Part One | Part Two | Part Three
By: Jean Johnson for Uterus1
In the first two parts of this series on ways to manage symptoms common to menopause, we focused on the basics of nutrition, activity and de-stressing. Indeed, according to sources as far ranging as the National Institutes of Health (NIH) and the Mayo Clinic these non-invasive approaches to wellness can go a long way toward maintaining vitality and enable women to navigate menopausal changes in a healthy, successful fashion.
Clearly when it comes to eating right, staying active and making time for relaxation from stressful lives, it’s easy to build a consensus regardless of whether the subject is menopausal symptoms, heart disease or cancer. It’s when we depart from the sphere of lifestyle changes and enter other realms, however, that traditional medical practitioners and those who ascribe to complementary and alternative approaches tend to diverge.
Since the 2002 Women’s Health Initiative study showed traditional hormone replacement therapy increased risks for heart disease and breast cancer, many women have consulted practitioners of complementary and alternative medicine in an effort to relieve symptoms associated with menopause.
| Things to consider when seeking menopause treatment:|
As the term complementary and alternative medicine (CAM) implies, the choice between a traditional mainstream physician and a CAM practitioner does not necessarily need to be an either/or one.
Most insurance companies will pay for a second opinion. Thus it’s possible to see practitioners on both sides so that you can evaluate which perspectives seem most compelling in your case.
Many large hospitals have what are often termed integrative medicine departments. These are generally staffed by medical doctors or doctors of osteopathy who by virtue of their positions must ensure that all approaches are backed by sound science. For those who are interested yet uncertain about the world of naturopathy and clinics devoted to alternative aims, integrative programs may provide a reassuring entry into this relative new area of complementary and alternative medicine.
So in an effort to provide the information this group needs to make informed decisions, the following discussion is balanced by information from both the traditional and complementary/alternative perspectives.
Herbal Supplements – Complementary and Alternative Perspective
“Once we’ve address the basic lifestyle issues, the next tier is herbs,” said Rose Paisley, N.D. a naturopathic physician at Nature Cures Clinic in Portland, Oregon. “Black cohosh, chaste tree berry, dong quai, licorice and other liver herbs, and Siberian ginseng to balance adrenal hormones.”
Paisley’s colleague at Nature Cures – Greg Eckel, N.D., M.S.O.M., who added a master’s of science in Oriental medicine to his naturopathy degree – has further thoughts on bringing herbs into treatment. “Red clover, Vitamin C bioflavonoids – there are a lot of options for women who don’t want to do hormone therapy. We have had lots of success with botanicals. Does it work for everybody? No. But a lot of women are pleasantly surprised.”
“The most widely-used herb is black cohosh, and there is some good research out there that points to its effectiveness. Clinically we get good results as well,” said Eckel.
Eckel, as well, is careful to say that black cohosh is not a cure all. “Again it doesn’t work for everybody. In alternative medicine, the best medicine is to tailor individually for patients.” The herb has also been in the news linked to liver damage. Click here to read more. Before taking any herb or medication it’s best to meet with your healthcare provider to discuss the best course of action for you.
He goes on to explain a fundamental difference between naturopathy and western medicine. “What we do is ask where estrogen and progesterone are getting produced and where they are getting broken down.”
Eckel notes, for example, that since estrogen and progesterone are stored in the fat, keeping fat off during menopause is an especially helpful thing to do, and he points out that assessing a woman’s health profile holistically is central to his work.
“Western medicine or symptom management is like trying to take all the leaves off the tree. The symptoms are the leaves, but by tracing symptoms all the way back down to the root is where we can really address the source of the problems,” Eckel said. “You have to change your mindset a little bit – ask questions like ‘What does a symptom mean?’”
Once naturopaths start doing that, Eckel suggests, hot flashes are understood in a more comprehensive manner and treatment can proceed in a way that helps restore health generally instead of simply addressing the symptom in an isolated way.
Paisley agrees. “That’s the goal of the naturopath. A patient walks in the door and says, ‘I want to deal with my hot flashes,’ but our goal is more complex than that. That’s why we spend an hour and a half with women on the first visit because we want to hear their story.”
Once Paisley and Eckel hear their patients’ stories, then they go through their paces. Address lifestyle factors and see what else might help.
Herbal Supplements – Traditional Perspective
The NIH is less certain about the beneficence of herbs and their ability to treat menopausal symptoms. In particular the State-of-the-Science paper the NIH produced in 2005 after bringing together dozens of experts on menopause from around the nation noted difficulties associated with credible research. Because botanicals have a natural variability not seen in synthetically-produced drugs that can be measured accurately, concluded the SoS statement, it is difficult to skirt the inherent “methodologic challenges.”
The SoS does acknowledge that black cohosh has been studied extensively, but although “originally it was thought that black cohosh had estrogenic properties, recent work suggests that it does not.” More the SoS states that “In the English language literature, there is little evidence that black cohosh is an effective treatment for hot flashes.” Still, since the herb is prominent in alternative and complementary approaches, the NIH is sponsoring ongoing clinical trials that it thinks “should provide helpful data.”
Red clover leaf, the NIH agrees, does contain “phytoestrogen compounds and is believed to work as a weak estrogen.” Despite this, the governmental organization concludes that studies suggest red clover is not effective in reducing hot flashes.
Similarly, the NIH disagrees that dong quai is effective for hot flashes, despite its use for a variety of menopausal symptoms. Also, the SoS paper notes that “there is an interaction with warfarin that may lead to bleeding complications.”
The SoS report on ginseng root is the same. Although the herb revered in Chinese medicine for centuries “may be helpful with respect to quality of life outcomes such as wellbeing, mood, and sleep, it does not seem to affect hot flashes.”
NIH experts speaking under the rubric of the SoS report conclude that “in general the study of botanicals as treatments for hot flashes in still in its infancy. There are major methodological problems associated with studying products that are not standardized. Basic research on dosing, factors that affect the metabolic processes of these products and mechanisms of action is needed for this area of investigation to move forward on a solid foundation.”
If you enjoyed this article, you might also be interested in the following:
Examining Conflicting Views on Hormone Replacement Therapy
Do You Feel the Heat? Hot Flashes – How They Happen and Why
Menopause and Depression – Jury Still Out on the Connection
Alternatives to Hormone Replacement Therapy for Menopause