Alternatives to Hormone Replacement Therapy HRT

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Alternatives to Hormone Replacement Therapy HRT

 

The Western medical paradigm has been treating menopausal symptoms in women with

the replacing of hormones or hormone replacement therapy (HRT). From the Western

viewpoint, menopausal symptoms are only hot flashes and vaginal dryness; both

solely considered an estrogen deficiency problem. Therefore, HRT is considered

the cure.

 

The Women's Health Initiative (WHI) is a set of studies conducted by the

National Institutes of Health, a division of the U.S. Department of Health and

Human Services. Through these studies, WHI researchers gathered information

about the health of women who have gone through menopause. In the HRT trial,

researchers were studying the effects of HRT on the health of postmenopausal

women. Researchers were trying to determine whether using HRT affects a woman's

chances of developing breast and colorectal cancers, heart disease and

osteoporosis after she has gone through menopause. Two groups of women were

involved in the HRT trial. In one group, women who had undergone hysterectomy

(surgical removal of the uterus) took either estrogen or a placebo (sugar pill).

Women in the other group were also postmenopausal but they had not undergone

hysterectomy. These women took either combination HRT (both estrogen and

progestin) or a placebo. The specific brand of combination medicine used in this

group was Prempro. There are other brands of combination-therapy HRT available,

but only Prempro was used in this study.

 

The HRT trial was scheduled to end in 2005. However, researchers decided to stop

the combination-therapy part of the study in 2002 because they could see that

the risks associated with combination HRT outweighed the benefits. Specifically,

it was found that long-term use (5 years or more) of combination HRT resulted in

an increase in a woman's risk of breast cancer, blood clots, heart attacks and

strokes. For each of these problems, the increased risk was about 8 more events

per 10,000 women per year, compared to women who did not use HRT.

 

The European Heart Journal, Europe's leading cardiology journal, published the

largest study to look at the effects of HRT since the Women's Health Initiative

trial was stopped early after finding that HRT increased the risk of women

developing a range of conditions including breast cancer and thromboembolism.

The research is an observational study of 698,098 healthy Danish women, aged

51-69, who were followed between 1995-2001. It has found that overall there was

no increased risk of heart attacks in current users of HRT compared to women who

had never taken it.

 

The results did find that in women (aged 51-54) who were taking HRT during the

period of the study, their risk of heart attacks was about a quarter (24%) more

than in women who had never taken HRT. In addition, in younger women there was

an increasing risk with longer duration of HRT, which was not seen in the older

age groups.

 

The study also found that the type of HRT and the way that the women took it

made a difference to the risk of heart attacks. Continuous HRT (a continuous

combination of estrogen and progesterone) carried a 35% increased risk of heart

attacks compared with women who had never used HRT. But if HRT was taken on a

cyclical basis (estrogen, followed by a combination of estrogen and

progesterone) there was a tendency for these women to have a reduced risk of

heart attacks compared to women who had never used HRT, and this was also seen

if a synthetic hormone, tibolone, was used. If the method of taking the estrogen

was via a patch or gel on the skin or in the vagina, the risk of heart attack

reduced by more than a third (38% and 44% respectively).

 

The New England Journal of Medicine, in 1995 confirmed the link between estrogen

therapy and breast cancer. Also, long-term use of estrogen may increase the risk

of ovarian cancer.

 

The Brigham Multipurpose Arthritis and Muskuloskeletal Disease of Boston

analyzed a recent report indicating a possible connection between long-term

estrogen use and lupus.

 

HRT therapy is given to regulate a hormone called FSH (follicular stimulating

hormone), which, during per/menopause, is running high through the blood stream.

This surge in FSH is in response to the decreasing unresponsive follicles during

ovulation. HRT therapy increases the estrogen in the body, causing the pituitary

to think that ovulation and estrogen production are continuing. The therapy

decreases the FSH levels and therefore symptoms of hot flashes and dryness

decrease. HRT therapy therefore, " tricks " the pituitary gland into thinking it

is getting what it needs, artificially. It appears to the body ovulation and

estrogen production are continuing, decreasing FSH levels and therefore,

decreases such symptoms as hot flashes, anxiety and dryness. Stopping the

estrogen causes the body to revert back to its initial state.

 

The Western medicine approach to HRT is given in several forms. They can be

given in a combination of several estrogens (estradiol, estrone and estriol).

