Women's health update: frequently asked questions

[Guest guest]

Women's health update: frequently asked questions; what women want to

know by Prof. Tori Hudson, N.D., Townsend Letter for Doctors and Patients

Q: I am dying of hot flashes! I need something that really works and not just

some gimmick. I would rather not take prescription medication because I am

afraid of side effects.

A: It sounds like you are pretty miserable with your hot flashes. Non-hormonal

botanical alternatives that have sound scientific research to support their

efficacy include black cohosh extracts, red clover extracts, soy isoflavones

and natural progesterone cream. You asked about a combination herbal

formula as well. The one that I know the most about is a formula which

contains burdock root, licorice root, wild yam root, motherwort and dong quai

root. I was the co-investigator on a research study examining the

effectiveness in menopausal women. Black cohosh studies show doses of 40

mg of standardized extract can completely relieve hot flashes in 50% of

women and another 30% get at least partial relief. Red clover extracts (40 mg

standardized extract) or soy isoflavones 50-75 mg per day provide

approximately a 50% reduction in hot flashes in most of the research.

Women's Phase II at 2 caps 3 times per day demonstrated an ability to

provide a reduction in their hot flashes in 71% of the women. A natural

progesterone cream containing 20 mg of progesterone per 1/4 tsp was

studied in a clinical trial and shown to improve or completely resolve hot

flashes in 83% of the women using it. The dose used was 1/4 tsp daily. Herbal

products that are popular but have shown no scientific efficacy in treating hot

flashes include evening primrose oil, chaste tree berry, Dong quai and

ginseng.

Q: I have been on hormones for 8 years because I underwent a complete

hysterectomy. I have heard recent news that estrogen can cause cancer.

What would you recommend as a replacement for estrogen? I am 51 years

old.

A: You were apparently 43, and prior to menopause when you had your

complete hysterectomy (both ovaries and the uterus removed), and now are

concerned about the research news you have heard about long-term

hormone replacement therapy. Your situation has some important features:

Women who have had both ovaries removed are at a higher risk for lower

bone density and osteoporosis. In the recent study from the Women's Health

Initiative, the women who took Premarin and Provera longer than 4 years had

an increased risk of heart attacks, blood clots, strokes and breast cancer. The

women who took Premarin only (just estrogen), had no increased risk

reported.

You are only taking the estrogen, because your uterus was removed.

Estrogen only seems to be much safer than taking both the Premarin and

Provera. I would recommend you ask your doctor for a bone density test

called a DEXA scan. If that is normal, and you are not terribly bothered by

menopause symptoms, then a healthy low-fat, high-vegie/fruit, soy, whole

grains and fish diet, regular weight-bearing and aerobic exercise, calcium

500-1500 mg (depending on dietary sources) magnesium 500 mg, vitamin D

400-600 i.u. and vitamin E 400-800 i.u. would be a basic approach to long-

term good health. If you have a low bone density, you would be wise to take a

natural estradiol prescription from your doctor (0.5mg to 1.0 mg). If your bone

density is normal but you have some menopausal symptoms, you might try

black cohosh extract. You will want to have your bone density checked again

in 2 years.

Q: I have been taking 1,000 mg black cohosh once a day for the past year and

a half to get me through menopause. I just had my hormone levels checked

and the doctor says that I am now post menopausal. Should I still take black

cohosh? If so, should I stay on the same dosage?

A: It certainly is safe for you to continue taking the black cohosh even though

you are now post-menopausal. It may not be necessary. You can experiment

by reducing the dose-try half your current dose. There is no time limit for the

duration of use of black cohosh. As long as you need it, you can take it.

Q: I'm a 43-year-old woman, premenopausal. I got my hormones checked with

a saliva kit. At 7:00 a.m., I tested in the normal range for estradiol, but was

low

in estriol, estrone, and progesterone. I was a little high in testosterone, and

very high in cortisol. I would like to know the best way to balance these

hormones. I am willing to try conventional medicine if I can take them a limited

time and if it's possible to take the estrogens separate, even though I'd rather

try herbs.

A: If you are 43 and premenopausal, meaning still menstruating regularly and

without menopausal symptoms, I would take no action based on your saliva

tests. (Note: premenopausal is different than perimenopausal;

perimenopausal is a transition time of changes in the interval of the menstrual

cycle, with or without additional menopause symptoms). These hormones

fluctuate continually in a premenopausal, reproductive aged woman. If you

are perimenopausal (in the menopause transition) and having irregular

periods and/or some other symptoms, it would be best to make decisions

based on the symptoms you are experiencing and your risks for osteoporosis

rather than the saliva levels. Saliva tests are not proven to be accurate for

progesterone, estriol, estrone and estradiol. They may have some value in

cortisol and testosterone evaluations. Supporting the adrenal glands with

vitamin B6 25 mg-200 mg, vitamin C 1,000mg-3,000mg, licorice root 1-2

grams of powdered root or 2-4 milliliters of a liquid extract and ginseng root

4-

6 grams daily can have some effects on cortisol and testosterone.

