Women's Bodies, Women's Wisdom (123 page)

A new and very promising natural phytoestrogenic supplement called Nutrafem was found to reduce hot flashes by 46 percent in one study.
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The researchers further reported that 43 percent of women taking Nutrafem (a formulation of two botanical extracts—
Eucommia ulmoides
bark and
Vigna
radiata,
or mung beans) experienced a 50 percent reduction in menopausal symptoms. Women reported relief after seven days of taking this supplement. Nutrafem is available from Emerson Ecologics (800-654-4432 or 603-656-9778;
www.emersonecologics.com
.

Pueraria mirifica (PM)

Also known as Thai kudzu, PM has been shown to be very effective at relieving menopausal symptoms, including vaginal dryness, hot flashes, insomnia, and irritability. Thirteen different species are native to Thailand, but only one has been used for seven millennia by both men and women for its hormone-like effects. The standardized form of PM contains a potent plant sterol known as miroestrol, which is particularly effective for relieving menopause symptoms safely and effectively. Miroestrol has estrogenlike effects on bone and vaginal tissue, while also protecting the breasts and endometrium from the adverse effects of excess estrogen.
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In one study that compared PM to conjugated equine estrogens (Premarin), PM had an estrogenic effect that was similar to Premarin but without the side effects.
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Research further shows that PM can halt the growth of breast cancer cells in vitro (in the lab).
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To obtain the benefits of PM, you need a product that contains standardized miroestrol (approximately 20 mg of miroestrol per 100 grams). One such product is H.R.T. (Herbal Remedy from Thailand) Plus from Longevity Plus, available at
www.longevityplus.com
. Another is PM PhytoGen Complex from Solgar. The usual dose is two tablets per day.

Maca

Species of maca grow all over many South American countries, but only the maca from Peru has been studied in any significant way. Maca is a dietary staple in Peru and has high nutritional content. It is an adaptogenic plant, which means that it helps modulate the body’s response to stress of all kinds. The herb has been traditionally used to benefit the endocrine and reproductive systems of both men and women. Research shows that maca increases the production of sex hormones, enhances sex drive, increases energy, and also results in mental improvement in many. Its properties make it a particularly useful herb for perimenopausal and menopausal women.
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Femmenessence MacaPause, a formulation of maca that has guaranteed potency and excellent bioavailability, is made by Natural Health International (
www.naturalhi.com
).

Natural Progesterone

Natural progesterone has been shown to help hot flashes in some women.
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This effect is most likely ascribable to the fact that it is a precursor hormone and also because it down-regulates estrogen receptors.

Hormone Therapy

The gold standard treatment for relief of hot flashes is estrogen therapy. Note that
not
all hot flashes are related to decreases in estrogen. Hyperthyroidism can cause them, as can alcohol intake and out-of-control diabetes. I had hot flashes during my pregnancies and sometimes premenstrually. Many women report similar patterns.

Energy Medicine

Meditation, relaxation, and slow, deep abdominal breathing can help to relieve hot flashes.
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The relaxation response (see PMS section in chapter 5) has been successfully used by many women to decrease hot flashes by as much as 90 percent.
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Traditional Chinese medicine and herbs are also very effective. The reason these work is because they all reduce levels of stress hormones that trigger hot flashes. The adrenal restoration program (see page 536) will also reduce hot flashes.

VAGINAL DRYNESS, IRRITATION, AND THINNING

Thinning of vaginal tissue in menopause is associated with decreased estrogen levels. Vaginal tissue is made of many cell layers. When the vaginal mucosa is well estrogenized, it is called “cornified epithelium.”
Cornified
refers to cells that are tough and resilient. After menopause, some women lose the outer cornified layers of their vaginal tissue. This can lead to complaints of vaginal dryness and irritation. Such complaints are highly individual and subjective; a woman who has been diagnosed with atrophic vaginitis may not have any symptoms at all. In some women, thinning and irritation are accompanied by an increase in the vagina’s alkalinity. At these higher pH levels, bacterial vaginitis sometimes results.

The phytohormones mentioned above often work well to restore vaginal tissue, particularly
Pueraria mirifica
(PM) and high-dose soy (such as Revival). However, some women require topical or oral estrogen. For some women, an application of estrogen cream directly to the vagina may be all that’s required. Transdermal estrogen or the vaginal ring (Estring) are also very effective. In fact, research shows that using 0.1 percent estradiol gel for twelve weeks not only improved hot flashes but also increased the estradiol/estrone ratio in postmenopausal women to premenopausal levels.
⁵⁵
A low-dose synthetic conjugated estrogen cream (made with Premarin) used twice per week has also recently been shown to be helpful, with no endometrial problems.
⁵⁶

Urinary frequency and symptoms of urinary tract infection are sometimes also associated with thinning of the vaginal mucosa and ure thral tissues. (See section on UTIs and hormones in chapter 9.) This problem is easily alleviated by applying a small amount of estrogen cream directly to the vaginal tissue covering the outer third of the urethra, which you can feel running just beneath the top of the vaginal opening.

Treatment

Botanicals

Pueraria mirifica (PM) (see above) and high-dose soy (such as Revival) have been found to relieve vaginal dryness in many women. Remifemin (black cohosh) works similarly to estriol to effect a thickening of the vaginal mucosa. Herbs such as dandelion leaves and oatstraw have also been used to restore vaginal lubrication.
⁵⁷
These herbs should be taken orally.

Lubricants

A wide range of effective lubricants have been shown to work well, ensuring that there’s a lubricant available to suit just about every taste.
⁵⁸
Overthe-counter options include K-Y jelly, Sylk, Probe, and Good Clean Love, to name a few. Crème de la Femme (available from Amazing Solutions; 800-576-7616 or
www.amazing-solutions.com
) is an oil-based lubricant that is very well tolerated and very effective. Estriol or testosterone can be added by a formulary pharmacist (150 mg of testosterone in oil per ounce of Crème de la Femme). The usual dose is 1 gram per day.

