Menopause: A Discussion of Options

Nearly fifty million American women should be investigating the present options available for countering the effects produced by the permanent loss of their bodies' most potent anti-oxidant--estrogen.

Aging, cancer, and degenerative disease result when the body cannot handle or eliminate safely all the toxic breakdown products of cellular metabolism--products now called free-radicals--which act like cut electrical wires whose sparks disrupt or damage whatever they touch. Anti-oxidants are needed to neutralize or turn off the free-radicals.

The menopause should not be viewed as a new disease that must suddenly be treated but rather as a time when the life-long invisible battle between the free-radicals and the anti-oxidants turns in favor of the free-radicals. Thus, the question for any woman cannot be "should I do anything about my loss of estrogen?," but rather the question should be: "What are my menopausal options?"
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Estrogens Hormone Replacement Therapy (HRT)

Replacing the ovarian hormones, a treatment approach called "hormone replacement therapy (HRT) is not always possible, safe, or desired by the woman herself. Even the use of synthetically-derived, natural hormones, that is, hormones that are identical to the ovarian hormones, demands a scrupulous attention to detail on the part of the woman and the health-care provider.

Despite the proven benefits, most women reject or abandon hormone replacement therapy (HRT), as unproven, unsafe, or too complicated. Besides the justifiable fear of breast cancer and of side effects (like the return of menses), women (and many of their physicians) remain confused or ignorant about which hormonal preparations are best for them. Finally many women cannot find a healthcare provider who has both the knowledge and the commitment needed to reduce the inherent risks.

As a clinician with four decades of experience, I know that guiding a woman through the decisions she has to make and remake, year after year, when she selects hormonal replacement approach, is a daunting task.²
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An Alternative to Hormone Replacement Therapy

Phyto-estrogens, that is, plant estrogens should be able to provide many of the actions of natural estrogens. The miracle of these phytoestrogens is that even though they act physiologically like the natural estrogens produced in the body, they accomplish nature's purpose with absolute safety. Harmful side effects are avoided because plant estrogens are 100-500 times less potent in their estrogen effect. Despite their "weakness" relative to ovarian or ovarian-like estrogens, plant estrogens help insure that the body's estrogen level never gets too high or too low by acting as anti-estrogens when the body's own natural levels are high, and acting as estrogens when the body's own estrogens are gone. Perhaps almost as important, plant estrogens strongly and effectively prevent the toxic estrogens found primarily in animal fats from attaching to the human body's myriad estrogen receptors and causing harm. Thus nature has provided an antidote for the sea of toxic estrogens in the environment, by putting good estrogens in many different foods, and especially in soybeans and red clover, the two most abundant legumes on the planet Earth. While soy has two of the four known "strongly estrogenic" isoflavones, red clover has all four. See our extended discussion of estrogens below for more information.
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GENERAL HEALTH SUGGESTIONS

As a woman ages, her continued health depends more and more on a planned health program with several key components. ³

• A planned program of regular exercise is probably the most important commitment a woman can make to her present and future health. With such a program, every other component of one's health plan seems to become easier and more effective. While achieving "fitness" (for example, being able to walk 3.5 miles per hour three hours per week in 30-60 minute segments) is usually much more important that what one weighs, the amount of adipose tissue at our waist is directly related to the risk of breast cancer, high blood pressure, strokes, heart attacks and diabetes, among many other problems.
• Regular checkups and testing is a must, even when one has "no health problems." This includes annual mammograms and a lipid profile of all cholesterol fractions with follow-up as indicated. By age fifty, a DEXA scan of spine and hips to assess one's status relative to osteoporosis is an excellent idea. If possible, a colonoscopy should be done at age fifty to rule out polyps in the large bowel. This exam should be done at age forty if a parent or sibling had bowel cancer.
• Good nutrition is essential for health and well-being. Excellent books are available 4 if your health care system does not provide you with up-to-date lists of foods high in phyto-nutrients and fiber and low in toxins and harmful fats and proteins.