Hypoglycemia may be affecting your cortisol levels. For future reference, the

individual hormones can be prescribed separately by using a compounding

pharmacy such as " The Women's International Pharmacy, " for more

information, call the pharmacy at .

Q: I'm thinking about taking black cohosh and/or increasing my intake of soy.

I'm concerned about breast cancer because of a family history of breast

cancer. I'm confused about the effect of soy on the breast and how long I can

take black cohosh safely. I hear mixed information.

A: Let's start with black cohosh. First of all, contrary to what you may have

heard previously, the current technology on the analysis of plant constituents

has been able to demonstrate that black cohosh does not contain any

phytoestrogen compounds. It also can be used longer than 6 months. Toxicity

studies have been done for up to 6 months, in which there is no toxicity. All

toxicity studies on plants or nutrients or pharmaceuticals are done for a finite

amount of time. They are not done into infinity. Black cohosh has been noted

to have minimal side effects in a very small amount of people. These include

headaches, gastrointestinal upset, and minor weight gain. In addition,

laboratory studies have shown that black cohosh inhibits the cell division of

estrogen positive breast cancer cells, blocks the effect of estrogen on those

same cells and enhances the anti-estrogen effect of Tamoxifen on breast

cancer cells.

The effect of soy on breast tissue is a bit more complicated. I can say that 19

out of 26 animal studies show that soy reduces the incidence of breast

cancer. In the other 7, there is no protective effect but no adverse effect. In

studies on large populations of women who eat soy, it has been observed in

at least two, that higher amounts of soy in the diet are associated with lower

rates of breast cancer. In the other two, that association was not evident. No

studies show an increased rate of breast cancer associated with a high soy

diet. Most all laboratory studies show that soy does not stimulate breast

cancer cells. One study did show that in small amounts, soy did increase cell

division, when higher amounts of soy were used, the soy actually inhibited

breast cancer cell division. There is also some possibility that soy may

interfere with the estrogen blocking effect of Tamoxifen--this has been

demonstrated in a test tube. So, for a breast cancer survivor not on Tamoxifen,

I recommend not a little soy but a lot (greater than 75 mg of isoflavones per

day). If the breast cancer patient is on Tamoxifen, I recommend that soy be

used minimally or not at all. For non-breast cancer patients, including those

women who have a family history of breast cancer, I recommend a diet that

includes a regular and even daily amount of soy, using the traditional Asian

diet as a guide. Soy includes antioxidants, inhibits enzyme system involved in

cancer cell division, lowers blood levels of estrogen, and phytoestrogens that

actually serve to interfere with estrogen binding to breast cell receptors, and

is

able to alter the metabolism of estrogen such that the breakdown products

include more anti-carcinogenic compounds and less carcinogenic

compounds. For all of these reasons, soy should be considered a food that

most likely reduces the risk of breast cancer.

Q: What herb may improve fertility in women?

A: The best known herb to improve fertility is chaste tree berry. This herb can

stimulate ovulation and therefore also have a progesterone effect. For those

women who have infertility due to a lack of ovulation or regular ovulation, or

those women who have deficient progesterone levels, chaste tree berry may

be a useful herb. I recommend a liquid extract of 1 tsp per day or a

standardized extract that contains 215 mg of chaste tree berry standardized to

contain .6% aucubin.

Q: What are some of the proven supplements for menopause?

A: Hopefully, some of my answers to questions in a couple of the previous

issues has already helped you with your question. I can offer you some added

information. Vitamin E has been studied in a few older studies from the 40's

and 50's and showed a significant ability to reduce hot flashes and night

sweats. We find that vitamin E helps some women, some of the time, but not to

the degree reported in that research. Bioflavonoids and vitamin C (1,000 mg

of each) have also shown some benefit in reducing hot flashes as well. Soy

isoflavones (50-100 mg) has also been shown to reduce hot flashes and night

sweats by about 40-55%. Black cohosh standardized extract (40 mg) is the

most studied herb for menopause symptoms. It can help with an array of the

symptoms, and especially hot flashes and night sweats. Red clover has

shown about a 50% reduction in hot flashes and night sweats at 40 mg - 80

mg of the standardized extract. Kava, St. 's wort, natural progesterone

cream, and a combination formula with wild yam, Dong quai, burdock root,

licorice and motherwort have been less studied, but in published research

trials have shown considerable benefit.

Q: I took antibiotics for two years for the treatment of my acne. I have gone

off

the antibiotics and am treating my acne successfully with other means.

However, I have recurring vaginal infections and I have assumed they were

yeast vaginitis. I have been using Monistat but would like something more

natural. What else could I do?

