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women are thinking about abandoning the use of hormones for menopausal
symptoms in the wake of a second blow against the safety and effectiveness
of the most common form of hormone therapy (HT).
The May 2003 announcement that research indicated the Estrogen/Progestin
combination known as PremproTM doubled the risk of dementia
in women over 65 came only a year after a major study of the same
formulation was halted because of indications it increased risk
of heart disease and breast cancer. Both studies, commissioned by
the U.S. Women's
Health Initiative, looked at long term use of hormone therapy
- up to five years in the most recent study on mental functioning,
and four years, in the earlier study assessing the health protective
effects of PremproTM.
Emails and calls have poured in from across the country to health
professionals and women's health organizations like the Canadian
Women's Health Network with questions about the implications
of these findings. "I am trying to decide whether to discontinue
HT," wrote one woman. "Can you direct me to the most up-to-date
information on this controversial issue?"
"I'm really uncomfortable with what I'm hearing about hormone
therapy," wrote another. "Now I'm wondering if I should
stop, and look into natural health products. What do you suggest?"
Others wondered if they should consider hormone therapy at all,
once they enter menopause.
Looking for answers - is hormone therapy
(HT) still for me?
The reasons some women are interested in using HT vary. In making
a choice for - or against HT, it's important to consider a number
of personal factors, including the risks for future diseases versus
the benefits of HT for an individual woman's health and wellbeing,
and whether a woman is comfortable with side effects of treatment.
A good place to start is to talk with your doctor, who can also
establish whether the symptoms and changes a woman is experiencing
are actually due to menopause, or some other underlying health concern.
Once this picture is clear, there are many things you can do to
help reduce the discomforts and symptoms of menopause. If you are
already using HT, check with your doctor before making a decision
about whether or not to continue with it.
In both mainstream medicine and complementary
and alternative health care the primary tool for handling menopausal symptoms
and overall health and well being is taking good care of yourself: eating a
healthy diet, especially one that emphasizes soy; exercising and reducing stress.
For more detailed descriptions of options for relieving symptoms, see Help
yourself: what you can do.
When, and if these measures fail to provide enough symptom relief,
women often look to Natural Health Products (NHPs) such as nutritional
supplements, natural hormones or herbal medicines. A lot of information
is available about what may work, much of it conflicting, even from
highly regarded sources.
Should I use natural health products
instead of HT?
Even before the Women's Health Initiative called off its HT study
in 2002, many women were interested in more natural alternatives
to HT - hoping they would be safer, while offering the same benefits.
Unfortunately, there are no panaceas - natural, or otherwise - for
menopausal symptoms.
Though they are derived from natural sources, natural hormones
should be viewed with as much caution as conventional HT. Hormones
have powerful effects in the body, and just because they are natural,
doesn't mean they are safe.
Making an informed choice about NHPs means doing some research.
There is far less reliable information on NHPs than on pharmaceuticals
at this point. Many NHPs, including those recommended by doctors,
naturopathic doctors and doctors of Traditional Chinese Medicine,
are used based on anecdotal evidence and traditional use rather
than on clinical trials.
Before a woman takes an NHP to treat menopausal symptoms, she should
attempt to find out if:
- there are studies showing the product is effective for its recommended
purpose.
- the risks of taking the product are known
- there are contraindications - risks for specific health conditions,
or conflicts with certain pharmaceutical drugs - for taking the
product that apply
It may not be easy to come up with answers, as the limited number
of studies available disagree about the safety and effectiveness
of a range of NHPs currently being promoted as HT alternatives.
This situation will likely improve over the next few years, as research
studies are underway looking at dietary changes and several of the
most promising herbal medicines typically used to relieve symptoms
such as hot flashes, memory, concentration, sexual function, and
irregular bleeding. These herbs include:
- Black Cohosh (Latin name: Cimicifuga racemosa - or more currently,
Actaea
racemosa)
- Chaste Tree (Vitex
agnus-castus)
- Red Clover (Trifolium
praetense)
- Ginkgo (Ginkgo
biloba)
If you do buy NHPs
- Buy standardized products. This means that every tablet, capsule
or teaspoon of liquid (tincture) you take - according to the product
directions - should have the same amount of what is has been identified
as the active ingredient, or a particular chemical component unique
to the plant, known as a marker compound.
- Look for a D.I.N. (Drug Information Number) or G.P. (General
Public) number, which shows that Health Canada has reviewed and
approved information submitted by the manufacturer about the product,
its labeling and instructions for use.