Because the foods we eat could never provide all the vitamins, minerals, and other nutrients we now know are necessary for best health at the menopause and beyond, NUTRITIONAL SUPPLEMENTS are vital. While PHYTO-ESTROGENS are the most important nutritional supplements for women, especially when ovarian estrogens are lost, the following other supplements are also vital: VITAMINS AND MINERALS, ESSENTIAL FATTY ACIDS, HERBS and ACCESSORY NUTRIENTS, and PROBIOTICS and DIGESTIVE ENZYMES.
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SUMMARY; NUTRITIONAL SUPPLEMENTS FOR THE MATURE WOMAN

1. Phyto-Estrogens.

That is, plant estrogens. Happily, nature has provided an antidote for the "sea of toxic estrogens" in the environment by putting good estrogens in many different foods, and especially in soybeans and red clover, the two most abundant legumes on the planet Earth.

2. Vitamins and Minerals.

The Fat-Soluble Vitamins (A, D, E) and the Water-Soluble Vitamins (C, B1 or Thiamine, B2 or Riboflavin, B3 or Niacin, B5 or Pantothenic Acid, B6 or Pyridoxine, B12, Folic Acid, and Biotin.

The carotenoids like lycopene or beta-carotene perform some of the various anti-oxidant functions of Vitamin A itself. Unlike Vitamin A, supplementation with very high doses of the carotenes does not produce any significant toxicity.

Since our bodies produce Vitamin D by the action of sunlight on the skin, it should perhaps not be considered a vitamin but rather a very important hormone.

Vitamin K is a Fat Soluble Vitamin that is generally not needed in vitamin supplements as it is found in virtually any leafy green vegetable.

Biotin for strong nails and healthy hair, aids in the treatment of diabetes, and when used in conjunction with the entire B-complex, aids in the treatment of seborrheic dermatitis

At least 18 Minerals are important in human nutrition. More than 100 milligrams are needed daily of the Major Minerals: Calcium, Phosphorous, Potassium, Sulfur, Sodium, Chloride, and Magnesium.

Calcium supplementation is probably important throughout a woman's life but is especially important in preadolescent and growing children, pregnancy and lactation, in the peri-menopause and in all the decades thereafter. Calcium Citrate Maleate is a highly bioavailable form of calcium.

Magnesium supplementation is also a good idea in all adult females.

The need for less than 100 milligrams per day designates a Minor, or Trace, Mineral: Boron, Chromium, Copper, Iodine, Iron, Manganese, Selenium, Silicon, Vanadium, and Zinc.

Many individuals in this country have marginal zinc deficiency, especially the elderly. Zinc is essential to health. Zinc supplementation in pregnancy has been remarkably beneficial. Zinc deficiency is probably a factor in the development of Alzheimer's disease.⁵

Selenium is a very important anti-oxidant. Chronically low selenium levels in the diet are associated with an increased risk of cancer, heart disease, and immune disorders.

Copper deficiency may be a major risk factor in atherosclerotic vascular disease, especially if this deficiency results in high LDL and low HDL levels.

Human Manganese deficiency may result in a skin rash, loss of hair color, problems in bone remodeling, reduced growth of hair and nails, and reduced levels of good (HDL) cholesterol. Low manganese levels have been associated with epiplepsy and an increase in seizures.

The primary sign of Chromium deficiency is glucose intolerance with high blood sugars and high insulin levels. Chromium can increase lean muscle mass, which means greater fat-burning potential.

Molybdenum is the final trace mineral that might need supplementation. Deficiency of Moybdenum can interfere with the detoxification of sulfites and of alcohol. In areas where the level of this trace mineral is low, the incidence of tooth decay increases significantly. In the United States, the incidence of esophageal cancer is increased 30% in those areas where this trace mineral is missing from the drinking water.

Boron is a trace mineral now believed to be essential in maintaining healthy bone and joint function. Fewer than 10% of Americans get the recommended two servings of fruit and three servings of vegetables per day that would ensure sufficient dietary boron.

3. Essential Fatty Acids.

Probably four of every five Americans consume an insufficient quantity of the essential omega-3 fatty acid, alpha-linolenic acid, which results in deficiencies as high as 90%. Such deficiencies can result in fatigue, dry skin, and dry mucous membranes (mouth, vagina, tear ducts), dry hair, cracked nails, depression, forgetfulness, aching and sore joints with arthritis, as well as a host of others problems.

