IU beta-carotene. You can also add trace minerals and protein in the form of a Super Green drink (3 tsp. a day). Greens+ is the one that I personally like, because it is a very high quality drink. You can also make your own green juice. The Green Life juicer makes the best quality juice I have ever seen, but it is very pricey.
Every woman over 35 should take at least 1,000 to 1,200 mg (or more) of calcium per night. Some studies show that 1,500 mg of calcium will help with bone loss, PMS, and other symptoms.
Magnesium is also extremely critical for women. Some of the symptoms of magnesium deficiency are irritability, memory loss, and chocolate cravings. The magnesium dosage should be anywhere from 300 to 600 mg per night. There are different types of calcium. Calcium and magnesium citrates are very good. After age 60, your hydrochloric acid declines, so you may have to take some enzymes along with the calcium so that it absorbs. It is good to take calcium and magnesium at night because they help you relax and sleep.
The ‘B’ vitamins also are extremely important, very calming and toning to the nerves for people who have anxiety attacks. Use a B-50 complex. Factors like methionine, choline, and inositol improve the liver function. You can find these in the health stores.
• HERBS — When you are using estrogen-type botanicals like angelica, dong quai, burdock and black cohosh for menopause, take care to use herbs like licorice and wild yam for their known progesterone-like qualities to balance the formula. Some of the menopausal formulas on the market right now are horrific: they have just been thrown together and there is no knowledge of the delicate relationships and balance between herbal families.
That said, herbal medicines are excellent in menopause, especially black cohosh. Black cohosh extract has a very positive estrogen effect on the vagina. The only brand of black cohosh which has been studied extensively is called Remifemin. It is available in your health food store; take one tablet twice a day. It improves all menopausal symptoms with virtually very few side effects, and has been used in Europe for 40 years. The only side effect may be gastric irritation, in which case you should take it with meals. In my opinion it should be combined with natural progesterone. A lot of the black cohosh on the market, however, is not standardized extract, so make sure you check product labels. Natural Factors makes a good standardized extract of black cohosh, and they also offer a menopausal formula which uses black cohosh and chaste berry.
Kava kava is a wonderful herb from the South Pacific. Research shows that it alleviates anxiety, irritability and nervous problems; it makes you calm and relaxed without sedation.
Susan Weed suggests alternating four weeks of dong quai with two weeks of panax ginseng throughout menopause. They both have strongly estrogenic qualities and can raise estrogen, sometimes very high. However, dong quai can sometimes create breast swelling and tenderness. Rina Nissam, a European gynecologist, uses black currant, stone seed, lady’s mantle, chaste tree, wild pansy and sequoia all in equal parts in a thyme distillation with alcohol to decrease estrogen overload. She has also used it successfully for fibroids and other conditions that create excess estrogen. It is a very simple formula: take one teaspoon every morning.
• AROMATHERAPY — The essential oils clary sage, sage, fennel, blue yarrow, bergamot and ylang ylang help balance hormones and increase oxygenation to the blood and brain. Geranium is another hormone-balancer, which also helps the adrenal glands. Clary sage and geranium are powerful aids for women in menopause. These oils can all be added to the natural progesterone cream.
• ACUPUNCTURE AND CHINESE HERBAL MEDICINE — will almost always get rid of all the symptoms of menopause and balance your meridians. A series of at least six acupuncture treatments is recommended.
• HOT FLASHES — Dr. Tory Hudson, a naturopath who runs a women’s clinic in Portland, Oregon, has created a formula that decreases hot flashes. It contains two parts licorice, two parts burdock, two parts dong quai, one part wild yam and one part motherwort. Hudson stresses the need to balance the estrogenic and progestrogenic herbs. “I usually prescribe natural progesterone along with estrogens, be they conventional, or natural or herbal estrogens.”
• THE LIVER — Fresh juices such as beet, carrot, garlic and parsley are beneficial to the liver, and a daily lemon juice is a very effective way to help the liver. When you have your first glass of water in the morning, squeeze lemon juice in it. Bitter greens like endive, raddichio, dandelion greens, stinging nettles, etc. stimulate the liver. If you don’t have enough bitter greens in your diet, you can get Swedish Bitters at health stores. Bitters promote liver and bile function and aid digestion. Other liver herbs like dandelion root, milk thistle, burdock, artichoke, turmeric are also recommended.
Take liver herbs regularly for up to three months to decrease the burden on your body caused by the excess estrogen. Then stop for awhile. Pesticides in food, cosmetics and environment contribute to estrogen excess in our bodies. Liver support is absolutely critical. These estrogen-like compounds go to the estrogen receptors and mimic estrogen, so there is a constant influx of estrogen and not enough progesterone. Most of the pesticides are concentrated in the fat of meat and dairy, so try to use only organic products. I do support butter over margarine as a fairly healthy product, and olive oil.
So cleansing and nourishing your liver can help your menopausal symptoms, especially if they are really out of control. When the liver is no longer able to detoxify, a second liver is created in the form of a cyst, fibroid, or arthritic inflammation where the toxins are stored. The cyst or fibroid plays a role in maintaining the organism’s equilibrium, actually doing us a favour by walling off the toxins. So if you detoxify, and you have any of these conditions (ovarian cysts, cystic breasts, fibroids, arthritis, etc.) you have to detoxify very slowly because the body is trying to protect you from those toxins.
• ADRENAL SUPPORT — There are a couple of ways to strengthen the adrenal glands. You can take a high quality adrenal gland extract made from animals, which will give your adrenal gland a rest. I happen to use Seroyal TAD Plus which is a good adrenal supplement. Take two at 8 am, and two at 3 or 4 pm. There are other good adrenal supplements made by Thorne and other companies. Take this adrenal gland support for three to six months if you are experiencing a stressful pre-menopause, but don’t take it indefinitely.
Other supplements which support the adrenal gland are vitamin C and pantothenic acid. Pantothenic acid is like the body’s natural cortisone. Take 500 mg four times a day, and combine it with 500 mg of vitamin C four times a day. Licorice root tea and black currant bud are also excellent adrenal balancers. Young Living Essential Oils makes Thyromin which is really excellent and Endoflex, both adrenal gland balancers. It is very important for women in menopause to get adrenal support through adrenal supplementation, licorice root tea, vitamin C and pantothenic acid, and taking extra natural hormones and liver support.
• THYROID — Thyromin is probably the best thyroid balancer that I have discovered so far. The thyroid gland is often involved in menopause, but sometimes if you just correct the adrenal gland, the thyroid will kick in. A lot of women these days have underactive thyroid problems. Thyromin contains myrtle and myrrh, which help balance the thyroid, whether it is underactive or overactive.
• FIBROIDS, FIBROCYSTIC BREAST DISEASE AND ENDOMETRIOSIS — Please see Dr. DeMarco’s book, Take Charge of Your Body, which has chapters on fibrocystic breast disease and endometriosis.
References: Recommended Books
Carolyn DeMarco — Take Charge of Your Body
Alan Gaby — Preventing and Reversing Osteoporosis
Susan Love — Hormone Book
John Lee — What Your Doctor May Not Tell You About Menopause and What Your Doctor May Not Tell You About PreMenopause
Miriam Nelson — Strong Women Stay Young (weight-training)
Rina Nissam — Natural Healing in Gynecology
Leslie Kenton — Passage to Power
Karen Jensen and Lorna Vanderhaeghe — No More HRT: Menopause, Treat the Cause