The Natural Management of Menopause

by Dr. James Meschino, D.C., M.S., R.O.H.P.

As the population ages, practitioners are frequently being asked by their female patients who are reaching the 45 plus age group, about the pros and cons of available menopausal management interventions. In helping patients arrive at a prudent course of action primary contact practitioners should be informed as to the current state of knowledge regarding the available choices.

In today’s world, women live one-third of their lives in the postmenopausal years. Helping them maximize their quality of life and lifespan should be the intent of our recommendations, which should be made on a case-by-case basis. Three major health concerns facing the postmenopausal woman include breast cancer, osteoporosis and heart disease and these concerns are well-founded:

• Heart disease is the number one killer of postmenopausal women
• Osteoporosis affects one in four women by age 50
• Breast cancer incidence rates have increased by 40% in the last 50 years with one in every 403 women afflicted between ages 50-59, one in 266 women afflicted between ages 60-69 and one in 220 women afflicted at age 70 and over.

In addition to these devastating conditions, the decline in estrogen production in menopause triggers a broad range of physical, psychological and age-related signs and symptoms that can be distressing to the woman involved.

Some doctors prescribe estrogen replacement therapy (often in conjunction with progesterone) to help manage menopausal symptoms and cut the risk of heart disease, osteoporosis and ovarian cancer. However, for each year that a woman is on estrogen replacement, she has a 2.5% increased risk of developing breast cancer vs. an age-matched control not on estrogen replacement. Thus, after 10 years of ERT, she has a 25% increased risk and, after 20 years, a 50% greater chance of developing breast cancer than an age-matched control woman who has not taken ERT for the same 10 or 20 years. Needless to say, this is a serious dilemma faced by both doctors and patients.

In the world of natural medicine, experts suggest that if a woman is showing signs of moderate to advanced bone loss and/or significant cardiovascular risk factors, then estrogen replacement may be warranted. If a woman enters menopause and is otherwise free from these problems, then a more natural approach may be all that is required to ease menopausal symptoms and reduce risk of degenerative diseases. General advice includes following a low-fat diet, exercise and acquiring sufficient bone-building nutrients such as calcium, vitamin D, magnesium, zinc, silica, protein, etc.

In addition, other nutritional factors appear to be of great importance to the menopausal woman. For instance, the regular ingestion of soy products in Asia has been attributed, in part, to the lower risk of breast and female reproductive cancers in these countries. In fact, there is a 75% lower incidence of breast cancer among Asian women who follow traditional dietary practices. Investigation into soy isoflavones (phytoestrogens) suggests a number of possible protective influences including antioxidant properties, slowing cell proliferation, reducing the build-up of more dangerous estrogen by blocking aromatase activity and blocking the ability of the more dangerous estrogens from entering breast cells as easily. Isoflavones have been shown to reduce menopausal symptoms, support hormonal function, help maintain bone density and lower blood cholesterol.

Gamma-oryzanol has also been shown to lower cholesterol and triglycerides and successfully manage the symptoms of menopause, especially hot flashes.

The natural management of menopause should include attention to soy products and possibly a concentrated form of soy isoflavones from a dietary supplement.

With respect to supplementation and the natural management of menopause, the most widely used and thoroughly studied approach involves the herbal agent known as black cohosh (cimifuga racemosa), standardized to 1 mg of triterpenes.     Four major human studies have demonstrated the ability of black cohosh to help manage menopausal signs and symptoms. In the first study (open study) involving 131 doctors and 629 female patients, 80% of patients experienced improvement of physical and psychological symptoms within 6 to 8 weeks. Significant improvement was noted in the following symptoms:

• Hot flashes
• Profuse sweating
• Headache
• Vertigo
• Heart palpitations
• Tinnitus
• Nervousness / Irritability
• Sleep disturbances
• Depressive moods

Only 7% of patients reported mild transitory stomach complaints.

A second study (controlled study) compared the effects of black cohosh to estrogen replacement therapy (0.625 mg C.E.E.) or diazepam (2 mg) for 12 weeks. Black cohosh out-performed both Premarin (C.E.E.) and Valium (diazepam) using the Kupperman Menopausal Index.

This index is one of the most utilized assessments in clinical studies of menopause. This quantitative assessment of menopausal symptoms is achieved by grading in severity:

Severe = 3
Moderate = 2
Mild = 1
Not present = 0

After grading each symptom, the total score is achieved by adding all of the symptom scores together. Symptoms assessed are:

• Depressive moods
• Feelings of Vertigo
• Headache
• Heart Palpitations
• Hot flashes
• Joint Pain
• Loss of Concentration
• Nervousness / Irritability
• Profuse sweating
• Sleep disturbances

The third study (double-blind) compared the effects of black cohosh to estrogen replacement therapy (0.625 mg C.E.E.) or a placebo for 12 weeks. In this study, black cohosh produced better results in controlling menopausal symptoms (Kupperman Menopausal Index), the Hamilton Anxiety Test, and produced greater improvement in the vaginal lining than estrogen or the placebo. In the black cohosh group, the number of hot flashes per day dropped from an average of 5 to less than 1. In the estrogen group, this number dropped from 5 to 3.5 hot flashes per day on average.

In a fourth study (double-blind) black cohosh was compared to a placebo in a study following 110 women. The black cohosh group demonstrated significant improvement in menopausal symptoms and blood hormone measurements. In addition to relieving hot flashes, it once again produced impressive age-reversal results on the vaginal lining as confirmed by vaginal smear analysis.