It is now known that the deficient fatty acid is almost always the omega-3 fatty acid. In fact, if there is too much omega-6 fatty acids in the body, the production of good prostaglandins and their hundreds of health-enhancing qualities is decreased. Thus, in long-term supplementation, omega-3 fatty acids, for example, eicosapentanoic acid (EPA) and docosahexoic acid (DHA), are definitely preferred over omega-6 supplementation, for example, gamma-linolenic acid, or GLA. Thus flax seed or fish oil is definitely preferable to oil of evening primrose or borage oil as a source of essential fatty acids.

4."Herbal" Supplements and Accessory Nutrients.

Ginkgo Biloba extract is the most frequently used herb. Works best when used with the omega-3 fatty acids, 800 mcg. of folic acid, 800 mcg. of vitamin B12, and 1000 mg. of Vitamin C daily. Properly used, Ginkgo Biloba improves depressive symptoms, memory and behavior. If use is continued for several months, circulation to the hands and feet, which is often a problem as women age, is usually noticeably improved.

Gamma-Oryzanol has been officially used for about forty years for the treatment of menopausal symptoms like hot flashes, anxiety, irritable bowel, and nausea, and to reverse the post-menopausal elevations of cholesterol and triglycerides. It is also said to increase the level of good cholesterol.

Over 4000 Flavonoids have been isolated, chemically characterized, and classified. Their medicinal actions include anti-viral, anti-allergic, anti-inflammatory, and anti-cancer effects. The group of flavonoids called the proanthocyanidins (PCO) are potent antioxidants and free radical scavengers, that can act like Vitamin C in water-soluble environments, and like Vitamin E in fat-soluble environments. However, their anti-oxidant activity is 50 times more potent than those two vitamins. Grape seed extract contains PCO. Quercetin is a flavonoid that is used primarily for its anti-inflammatory properties, and that probably works best when combined with bromelain, an extract of pineapples. Hesperidin and green tea extract are the other classes of flavonoids. Red wine extract should be included in any nutritional supplement, especially one designed for older American women (who die of cardiovascular vascular disease more often than from all other causes combined) because the PCO (see above) in red wine have been shown in hundreds of recent clinical studies to prevent the atherosclerotic changes in blood vessels leading to heart attacks and strokes. Tumeric (Curcumin) is another flavonoid and anti-oxidant that has shown significant health benefits in clinical studies involving both animals and humans. When combined with pepper, tumeric's anti-inflammatory effect against arthritis is said to be enhanced.

Preventing cardiovascular disease is also part of the rationale for including Magnesium Taurate, a complex of the major element Magnesium and the amino acid Taurine, in a nutritional supplement for women. Twenty percent of our population have an genetic defect in apolipoprotein E synthesis that increases their risk of atherosclerosis. The risk can be significantly reduced by adding Folate, Vitamin B6, Vitamin B12, Selenium, Magnesium, and Taurine to the diet. Taurine can also help protect against retinal diseases, and to prevent ulcerations of the stomach caused by ibuprofens and other non-steroidal anti-inflammatory drugs (NSAIDS). Like Coenzyme Q 10 , Taurine is a powerful anti-oxidant that may also be useful for treating congestive heart failure.

Alpha Lipoic Acid (ALA) is a coenzyme (similar in function to a vitamin) that increases the burning of fat for energy rather than the storage of fat in fat depots. Equally important, ALA is a potent anti-oxidant that can inhibit the oxidation of cholesterol and other fats in the blood, arteries, and heart muscle. It also helps to regenerate Vitamins C and E. Alpha Lipoic Acid also prevents a toxic combination of glucose and protein that accelerates aging.

Inositol is included on the list of "unofficial vitamins" because supplementing the diet with inositol has been found beneficial in the treatment of liver disorders, depression and panic disorders, and diabetes.

