Traditional medicine or alternative medicine? Who”™s right when it comes to treating menopause? Where is the balance? Do women need any hormones or natural remedies during this natural aging process? The literature is vast, and the messages are confusing. So, how do you decide what is best for you during this transition in life?
The average age of menopause is 51 with a range of 40-58. Both perimenopause and menopause can create dramatic changes. These experiences often create memories that remain with women for life and are the subject of stories, humor, books and movies!
Menopausal therapies include not only hormones, but also mind-body support, exercise, good nutrition, appropriate supplements, acupuncture and laughter. The primary purpose is to manage the transitions, prolong life and preserve a healthy, active lifestyle. The approach to achieving these important goals is to normalize as many hormones as possible using conventional pharmacology or natural therapies. The choice is yours.
Hormones are great messengers between the cells and the systems of the body. If your hormones are deficient or out of balance, you may not feel well or your body may have accelerated metabolic aging.
You can improve the balance of your hormones by practicing good nutrition, decreasing stress and implementing an appropriate exercise program. Replacement of hormones can also improve the balance. Multiple hormones are vital to your well-being. Some of these include cortisol, insulin, estrogen, progesterone and thyroid. Request that your physician order specific labs to determine your levels and ratios. Many physicians recommend that women obtain a 2- and 16- OH estrogen levels test before and after taking estrogen. This test determines how you are metabolizing estrogen (16-OH is stronger) and may help you and your doctor identify if you are at a higher risk for developing breast cancer. Supplements like indole 3 carbinol are available to increase the protective 2- OH estrogen.
The Women”™s Health Initiative (WHI), a 15-year research study launched in 1991, stunned the medical community as well as women nationwide with results that reported Hormonal Replacement Therapy (HRT) actually posed more health risks than benefits for women in the clinical trial. The data confused people ”“ and scared them. A 41% increase in strokes? The percentages seemed high. What were the real numbers? Out of 10,000 women on the Estrogen-Progestin arm, there were 29 cases of strokes as opposed to 21 in the placebo group. The rate of breast cancer was 38 per 10,000 hormone-using women as opposed to 30 per 10,000 non-hormone users, but there were no deaths from breast cancer in either group. The media rarely mentioned the absolute numbers. There were fewer osteoporosis-related hip fractures and colorectal cancer in the HRT group.
Later, the Estrogen (CEE) arm with hysterectomized women was discontinued. The results showed there was actually less breast cancer in the hormone group. There was no increase in heart disease, but an increase in the number of strokes.
The WHI”™s population consisted of older postmenopausal women. Participants were an average age of 63 at the start of the study. What is less certain is whether the study findings can be applied to younger women, such as the women that typically start estrogen therapy early in the menopause. According to the Mayo Clinic, the data analysis revealed that participants ages 50-59 who took estrogen experienced fewer heart attacks and deaths from coronary heart disease than participants who took the placebo. Later analysis also indicated better mental function in this group using the hormones. The WHI only studied Premarin and Prempro synthetic hormonesThe bio-identical hormones were not studied.
Bio-identical hormones are structurally identical to the hormones produced by the human body and are intended to replace these hormones when levels decline as a consequence of aging, disease or surgery. Customization through a compounding pharmacy can maximize the therapeutic effects while minimizing the potential for adverse effects.
Researchers at the Mayo Clinic surveyed 176 women taking naturalized micronized progesterone who had previously taken synthetic progestins. After one to six months, the women reported an overall increase in satisfaction compared to their previous hormones, and they reported the following improvements: 50% fewer hot flashes, 42% less depression, and 47% lower anxiety. However, there have not been large clinical trials studying the risks and benefits of bio-identical hormones.
Decisions about whether to stop, start, or change your hormones should be made on an individual basis only after consulting your physician and a knowledgeable pharmacist. Whatever choice you make, it needs to be taken seriously. The way your body responds needs to be tracked with lab tests and physician follow-up. Levels of estrogen and progesterone need to be measured every six months or sooner depending on your symptoms. The results in consultation provide an exchange of important information and allow the woman to participate in the decision-making process.
A healthy start includes lifestyle changes:
”¢ Don”™t smoke.
”¢ Eat low-fat (but include “good” fats), high-fiber and several servings of fruits and vegetables.
”¢ Manage stress.
”¢ Maintain a normal weight.
”¢ Be physically active.
Supplements include the following: a high-quality multivitamin, which does not contain iron unless there are specific indications for it; calcium (1500 mg); and vitamin D3 400-800 IU.
To manage menopausal symptoms, natural botanicals may also be considered such as black cohosh, a perennial plant native to North America. Remifemin, which contains black cohosh extract, has been the most studied with patients use 20-80 mg twice a day on average. Before taking any herbs or botanicals, check with your physician and a knowledgeable pharmacist, as there are herb-herb interactions, herb-drug interactions and supplements that interact with both. Take only what you need as determined with your health care provider to improve your health or minimize your symptoms. Your family history as well as your personal health history are keys to your health path.
Often when we focus on only one aspect of a health condition, such as hormones, we are treating the “tip of the iceberg.” A range of therapies such as massage, homeopathy, traditional Chinese medicine and acupuncture, and mind-body therapies have all been shown to help during this period of transition. Medical acupuncture is rapidly gaining recognition in the Western world as an effective treatment. Many integrative medicine practitioners offer medical acupuncture as one of many options. They also design a healing program and partner with the patient in the decision-making and healing journey.
”¢ Choose a physician that allows you to tell your story and is an engaged listener.
”¢ Be knowledgeable and participate in the decision-making process.
”¢ Use the lowest dose of hormones and only what you need in supplements.
”¢ Be your own advocate.