They can be given as a conjugated equine estrogen or a synthetic estrogen.

Synthetic estrogen is manufactured in laboratories and therefore not easily

broken down in the body and because of this, tend to accumulate in the body.

Dangerous metabolic changes can occur with synthetic estrogen resulting in

increased incidents of high blood pressure, blood clots and fluid retention.

Natural estrogens too are manufactured in laboratories, one of the most popular

types being equine estrogen, manufactured from the urine of pregnant mares.

These are sold under the name of Premarin and Estratab. As this is an extremely

potent form of estrogen, it too can create metabolic changes in the liver. This

form of estrogen is not recommended for women who are extremely over weight to

obese, who currently smoke, have high blood pressure, high cholesterol or

varicose veins. The other natural form of estrogen is estradiol sold under the

names Estraderm, Emcyt and Estrace. These forms are more easily metabolized by

the body and should be taken in the smallest dose possible, taken orally and

every other day.

 

HRT can also be prescribed as a combination of estrogen along with progesterone.

It was often given to neutralize such potential carcinogenic effects of the

breasts and endometrium. Two classes of progestin are used, which include a

progesterone and 17 hydroxyprogesterone combination or synthetic progestins.

There has been an ever-growing body of research around replacing progesterone

instead of estrogen. Natural progesterone cream is sometime recommended. There

are two reasons to be cautious with this protocol. Often creams that say they

are natural are actual synthetic ingredients, which make it no safer than

synthetic progestins. The other reason is that women start feeling good on

progesterone and do not regulate their dosage properly. Adverse effects of

improper progesterone use include break through bleeding, changes in cervical

erosion and secretion, breast tenderness, weight gain and edema.

 

 

Potential adverse effects of HRT:

 

-endometrial hyperplasia

-cancer

-thromboembolism

-stroke

-hypertension

-breast cancer

-gallbladder dysfunction

-nausea

-vomiting

-headaches

-water retention

 

 

HRT Therapy is contraindicated for any woman who ever had:

 

-breast cancer

-breast lumps of unknown origin

-active liver cancer

-a history of thromboembolism

-hypertension that is untreated

-vaginal bleeding of unknown origin

 

 

It is crucial to analyze your medical history. Women with a history of breast,

uterine or ovarian cancer, fibroid tumors, breast cyst that have been diagnosed

as atypical hyperplasia, or have liver or gallbladder disease, should not take

estrogen replacement therapy.

 

In conclusion, HRT not only failed to provide the heart and bone health benefits

promised, the research showed that these synthetic hormones would promote

breast, ovarian and uterine cancer, as well as, cause blood clots, stroke and

high blood pressure.

 

Estrogen therapy alone was shown to increase risk of endometrial cancer if not

taken with progestin in woman with a uterus. It also increases the risk of

stroke, developing gallstones and urinary incontinence.

 

Progestin therapy alone such as medroxy-progesterone, was shown not to relieve

vaginal dryness and may increase the risk of atherosclerosis as well as negative

effects on cholesterol. The effects such as coronary artery disease, stroke,

breast cancer, blood clots and breast cancer are yet unknown. However,

micronized progesterone appears to have fewer side effects and may not adversely

affect cholesterol.

 

Combination therapy (estrogen plus progestin) was shown to increase the risk of

coronary artery disease, stroke, breast cancer blood clots dementia and urinary

incontinence.

 

There are other drugs that have been recommended to woman for treating symptoms

of per-menopause and menopausal symptoms. Selective Estrogen Receptor Modulators

(SERMs) function like estrogen in certain parts of the body and as an

anti-estrogen in other areas. The drug Raloxifene, has been given to prevent and

treat osteoporosis. Like estrogen, it helps with bone loss. Recently, it has

shown to decrease the risk of breast cancer in postmenopausal women. However, it

has been shown to increase the risk of blood clots, increase hot flashes in 1

out of 10 women and can cause leg cramps.

 

Selective Serotonin Reuptake Inhibitors (SSRIs) such as Fluoxetine, Sertraline,

and Paroxetine have been prescribed to relieve anxiety, depression irritability

and insomnia with an " a side " for relieving hot flashes. Depending on the drug,

these SSRIs can cause such side effects as sexual dysfunction, nausea, diarrhea,

weight loss (short term use), weight gain (long term use), dry mouth, mental

confusion, and can have effects on blood pressure.