5. Probiotics and Digestive Enzymes.

It has been known for nearly a century that eating fermented foods containing "friendly bacteria" has important nutritional and therapeutic benefits. Potentially toxic bacteria are also present in the Gastro-intestional tract. Anti-biotics, whether prescribed by physicians or obtained as contaminants of our foods can adversely affect the balance of good and bad bacteria, not just in the intestines but also in the urinary tract and in the female reproductive tract, especially the vagina. Adding friendly bacteria to a nutritional supplement can, by a variety of different mechanisms, markedly improve health.

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A SAFE AND SIMPLE ALTERNATIVE FOR MENOPAUSE

Menopausal symptoms and signs are not inevitable because "hormonal replacement" can be accomplished without drugs. All the phytonutrients a mature woman needs, including the plant-estrogens, are available from the new nutritional supplement, SYNERGY 3000 WOMEN. To buy this and hundred's of other quality supplements at wholesale prices, check vitacost.com

Other Herbs Traditional Used For Hormonal Symptoms

The four most useful herbs in the treatment of hot flashes have been angelica (Dong quai or Angelica sinensis), licorice root (Glycyrrhiza gabra), black cohosh (Cimicifuga racemosa), and chasteberry (Vitex agnus-castus). The beneficial effects of these herbs is not due exclusively to their phytoestrogen action, that is, their ability to act as anti-estrogens when the body's estrogen level is too high, and to act as estrogens when the body's estrogen are gone.

The use of dong quai is probably second only to ginseng in Asia, being used not only for the menopause but for PMS-like problems, painful periods and for abnormal menstrual bleeding patterns. Its effectiveness in relieving hot flashes may be a combination of dong quai's mild estrogen effects coupled with other components that act to stabilize blood vessels. Recent controlled studies at several traditional medical clinics have failed to find any difference from placebo when dong quai is used alone. The orientals use this herb in combinations with other herbs, which may explain the difference results.

Licorice root, besides its use in treating the menopause, is reputed to be especially useful in PMS because of a estrogen-lowering effect and a progesterone-raising effect. Licorice also helps PMS by blocking the adrenal hormone, aldosterone's salt-retaining actions. Too much licorice can cause anti-diuretic effects and even cause high blood pressure.

A standardized extract of black cohosh called Remifemin has been safely and effectively used for menopausal symptoms by many millions of women, especially in Germany originally but in recent years throughout the world. Originally approved by the German Commission E (which regulates, recommends, or approves herbs for medical uses) for use up to six months, animals studies and clinical results in thousands of users who have ignored the treatment limitations has made long-term treatment of the menopause with remifemin, an acceptable option. ⁶ The use of one-half the menopausal dose of black cohosh, that is 20 mg./day is recommended for the treatment of PMS.

Chasteberry is the preferred herb in Germany for treating PMS. It appears to work at the level of the hypothalamus and pituitary gland, which control the level of those hormones involved in menstruation, lactation, and reproduction. Chasteberry seems to be able to normalize the production of the hormone prolactin, which not only effects the breast, but which also controls the estrogen-progesterone ratio. Thus chasteberry would seem to be the preferable herb if a woman had breast pains or menstrual irregularities, while dong quai would be preferable for treating painful periods.

BIBLIOGRAPHY

¹. Haas, Robert. Permanent Remissions: Life-extending Diet Strategies That Can Help Prevent and Reverse Cancer, Heart Disease, Diabetes and Osteoporosis. Pocket Books:New York (1997) Chapters Three and Four.
². Schaller, James A. It's Your Life: A Gynecologist Challenges You To Take Control. Blue Dolphin: Nevada City, CA. (1999). (revised.)
³. Schaller, James A. Ibid, and Becoming the Husband Your Wife Thought She Married: It's Your Life, Too, Man. Blue Dolphin: Nevada City, CA. (2000.)
⁴. Crawford, Amanda McQuade. The Herbal Menopause Book: Herbs, Nutrition and the Natural Therapies. The Crossing Press: Freedom, CA. (1996.) Also references #1 and #5.
⁵. Murray, Michael T. Encyclopedia of Nutritional Supplements..Prima Health: Rocklin, CA. (1996.) Pg. 181-189.
⁶. Murray, Michael T., and Joseph Pizzorno. Encyclopedia of Natural Medicine. Prima Health: Rocklin: CA. (1998.) (revised-2nd Ed.) Pg. 641.