Since 1956, over 1.5 million menopausal women in German have used black cohosh extract with great success and without side effects. Physiologically, black cohosh extract appears to mimic the effects of estriol, which is an estrogen made by the body. Estriol is a weaker form of estrogen than estrone or estradiol and is not associated with an increased risk of reproductive cancers. Like other forms of estrogen, estriol helps to maintain bone density and aids cholesterol removal from the bloodstream. Black cohosh extract has also been shown to inhibit the over-secretion of leutinizing hormone (L.H.), providing proof of its estrogen-like properties. To help practitioners deliver the most optimal dosage and standardized grades of these important nutrients that have been shown to support female health and well-being, Nutra Therapeutics recently introduced the Women’s Hormonal Support formula which contains (per two capsules):

1. Black cohosh extract – 160 mg, yielding 4 mg of triterpenes
2. Soy extract – 500 mg, yielding 50 mg of soy isoflavones
3. Gamma-oryzanol – 300 mg

This product can be used by low-risk menopausal women as a viable alternative to estrogen replacement therapy (monitoring of bone density and blood lipids should be performed periodically), and by women who have contraindications to estrogen replacement therapy. (fibrocystic breast disease, endometriosis, uterine fibroids, liver or gallbladder disease, a history of cancer, pancreatitis or unexplained uterine bleeding.) As well, women taking estrogen replacement can also use this product for general nutrient support to acquire important isoflavones and related phytoestrogens.

Due to the bothersome side effects and fear of breast cancer, less than 20% of North American women are currently using estrogen replacement therapy. Through guidance directed at nutrition, exercise and supplementation, health practitioners can greatly influence a woman’s quality of life and health risk profile during the menopausal years. These principles of natural menopausal management are often overlooked by traditional medicine and thus, it is incumbent upon holistic practitioners to enlighten their female patients in regards to these matters.

Doctor’s Notes

This product is appropriate:

1. As a natural alternative to estrogen replacement for postmenopausal women with normal bone density and cholesterol values.
2. As an important source of phytoestrones and phytonutrients for women of all ages to help reduce the risk of female-related diseases
3. As a supplement for women with PMS, fibroids, endometriosis and fibrocystic breast disease
4. As an alternative for women with contraindications for estrogen replacement therapy (see article)
5. As a dietary adjunct to estrogen replacement therapy or the birth control pills.

References

Black Cohosh References

• Stolze, H: An alternative to treat menopausal complaints. Gyne 3:1416,1982
• Warnecke, G: Influencing menopausal symptoms with a phytotherapeutic agent. Med Welt. 36:871-4,1985
• Stoll,W: Phytopharmacon influences atrophic vaginal epithelium. Double-blind study — Cimicifuga vs. estrogenic substances. Therapeuticum 1:23-31,1987
• Schildge,E: Essay on the treatment of premenstrual and menopausal mood swings and depressive states. Rigelh Biol Umsch 18 (2):18-22,1964
• Bruker,A: Essay on the phytotherapy of hormonal disorders in women. Med Welt.44:2331-3,1960
• Murray,M: Remifemin:Answers to some common questions. AM J Natural Med. Vol.4 (3), April 1997
• Gorlich,N: Treatment of ovarian disorders in general practice. Arztl Prax. 14:1742-3,1962

Gamma-Oryzanol References

• Murase,Y et al: Clinical studies of oral administration of gamma-oryzanol on climacteric complaints and its syndrome. Obstet Gynecol Prac (12) 147-149,1963
• Ishihara,M: Effect of gamma-oryzanol on serum lipid peroxide levels and climacteric disturbances. Asia Oceania J Obstet Gynecol (10), 317, 1984
• Yoshino,G et al: Effects of gamma-oryzanol on hyperlipidemic subjects. Curr Ther Res (45), 543-552,1989
• Yoshino,G et al: Effects of gamma-oryzanol and probucol on hyperlipidemia. Curr Ther Res (45), 975-982,1989

Soy References

• Murkies,A L et al: Dietary flour supplementation decreases post-menopausal hot flashes: effect of soy and wheat. Maturitas (21), 189-195,1995
• Albertzazzi,P et al: The effect of dietary soy supplementation on hot flashes. Obstet Gynecol (91), 6-11,1998
• Cassidy,A et al: Biological effects of a diet of soy protein rich in isoflavones on the menstrual cycle of pre-menopausal women. Am J Clin Nutr (60), 333-340,1994
• Valente,M et al: Effects of 1-year treatment with ipriflavone on bone in postmenopausal women with low bone mass. Calcif Tissue Int 1994; 54:377-80
• Tsuda,M et al: The effect of ipriflavone on bone resorption in tissue culture. J Bone Miner Res 1986:1:207-11
• Patter,S M et al: Soy protein and isoflavones: their effects on blood lipids and bone density in postmenopausal women. Am J Clin Nutr 1998:68 (suppl) 137-9
• Dalais,F S et al: Dietary soy supplementation increases vaginal cytology maturation index and bone mineral content in post menopausal women Am J Clin Nutr 1998;68 (suppl) 1519 (abstr)
• Anderson J W et al: Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med 1995;333:276-82
• Messina,M: Legumes and Soybeans:overview of their nutritional profiles and health effects. Am J Clin Nutr 1999 Vol 70 (suppl); 439-50

Estrogen Replacement Therapy and Breast Cancer

• Colditz,G A: Relationship between estrogen levels, use of hormone replacement therapy and breast cancer. J Natl Cancer Inst 1998;90;11:814-823
• John Hopkins Medical Newsletter:Health After 50,Vol 11,Issue 9 (6-7 Nov,1999)
• Cancer and Nutrition. Simone, B. Avery Publishing Group Inc., 1992:219-23