Testosterone

One-half mg to 1 mg transdermally or as vaginal cream, daily or every third day, will restore vaginal mucosa function without the risk of creating excessively high systemic estrogen levels.
⁵⁹

Estriol

Estriol vaginal cream is applied in a dosage of 0.5 mg twice a day for one week, then once a day for one week, and two or three times weekly thereafter. Concerns surrounding the effect of estrogens on breast cancer are mitigated by the use of estriol, which exerts a very powerful local action but is weak systemically.
⁶⁰

Estradiol Vaginal Ring

Estring is a vaginal ring made of silicone and impregnated with estradiol. It is placed in the vagina like a diaphragm and continually releases small doses of estradiol for three months. It is a convenient choice for many women. A small percentage of women will experience side effects such as recurrent vaginal infections, headache, and vaginal irritation.

Conventional Vaginal Creams

Estrace (estradiol) is a bioidentical estrogen cream that works well for treatment of vaginal dryness, thinning, and other symptoms.

Use It or Lose It

The very act of regular vaginal stimulation, whether through intercourse or through use of a jade egg, vibrator, or dildo, helps keep vaginal tissue healthy and well vascularized. Many women notice that their initial vaginal dryness goes away with this practice.

OSTEOPOROSIS

Postmenopausal osteoporosis is one of the most common and dis abling diseases affecting women in North America today. Studies have shown a 2 to 5 percent loss in bone mass per year in women over a five-year period during and after menopause. Risk factors for osteoporosis include lack of exercise; a diet high in refined carbohydrates; deficiencies in calcium, magnesium, boron, trace minerals, and vitamin D; and never having borne a child. Depression has also been shown to be a significant risk factor for osteoporosis, most likely due to the increased levels of cortisol usually associated with this condition.
⁶¹

However, as much as 50 percent of a woman’s bone loss over a life span is lost before the onset of menopause. A history of ovulatory disturbances and subsequent progesterone deficiency can predispose women to osteoporosis. Women with a history of amenorrhea due to a low percentage of body fat, as is often found in athletes and dancers, are at greater risk for osteoporosis than the general population.
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Statistics show that 6 to 18 percent of women between the ages of twenty-five and thirty-four exhibit abnormally low bone den sity. Although low bone density is responsible for many hip fractures, two studies have shown that a predisposition to falling created by “senile gait” (a shuffling, tentative walking style caused by muscle weakness and general lack of fitness) and poor eyesight is equal to low bone density as a significant factor for hip fracture risk.
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Hip fracture rates for white women in the United States begin to rise abruptly between the ages of forty and forty-four, before the normal advent of menopause.
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Bone density screening is recommended for women who are sixty-five and older, or for younger postmenopausal women with certain risk factors (including those who smoke, have a history of excessive alcohol intake, suffer from rheumatoid arthritis, have a history of taking steroid drugs, or have a mother diagnosed with severe os teoporosis). The best way to determine your current bone density is through a screening test called dual-energy X-ray absorptiometry (DEXA). It can be used on the hips, spine, forearm, or entire body. It is brief (under ten minutes) and safe, because it uses a very low dose of radiation. The biggest problem with the test is that if you are small-boned, it may suggest that you are losing bone even if you are not. In other words, your bones may register in the lower range compared to an entire population, even though they may well have been in this range for your entire life. So do not allow one test result to cause undue stress. But do let it spur you on to a more bone-healthy lifestyle. A urine test for metabolic breakdown products of bone (Pyrilinks-D) is also helpful in determining whether or not a woman is actively losing bone. It’s a useful way to monitor any bone-building program because it will show improvement long before you are likely to see it on a DEXA test.

Bone Health Program

Although estrogen replacement is very effective for decreasing osteoporosis risk, preventing progressive bone loss in women requires dealing with far more complex factors. A program of dietary adjustments; exercise with just the right amount and type of stress on the bones and joints; and supplementation with vitamin D, calcium, and magnesium can also be very effective in preventing, halting, or even reversing bone loss. In fact, suboptimal vitamin D levels are increasingly implicated in osteoporo sis. Research presented at the 2009 meeting of the American Society for Bone and Mineral Research showed that combining a home-based physiotherapy program with high-dose supplementation of vitamin D significantly reduced the rate of falls and hospital readmissions in the elderly.
⁶⁵
And while dairy products are pushed as a panacea to prevent osteoporosis, it’s entirely possible to create and maintain healthy bones without eating dairy. (See box, below.) In fact, studies in both pre-and postmenopausal women report that consuming soy and soy isoflavones help to support better bone structure.
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Miroestrol, a potent phytoestrogen found in the Thai herb
Pueraria mirifica
(see above), increases bone density in rats who’ve had their ovaries removed—a sign that this same herb might work well in humans.
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One of my patients went in for a bone density test when she went through menopause at the age of fifty-three. It showed that her bone density was low normal. Her mother had died of breast cancer when my patient was thirteen, so she had no intention of going on estrogen. Instead, she was immediately advised to start taking Fosamax, a drug that prevents bone breakdown, and get the scan repeated in six months. She called me, deeply concerned that her bones were melting away. I reassured her that this wasn’t the case and suggested a program of weight training, natural progesterone, and supplementation with boron, calcium, magnesium, vitamin D, vitamin C, and trace minerals (see below). Within six months, her bones had shown a significant increase in density. The doctor at the osteoporosis center told her that he was very surprised at her results, and said that she should keep on doing whatever she was doing. She has had a scan every two years since then and her density has remained excellent.