ALSO RECOMMENDED:

Blumenthal, Mark. (ed.) The Complete German Commission E Monographs: Therapeutic Guide To Herbal Medicines. American Botanical Council, Austin, TX & Integrative Medicine Communications: Boston, MA. (1998.)

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A more detailed discussion of estrogen follows below for people who desire a greater amount of detail.

KINDS OF ESTROGEN

Anyone who has researched the literature on women's health, could not fail to be struck by the incredible amount of debate among professional and lay men and women, both inside and outside of medicine, on the subject of hormones, and most specifically the hormone, estrogen. No other health subject has seemed to engender such strong and conflicting feelings, emotions, and press, or to get as much time and attention.

Tragically, what is lost amidst all the fighting and political maneuvering is the fact that it is impossible for any woman to avoid all forms of estrogen even if she gives such avoidance her first priority. It is not surprising that estrogen should be everywhere in nature, since almost every cell of our bodies, in both males and females has not one kind of estrogen receptor, but two. For example, there are billions of estrogen receptors in the brain and on the coronary arteries, which protect us when properly stimulated from senility and from heart attacks.

1. Estrogens Produced Within the Human Body. Estradiol, estrone, and estriol are the natural female sex hormones. The first two are convertible within the tissues, but estradiol has 3x the affinity for estrogen receptors as estrone. Estriol is a very weak estrogen, and is reputed to be protective against breast cancer in the same way phyto-estrogens are, that is, they keep the stronger estrogens from attaching to the estrogen receptors.

Estrone is produced primarily from the conversion of androgenic (male-like) hormones from the ovaries and adrenal in many body tissues, but especially in the fat cells. The largest percentage of conversion occurs in the adipose tissue around the waist. The post-menopausal ovary produces no estradiol, although the androgenic hormones can be converted to estradiol in some tissues. The chief post-menopausal estrogen is estrone. The level of this hormone in a post-menopausal woman depends on the amount of adipose tissue available for conversion of adrenal androgens, and, of course on the adrenal glands ability to continue to make androgens. Natural Estrogens can be synthesized from wild yams. Progesterone is also made from wild yams. Conjugated Estrogens, the hormones used in over 90% of past hormone replacement regimes, can now also be synthesized from wild yams. Previously, these longer acting estrogens could only be obtained from the urine of pregnant mares. Wild Yams creams have no hormonal value. The steroids, or hormonal precursors, in wild yams must be processed chemically to convert them to estrogens and progesterone.

2. Xeno- (toxic) Estrogens. There are two categories of estrogen-like substances now found in nature. One--the phytoestrogens--are an incredible blessing to humanity, while the other--the xeno-estrogens and xenobiotics, or "foreign, toxic" estrogens--are a curse. These latter can mimic those undesirable effects of estrogen in the body that result when even "natural" estrogens are present in excessive amounts or are present without natural progesterone as a modifier. The toxic estrogens or foreign estrogen-like substances can also cause the body to metabolize its own natural estrogens in the most undesirable ways. For example, these toxins can change the breakdown products of the estrogen that results from the interaction of the adrenal stress hormones and the fat cells of the abdomen, increasing those breakdown products that can cause disease. The toxic estrogens or estrogen-like substances can be any environmental toxin or pollutant but most result from the interactions in the fat tissue of an animal's body with the antibiotics, pesticides, and artificial growth substances fed to poultry, cattle, and other animals by agribusiness and food producers. The resulting toxins are stored, as are most toxins in the human body, in the animal's fat tissues. Thus, the higher in the food chain a food is derived, the greater the level of contamination and the greater the risk of that contaminant producing degenerative disease or cancer eventually.

3. Phyto-Estrogens. Happily, nature has provided an antidote for the "sea of toxic estrogens" in the environment by putting good estrogens in many different foods, and especially in soybeans and red clover, the two most abundant legumes on the planet Earth.

While soy has two of the four known "strongly estrogenic" isoflavones, red clover has all four. The miracle of these phytoestrogens is that even though they act physiologically like the natural estrogens produced in the body, they accomplish nature's purpose with absolute safety because they are 100-500 times less potent in their estrogen effect.