 

Statins (lipid lowering drugs) are sometimes prescribed for preventing

atheroslerosis and coronary artery disease. The side effects of these drugs

include constipation, loose stool, abdominal pain, nausea, bloating, rash,

muscle weakness, muscle inflammation, increased levels of liver enzymes and

fatigue.

 

Antihypertensive drugs (used to treat high blood pressure), such as the drug

Clonidine, have also been given to lessen hot flashes. But again, caution should

be used as they can cause drowsiness, dry mouth and fatigue, abnormally slow

heart rate, rebound high blood pressure when the drug is withdrawn as well as

sexual dysfunction.

 

Testosterone (used in combination with estrogen) has been given to increase sex

drive in women. It does prevent osteoporosis and may improve mood, yet it

decreases HDL cholesterol (the good cholesterol) as well as having some

maculating effects such as lowering the voice and facial hair growth. They also

increase the risk of liver problems including liver cancer.

 

 

The Controversy Around " Bio-Identical " Hormones

 

Bioidentical hormones are supposedly chemically identical to those made by the

human body and are often described as " natural. " Many of those available today

are custom-mixed or " compounded, " in compound pharmacies. The term

" bioidentical " is more of a marketing term than a medical one. Different groups

define the term differently.

 

The FDA has warned seven pharmacies that sell these compounded " bioidentical "

hormones against making misleading claims about safety and efficacy of their

products. The FDA stated that the compounded products were no safer than

conventional forms of hormone replacement therapy (HRT). Premarin and most other

FDA-approved hormone therapy contain synthetic hormones. Misleading claims by

some pharmacies were made about their compounded hormones stating that they

could prevent or treat such diseases as Alzheimer's, stroke, and some cancers,

and yet could not show any credible evidence to supports those claims. However,

the agency stopped short of prohibiting the pharmacies from filling doctors'

prescriptions for these products.

 

Wyeth, the manufacturer of Premarin and Prempro, petitioned the FDA in 2005 to

restrict the availability of compounded " bio-identical " hormones. According to

the Wall Street Journal, sales of Premarin and Prempro have dropped by about

half since 2002 when two big government-sponsored studies from the The Women's

Health Initiative (WHI) found that the drugs raised the risks of breast cancer,

stroke, and heart attack.

 

Several FDA-approved bioidentical hormone products are available by prescription

and are federally regulated and tested for purity, potency, efficacy, and

safety, including 17-beta-estradiol (Estrace, Climara), estrone (Ortho-Est,

Ogen), and micronized progesterone (Prometrium, Prochieve 4%). The term is used

mainly for hormones made from a prescription by one of these compounding

pharmacists, such as Triest (estriol, estradiol, and estrone), or Biest (estriol

and estradiol), which are not approved by the FDA.

 

The North American Menopause Society and the American College of Obstetricians

and Gynecologists have raised concerns about the " bioidentical " hormones

dispensed by compounding pharmacies. Both groups have questioned whether the

hormones have been adequately tested and maintain that there is no evidence

showing that compounded hormones are better or safer than the pharmaceutical

drugs. In fact, they have the same risks as synthetic hormones like Premarin and

Prempro, but better side effect panels.

 

I feel the bioidentical controversy will go on and on primarily because

advertising and marketing agency have now latched on to a " marketing concept "

and are truly running with it. I do not condone this practice while advocating

" false hope and false claims " . Antidotal evidence is important as it can lead to

an accumulative base of knowledge that can encourage more studies to be done.

The fact that advertisers and companies are stating claims that are misleading

to the public, just demoralizes the entire industry and undermines the

foundation and direction in which these therapies need to go.

 

 

Traditional

 

Traditional (TCM) is the oldest, continually practiced, and

professionally administered health care system in the world. It is a documented

medical system spanning over 2,500 years based on comprehensive philosophies,

rational theories, clinically tested and empirically verified by over 100

generations of highly educated practitioners. is a total system

of internal medicine which is comprised of a diagnostic procedure based on

signs, symptoms and treatment styles including acupuncture, herbal medicine,

exercise, diet and meditation. It's foundation is based on the principles of

balance; the interdependent relationship of Yin and Yang. Through this balance,

health is achieved and maintained.

 

Traditional looks at any disease through a signs and symptoms

and then groups them into certain patterns.

 

Acupuncture and herbal medicine are effective therapies for the treatment of

peri/menopause. Acupuncture redirects your energy (Qi) into a more balanced

flow. It provides support to the underlying energetic spheres affected by

menopause and the pituitary-hypothalamus-axis.

 

In Eastern medicine the kidneys are looked at as an entire system, not just an

anatomical object. The " energy " of the kidney system encompasses not only the

physical traits of regulating blood, waste products and water metabolism, but

dominates reproduction growth and development. The kidney system is the producer

of marrow (or essence), dominates water metabolism working in conjunction with

the urinary bladder and the lungs. The kidney " system " in Eastern medicine is

the dominant force in our life vitality. They share a corresponding emotional

connection (fear), tissues (the ears), sensory organ (bones) and element

(water). As we age, the energy of the kidneys decline. Since the kidneys are

associated with our essence, they are the main organs treated during menopause.

Kidney disorders are generally of a cold and or deficient nature. Therefore,

tonifying and moistening the kidneys is the primary approach.

 

The bladder along with the kidneys form an important pair. As they are

anatomically connected through the ureters, the bladder not only excretes waste

material but also is a temporary receptacle for vital fluid retention and

transformation. The bladder functions largely at its optimum when the kidneys

are normal, strong and healthy. Therefore, water is metabolized properly and the

storage and excretion of waste through the bladder, is related to the general

function of the kidneys.

 

Formulations of Eastern Medicinals

 

The majority of the world's population since has used herbal treatments as front

line medicine before recorded history, and is still the most widely utilized

medical system in the world today.

 

Herbs are the medicinals in holistic medicine. Chinese herbs are specifically

used to create decoctions or " teas " and are a very powerful part of healing

dis-ease. Herbal decoctions can also be given in " tea pills " , tinctures, and

granules or as an external patch, compress or bath. Chinese herbal medicine uses

several hundred substances, mostly of plant origin (roots, seeds, flowers,

twigs, crystals, bones and barks). These are hardly ever prescribed singly. They

are combined into a formula, which usually contains between 8 and 12

ingredients. It is the " herbal synergy " that seems to be the strength behind

Chinese herbal formulas. The exact combination is adjusted to suit the patient's

individual condition, and is likely to be altered as the treatment progresses to

take account of changes that have occurred. It is therefore a very flexible

system, which can be closely developed to the needs of the patient. Adverse

reactions to herbs are extremely rare and are negligible when compared to those

commonly produced by pharmaceutical drugs.

 

The methodology behind an herb's function, indication, contraindication,

preparation and use are numerous. Herbs are categorized according to their

properties, taste, temperature and their " herbal synergy " is created by using a

dominant (chief herb) with a deputy, assistants and envoy herbs in a combination

to produce a better effect on one particular organ or condition. The chief herb

" rules " the prescription and has the primary effect on the disease condition.

The deputy and assistant herbs help to synergistically increase the effect of

the chief herb, to treat an illness, as well as, " supervise " the function of

other herbs.

 

Herbs are categorized according to their properties. By doing this, it allows an

herbologist to more efficiently utilize the power behind an herb to its fullest.

 

Herbs are categorized by:

 

1. Temperature

 

Hot, cold, (sligthly) warm, (slightly cool), or neutral.

 

2. Taste

 

Acrid- Disperses and moves (lung channel/organ) (see *Aromatic)

Sweet- Harmonizes, tonifies, moistens (spleen channel/organ)

Bland- Leaches dampness, promotes urination (urinary bladder channel/organ)

 

 

Bitter- Drains and dry (heart channel/organ) (see **3 Aspects)

Sour- Prevents/stops abnormal leakage of fluids(liver channel/organ)(see

***Astringent)

Salty- Purge and softens (kidney channel)

 

 

*Aromatic is an aspect of Acrid (spicy). Aromatic is considered a taste and not

only disperses and moves, but also penetrates turbidity and dampness, opens

orifices. (Often used on Middle Jao)

 

**3. Aspects of drain and dry are that they, 1. Move through a bowel movement,

2. Move downward, 3. Drain fire (inflammation).

 

***Astringent can be an aspect of Sour. Astringent alone prevents/soaks up

fluids. Astringent and sour together can generate fluids.

 

3. Directional Tendencies

 

1. Rise/ascend- moves upward and outward

2. Floating- keeps organs from collapsing (acrid, sweet warm, hot herbs)

3. Fall/descending- moving downward

4. Sink- keeps organs anchored (bitter, sour, salty, astringent cool, cold

herbs)

 

 

This is why the " herbal synergy " that seems to be the strength behind Chinese

herbal formulas, is the major difference behind any other form of herbal

medicine. The exact combination of herbs can constantly be adjusted to suit the

patient's individual condition, and is likely to be altered as the treatment

progresses to take into account the changes that have occurred.

 

 

Alternative to Bio-Identicals

 

" This is where a safer alternative for " bio-identical' formulas comes in. An

herb or herbal combination are not hormones, but work as a precursor, which in

turn, stimulates your body's own metabolism, works in conjunction with endocrine

system's mechanism of action in order to bring your own system back into

balance " .

 

I treat hundreds of woman for perimenopause and menopausal issues. 85% of these

woman fall into one of the three categories below. There are often additional

issues that need to be addressed in a private treatment, but for the most part

the herbal formulas I have created for these indications have helped the vast

majority of my patients throughout the years.

 

A Differential Diagnosis of Symptoms

 

The Eastern approach to treating any disorder is by treating the root of the

problem. Branch treatments (treating just the symptoms one sees) are the

equivalent to putting a band-aid on a broken bone. Treating perimenopause and

menopause requires an in depth look at signs and symptoms, past medical history,

family medical history and every symptom or sign, even if it does not seem

related to the current problem.

 

When differentiating such symptoms, it is important to realize which are the

most dominant set of symptoms and which are secondary. Not everyone would have

all symptoms in one category. They may have a few in one category and a few in

another. The more dominant or most symptoms from one category is usually the

predominant deficiency. Once you can identify the more predominant deficiency

then it is easier to pinpoint remedy-specific formulations to treat and tonify

the situation:

 

 

1. More blood/body/essence fluid deficiency

 

Dizziness, exhaustion, tinnitus, malar flush, night sweats, hot flashes, mental

restlessness, heat in palms and feet, sore weak lower back and/or knees, dry

mouth, dry throat, dry hair, dry skin, itching, constipation, anxiety,

irritability, headaches or cold feet. Premature graying of hair, low sperm count

in males, decreased menstrual flow in women, infertility in women or heel pain.

The tongue often presents as a red tongue body with little or no coat or peeling

coat. The pulse can feel empty or fine, deep or weak. It may also appear to be

overflowing or in excess closest to the wrist.

 

 

2. More energetic deficiency

 

Hot flashes, but cold hands and feet (extremities), night sweating (early

morning), pale face, depression, chilliness, backache, edema of the ankles. Pale

or dark complexion, listless spirit, an aversion to cold, low sex drive, weak or

cold low back, frequent urination or clear and profuse, clear vaginal discharge

and/or edema. The tongue is pale tender, sometimes with tooth marks, and a white

and/or slippery tongue coat with a fine deep pulse.

 

 

3. Used for BOTH an energetic as well as blood/body fluid deficiency.

 

Hot flashes, but cold hands and feet, (especially fingers and toes) nightsweats,

frequent urination, which tends to look pale, flushing around the neck, when

talking, slight agitation, chilliness, dry throat, dizziness, tinnitus,

backache, poor memory or vivid dreams and insomnia.. Tongue can be pale or red

depends on predominate deficiency. Pulse feels empty or very fine and rapid.

 

 

 

Additional underlying patterns that aggravate the above symptoms include

Dampness (being overweight, difficulty getting out of bed in the morning, a

feeling of heaviness in the body) Vital Energy (Qi) Stagnation (tiredness,

fatigue, listless speech…) or Blood Stasis (sharp stabbing pains anywhere in the

body, poor circulation…)

 

 

See your local acupuncture/herbalist for a proper diagnosis and treatment

approach.

 

-Tomorrow: Part 3 of a 3 part series: A Holistic Approach to Menopause

 

 

Andrew Pacholyk, MS, L.Ac

http://www.peacefulmind.com/menopause.htm

Therapies for healing

mind, body, spirit

 

 

 

 

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