A: It is likely that the problem you have acquired is a disruption of the

balance

of the organisms that normally inhabit the vagina. The antibiotics that you

took, altered the normal homeostasis in the vagina of lactobacillus species,

yeast, and the numerous bacteria of the vagina. Essentially, the antibiotics

inhibit the population of the lactobacillus, which is what keeps the vagina

acidic and all the organisms in balance. You may also now have an

overgrowth of bacteria called bacterial vaginosis. Without a microscopic

sample, you won't know for sure. If it is yeast overgrowth, then I recommend a

treatment plan of boric acid suppositories which was proven to be 98%

effective in 100 women with chronic persistent yeast vaginitis. Insert a 600 mg

capsule of boric acid twice daily for 4 weeks. After that, insert one capsule

daily for 4 days per month during your menses for the next four months.

Eating 8 oz of acidophilus yogurt daily for at least one month may also help to

repopulate the vagina with lactobacillus and help prevent recurring yeast

infections. Reducing sweets and simple sugars may also be helpful because

yeast use the sugar for their growth.

Q: Since using Depoprovera for contraception, I have had a lot of mood

swings and water retention like I'm premenstrual except that I'm not

premenstrual. What can I do for this?

A: What you are experiencing is not all that uncommon with Depoprovera.

What will probably help is a good PMS nutritional/herbal supplement and

some progesterone cream. What I would suggest is to purchase some natural

progesterone cream (not just wild yam extract, but wild yam cream with

natural progesterone in it--about 400 mg per 1 oz. container.) This will deliver

20 mg of natural progesterone per 1/4 tsp of cream. Apply 1/4 tsp twice a day

to palms and inner upper arms, for three weeks per month. Also, I would take

a PMS supplement--at least 2 caps daily for the next 3 months if not 2 caps

twice daily. Good ingredients to look for in a PMS supplement is vitamin B6,

evening primrose oil or borage oil, chaste tree berry, calcium and possibly

ginkgo and/or St. 's wort. The Depoprovera not only has typical side

effects like moodiness and bloating and water retention, but also your own

body ends up producing none of its own progesterone which then can cause

you to feel moody and weepy.

Q: I've read some things about evening primrose oil and am confused about

what kind of conditions it is used for. Also, does it contain estrogen and

should I worry about breast cancer? My mother had breast cancer and I want

to make sure I don't do something dangerous.

A: Probably the most well known use of evening primrose oil (EPO) for

women is in the treatment of fibrocystic breast disease. In more than one

study, EPO has alleviated pain and tenderness of cyclic breast pain and

fibrocystic breasts. Other conditions that have shown benefits and have been

studied include: premenstrual headaches, depression, irritability and bloating;

menopausal hot flushing; and anecdotal reports using it as a method to

stimulate cervical ripening during labor. In my own practice, I use EPO (as

well as fish oils, and borage oil), to treat menstrual cramps, pelvic pain due

to

endometriosis, and maximizing calcium metabolism to preserve bone health.

Some people have misunderstood evening primrose oil and created

confusion about how it works. It does not contain estrogen and does not

stimulate estrogenic effects in the breast. In fact, the gamma linoleic acid in

the EPO decreases the sensitivity of the breast to estrogen. That is a positive

thing. EPO is a safe supplement to use longterm without worries. Additional

common uses of EPO include eczema, diabetic neuropathy and rheumatoid

arthritis.

Q: I've heard that phosphatidylserine might be helpful for improving memory.

What is it, when and how should I use it?

A: Phosphatidlyserine is the major phospholipid in the brain. The brain needs

methyl donors like folic acid, S-adenosylmethionine, vitamin B12 and

essential fatty acids in order to manufacture sufficient phosphatidylserine.

Low levels of phosphatidylserine in the brain are associated with impaired

mental function, especially in the elderly. A number of double-blind studies

have looked at depression and impaired mental function in men and women

over the age of 65. In general, these studies have shown significant

improvements in mental function, mood, and behavior. Rather than

influencing serotonin and other neurotransmitters, it appears as though the

phosphatidylserine improves the brain cell membrane fluidity and perhaps

reduces cortisol secretion in response to stress. The standard dosage is 100

mg three times daily. No side effects or adverse interactions have been noted.

It is generally commercially made as a semi-synthetic product manufactured

from soy lecithin.

Q: I've heard that Vitex (chaste tree) should not be taken with birth control

pills. Could you explain, and/or do you agree with this statement?

A: Actually, I don't agree with this concept. Chaste tree does not contain

hormones in any part of the plant. Rather, one of its action is that of

increasing

the pituitary's production of luteinizing hormone (LH), thereby having a

progesterone like effect. The onset of the LH surge is the most reliable

indicator of impending ovulation, occurring about 10-12 hours after the LH

peak. The effect of chaste tree then, results in promotion of ovulation. The

theoretical concern is that since birth control pills inhibit ovulation, and

chaste

tree stimulates ovulation, maybe the herb will counteract the effects of the

birth control pill. My opinion and observation is that chaste tree just does not

have a powerful enough effect to promote ovulation such that it can override

the inhibitory effect of the high dose hormones in the birth control pills.