Despite their "weakness" relative to ovarian or ovarian-like estrogens, plant estrogens strongly and effectively block out the toxic estrogens from attaching to the body's myriad estrogen receptors and causing harm. Perhaps almost as important, phytoestrogens help insure that the body's estrogen level never gets too high or too low. They act as anti-estrogens when the body's own natural levels are high, and act as estrogens when the body's own estrogens are gone.

With nature's remedy for estrogen deficiency there is total safety: no increased cancer risks, no blood clots, no pulmonary emboli, and no cataracts. Rather than cause uterine or breast cancer, they prevent such cancers by blocking the estrogen receptors in the breast and womb. Thus, neither the abnormal estrogens produced in the fat tissues, nor those contained in the animal fats that are eaten, can induce changes leading to cancer. In addition, plant estrogens don't just slow the progression of osteoporosis, they actually stimulate the production of bone. They lower bad cholesterol and raise the level of good cholesterol and in at least three other ways prevent cardiovascular disease (that kills more American women than all other causes combined). They prevent bowel and prostate cancer by preventing the formation of the carcinogens that most commonly trigger the pre-cancerous changes. They provide brain cells the same protection as estrogen does from damage due to lack of oxygen.

For clear proof of estrogen's importance to the human female of the species one only has to look at what happens when a cancer that can effect both boys and girls, occurs between six months of age and nine years--the only interval when estrogen in girls is essentially absent. These are the only years in which boys/men survive those cancers common to both sexes more often than girls/women survive them

4. "Designer" Estrogens--"Nolvadex" and "Evista." A whole new class of drugs is being developed to treat or prevent the health problems produced by too much or too little estrogen, or too many toxic estrogens. Called Selective Estrogen Receptor Modulators (SERMS), they act as weak estrogens in somewhat the same fashion as natural plant estrogens do. Unfortunately, none developed so far can duplicate the safety of plant estrogens.

Evista (raloxiphene) is used for the prevention and treatment of osteoporosis. It shows promise in lowering a women risk for both breast cancer and cardiovascular disease. This drug can make hot flashes worse, produce leg cramps, and can give rise to serious blood-clotting problems with the same incidence (at least) as the birth control pills. Besides the increased risk of cataracts, thrombosis of the retinal vein, a serious complication, has been reported.

Nolvadex (tamoxifen citrate) has been used for a long time as part of the post-operative program for preventing breast cancer recurrence or for preventing the development of a new cancer in the other breast. It, too, has a favorable effect on the blood markers for cardiac risk. It is now being touted for use in preventing breast cancers in women who are judged to be at increased risk and also over 35 years of age,. An increased rate of uterine cancer is seen with this drug, especially in women over 50. Blood-clotting problems are also seen, as well as hot flashes, vaginal discharge, menstrual irregularities, and dyspareunia (painful intercourse), corneal changes or cataracts, or decreased color perception.
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BOTH SIDES IN THE DEBATE

For fifty years, there have been avid proponents for Hormone Replacement Therapy and just as passionate dissenters. Both groups have been partially right and partially wrong, with the patient often having paid a price for our ignorance. Those of us who have long viewed the cessation of periods as final evidence for a deficiency disease we called ovarian failure, as well as those on the opposite side of the fence who insisted that menopause was an inevitable, universal, and natural event that can become traumatic only if women are valued exclusively for their youth and beauty, have each missed a very important part of the truth.

Opponents of HRT miss this part of the truth: Unless a woman's daily diet contains up to fifty times more estrogen than the typical American diet she will probably become estrogen deficient sometime between 40 and 70 years of age--a deficiency for which she is probably going to pay a high price. Estrogen is a most potent anti-oxidant and scavenger of free radicals, whose greatest importance derives from the fact that it is active in virtually every cell of a woman's body to prevent cellular damage and enhance function.

Proponents for HRT miss this part of the truth: demographic studies correlating HIGH dietary intake of plant estrogens with the incidence of those diseases HRT is given to prevent, show equal or better protection without the risks of HRT.