- Tell all your health care providers about any herbs that you
are taking, especially if you are also taking any prescription
medication.
- Start with one herb at a time and observe its effects on your
body for a few weeks
Some complementary and alternative health practices may provide
symptom relief, improved quality of life, or a general sense of
wellbeing during menopause. See What
Can I Expect If I Visit An Alternative Health Care Professional?
Among the resources available from the Complementary and Alternative
Health section, a list
of contacts for national and regional organizations representing
a variety of complementary and alternative approaches is provided.
These associations can provide information about practitioners'
education, credentials, and the treatments available, as well as
referrals to practitioners in your area.
Remember - menopause is a process that changes over time. Symptom
management isn't one-size-fits-all, forever. You can change your
strategy based on your changing health, changes in medical understanding
and research, and new treatments in both conventional medicine and
complementary healthcare.
Other resources
Several excellent books are available that can help you make choices
about symptom management. Keep in mind that clinical information
in a book printed two years ago will not necessarily be up-to-date.
This doesn't invalidate the other information, or the positive perspectives
on menopause in these books, but it does mean you should check out
more recent and reliable information.
Don't go it alone. Talk with and learn from other women going through
menopause. Look for self-help groups, book clubs, or other ways
to get together with women in mid-life. Menopause can be a time
of great change and renewal in women's lives, and support from other
women can be very important as a woman makes her way through this
time.
Books in English:
- Menopause: A Naturopathic Approach to the Transitional Years
by Karen Jensen, ND 1999
- Menopause and Homeopathy: A Guide for Women in Midlife
by Ifeoma Ikenze, MD, 1998
- New Menopausal Years, The Wise Woman Way: Alternative Approaches
for Women 30-90, Susun Weed, 2001
- Good Nutrition for A Healthy Menopause by Louise Lambert-Legace,
1999
- Understanding Menopause: Answers and Advice for Women in
the Prime of Life by Janine O'Leary Cobb, 1993.
Where can I find more information?
Online resources:
CAMLINE: The
Evidence-Based Complementary and Alternative Medicine Web Site for
Health Care Professionals
The F.A.C.T.S.:
Web Site of the Friends of Alternative & Complementary Therapies
Society - useful for paid practitioner listings.
Health
Canada: Office of Natural Health Products
References for this article
Books and Newsletters
Allina A. and Fugh-Berman A. "Natural Hormones: Are They A
Safe Alternative? " in A Friend Indeed for Women in Menopause
and Midlife. Vol.29 no.6 January-February 2003.
Boon H. and Smith M. The Botanical Pharmacy the pharmacology of
47 common herbs
Quarry Press Inc. Kingston Ontario,1999
Consensus Opinion. The Role of Isoflavones in Menopausal Health:
Consensus Opinion of the North American Menopause Society. Menopause.
Vol. 7 No. 4; 2000, 215-229.
Hudson T. Women's Encyclopedia of Natural Medicine alternative
therapies and integrative medicine. Keats Publishing Los Angeles,1999.
Pizzorno L, Pizzorno JE, Murray M. Natural Medicine Instructions
for Patients. Churchill Livingstone, 2002.
Online
Herbmed: an
interactive, electronic herbal database with hyperlinked access
to scientific data underlying the use of herbs for health. A non-profit,
evidence-based information resource for professionals, researchers,
and general public.
Project
Aware: Association of Women for the Advancement of Research
and Education
What is Menopause?
U.S.
Office of Dietary Supplements, National Institutes of Health
Questions and Answers About Black Cohosh and the Symptoms of Menopause
NCCAM:
National Center for Complementary and Alternative Medicine
Newsletter: Complementary and Alternative Medicine at the NIH Winter
2003 Vol. 10 No. 1. "Menopausal Symptoms and Alternative Therapies."
NCCAM:
Alternative Therapies for Managing Menopausal Symptoms, Consumer
Advisory
U.S. National Institutes of Health Scientific workshop on menopausal
hormone therapy October 23-24, 2002. The workshop may be viewed
at NIH VideoCasting (go to "past events" and search on
"hormone therapy.") Select "Menopausal Hormone Therapy,
Day 1, October 23, 2002, or Day 2, October 24, 2002.
Speakers' slides and other print information from the workshops
are posted at: http://orwh.od.nih.gov/health/menopause.html
U.S. National
Institutes of Health Menopausal Hormone Therapy Information
- