Naturopathic Newsletter May 2009: MENOPAUSE

May 2009

UPCOMING LECTURES & WORKSHOPS 

Sunday May 17th at 12pm, I will be interviewed on CJAD 800AM to answer the numerous questoins women have about menopause and bio-identical hormones.

I have been invited as a guest on the Ecolibrium radio show hosted by Ryan Young MAY 19th to discuss naturopathic medicine. Tune into 90.3FM at 11am.

I would like to take this opportunity to share an exciting development in my professional life. I have been invited to be part of the health team at Millennium Health Center in Cornwall, Ontario. I am visiting with patients on Fridays, and I look forward to all the new and exciting experiences that this projects continues to bring.

www.millenniumhealthcenter.com

Working with women at all stages of their hormonal development from puberty to fertility to menopause is an integral part of my daily practice. In doing this work with women, it has become apparent over the years that women use the words perimenopause and menopause without necessarily having a clear understanding of what these words define.

Menopause can be used to describe a woman who has not had a menstrual period in the past year. This is due to a significant decline in ovarian function where estrogen production, and thus follicle maturation, has ceased. The average age is 51.4 years old. 

Perimenopause is the period of time prior to menopause where hormonal changes are causing changes in the menstrual cycle, often resulting in shortened cycle lengths. The first hormonal change to occur is variation in progesterone levels, followed by the decline in estrogen. This period of time can come with or without symptoms, depending on the woman. The perimenopausal period can last months to years, again depending on the woman.

Some fascinating facts:

*I apologize for the facts being US

there are currently 42.2 million women in menopause,

another 6 million women will be added to that group in the next decade,

by 2015, nearly 50% of women will be menopausal

Depending on the individual case, a woman can experience any combination of the following symptoms during the perimenopausal period or at menopause:

hot flashes

night sweats

insomnia

palpitations

depression

anxiety

loss of memory

cognition

vaginal dryness

urinary incontinence

decreased libido (sex drive)

acne

facial hair

hair loss

Conventional hormone replacement therapy (cHRT) consists of proprietary mixtures of conjugated equine estrogens (equine sources are from the urine of mares, as used in Premarin), as well as progestins that, while not progesterone, approximate its effects. Exampls of cHRT include:

Premarin

Prempro

Estraderm

Micronor

Provera

Cenestin

etc...

Studies have shown that certain risks are associated with these combinations of progestins and equine estrogens, for example:

· 2 trials published in the Journal of the American Medical Association in July 2002, regarding post-menopausal use of hormone replacement therapy

· HERS II study found that women who already have heart disease and commenced HRT experienced an increase in strokes and clots within the first year.

· Conclusion of HERS II was that "postmenopausal hormone replacement therapy  should not be used to reduce the risk of CHD events in women who already have     CHD" JAMA 2002;288:49-66{Parts 1 and 2)

· The WHI trial, which was supposed to last 8 years was stopped after 5.2 years, as the overall health risks exceeded the benefits.

·  Conclusion of WHI was that HRT "should not be initiated or continued for primary prevention of coronary heart disease" JAMA 2002;288:321-333

As a result of these studies, the National Institute for Health in the United States has concluded "long term use of estrogen and progestin increases a women's risk of a stroke by 41 percent heart attack by 29 percent and breast cancer by 24 percent". Clots were also found to increase by 100% in these studies as well.       

Dr. Salim Yusuf M.D. of McMaster University, a physician involved in the study stated "... we have never had good data that HRT prevented heart attacks or strokes, but people extrapolated based on some mechanisms".

Since the reults of these studies have been published, the use of cHRT has decreased by half. However, 38% of postmenopausal women in the US continue to use cHRT. 

Bio-identical hormones (BHRT) has become all the rage with media coverage by advocates such as Suzanne Somers and Dr. Oz. First and foremost of importance is to ensure that we have a clear understanding of what BHRT is all about.

BHRT is biochemically and molecularly identical to the human hormone form AND has been derived from plant sources. Via enzymatic reactions, the various estrogens (estradiol, estriol, estrone), progesterone, and even DHEA and testosterone, can be extract from soybean, as well as from Mexican wild yam.  

The big question is what is the difference between the synthetic cHRT and the naturally sources BHRT?

Natural hormones are identical to ours and match the hormone molecules produced by our own ovaries and adrenal glands. Synthetic hormones do not match our hormonal structure, arguably contributing to the short and long term effects of cHRT. The assertion further goes that women may metabolize these foreign hormones differently, taxing their metabolic pathways and producing more harmful metabolites and interactions with their own physiology. Foreign hormones may be excreted more slowly and, by lingering in the body longer, they may have an opportunity to affect recpeto sites negatively. The understanding is that natural hormones would have a far less taxing effect, yielding fewer, if no, short and long term effects. 

However, this statement remains speculation, as reseach and clinical trials in the area of BHRT is lacking. Funding needs to be put into such research, because women are using BHRT, and we need to know the facts.  

Although my office phone has been ringing with inquiries about BHRT, I educate women that BHRT is the last route of recommendation. There are NUMEROUS interventions that can be applied with overwhelming success before the options of BHRT needs to be entertained. As a Naturopathic Doctor, it is my pledge to use therapies that are the least invasive to produce the greatest outcome; less is often more.

Before considering BHRT, I will educate my patients on the following interventions:

1. lifestyle, including diet and exercise

2. nutritional supplements, such as certain vitamins and minerals

3. botanical medicine, the use of medicinal plants

These options is will discussed in June newsletter: MENOPAUSE - PART II