Managing Menopause Naturally

Without warning, a sensation of intense warmth spreads from your head to your neck and chest. Beads of sweat begin to form on your face and you feel a little dizzy. This brief episode is over in minutes and leaves you flushed (reddened), perspiring, hot and craving a cold glass of water. Like many women, you are experiencing a hot flash and would like some symptom relief.

In your search for managing your symptoms you may have come across Hormone Replacement Therapy (HRT), but not sure if it is right for you. You have read the testimonial of many women through different media resources who have successfully managed their menopausal symptoms using bioidentical hormones and would like to find out more about the treatment and its risks. You have also heard about nonhormonal ways of dealing with menopause. Whatever your questions, finding the right treatment can be just as overwhelming as the menopause transition itself.

A short history on Hormone Replacement Therapy (HRT)
For many years Premarin or Prempro were the prescription of choice for millions of women in America entering menopause. Premarin, a mixture of estrogens derived from the urine of a pregnant horse, and Prempro, a combination of horse estrogens and synthetic progesterone, serve to replace the hormones that the body is no longer producing in sufficient quantities in the perimenopausal and menopausal stages of a women’s life. These synthetic hormones are prescribed not only to alleviate menopausal symptoms, but also to protect women against heart disease, reduce fracture risk, and as an anti-aging regimen.

In 1991, the effects of hormone replacement therapy were tested in a large clinical trial called the Women’s Health Initiative. More than 16,000 healthy post-menopausal women participated in the study. They were given a placebo or a combination of conjugated equine estrogen and synthetic progesterone in 1 tablet daily for an average of 5.2 years. An important objective of the trial was to examine the effect of estrogen plus progestin on the prevention of heart disease and hip fractures, and any associated change in risk for breast and colon cancer. The study did not address the short-term risks and benefits of hormones for the treatment of menopausal symptoms.

In 2002 the study was stopped short because the health risks (increased risk of heart disease, breast cancer, stroke and pulmonary embolism) to participants outweighed the possible benefits.

While the study found that HRT does reduce the risk for fractures and colorectal cancer, the researchers concluded that the balance of harm versus benefit does not justify any woman beginning or continuing to take estrogen plus progestin exclusively for this purpose. Therefore, non-hormonal therapies and strategies for treatment of osteoporosis and prevention of colorectal cancer should be considered, respectively.

Recently, the 2008 reanalysis of the study concluded that hormone therapy is associated with increased risk of stroke regardless of age at which HRT started.

Although the associated risks were only reported for conjugated equine estrogens and synthetic progestin, many practitioners refrained from prescribing bio-identical and natural forms of the hormones as well.

Bio-identical Hormones
Bioidentical hormones share the exact same molecular structure as the hormones in our body. Since bioidentical hormones are not as profitable as their synthetic counterparts, there have been few large, well-designed studies to evaluate the risks and benefits of bio-HRT. More studies like the Women’s Health Initiative are needed to evaluate the safety and possible risks of bio-HRT. Although the exact risks for every woman using natural hormones are not known, the results of studies that have looked at bio-HRT thus far does not appear to show the same side effect profile as conventional HRT — particularly transdermal forms. HRT either conventional or bioidentical is not for everyone. Women who are interested in hormone therapy should discuss their individual risks for breast cancer, heart disease and stroke with their health care provider.

Natural Alternatives
The goals of treating menopause with an alternative approach are to provide symptomatic relief from common menopausal complaints and to prevent conditions such as heart disease and osteoporosis that increase in prevalence as a woman ages. A natural approach to treatment involves the following:

• Dietary recommendations: to help the body adequately metabolize estrogen.
• Exercise regimen (Aerobic and Resistance-Training): The risk of coronary artery disease rises dramatically in postmenopausal women.
• Aerobic exercise provides cardiovascular benefits and reduces menopausal symptoms.
• Resistance-Training protects against osteoporosis and fractures by increasing muscle strength and building bone.
• Stress Management: To help balance the hormone regulating system of the body (hypothalamic-pituitary-adrenal axis).
• Nutritional supplementation: To provide the body with adequate nutrition for prevention of developing heart disease, osteoporosis and cofactors needed for better mental function.
• Botanical therapies: Herbal preparations to help alleviate menopausal symptoms and provide active components for improved hormonal regulation.

Bio-identical hormone therapy should be the last step in the treatment of menopausal symptoms. When diet and lifestyle changes, nutritional supplements and botanical medicine are not enough to significantly effect menopausal symptoms, natural hormone therapy can be utilized. The dose and form of hormones should be determined based on the risk factors and unique needs of each menopausal woman.

It is important to recognize that each individual woman has a unique set of risk factors based on her family history, diet and lifestyle, past medical history, gynecological history, and other current medical conditions for which she is undergoing treatment. The most optimal treatment and prevention plan should be based on a comprehensive health history, physical examination, laboratory testing and assessment of risk factors, as well as a discussion with your healthcare provider about all the options (conventional and alternative) available and which ones are most likely to provide you the most benefit.

To find out about the health plans offered at Ocean Pacific Integrative Health Center, please call our office at 760-944-9300 or visit our website at http://opintegrativecenter.com.

Reference (detailed information available upon request)
NIH; JAMA (Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women); JAMA ( Health Risks and Benefits 3 Years After Stopping Randomized Treatment With Estrogen and Progestin) ; Women’s Encyclopedia of Natural Medicine. (Tori Hudson).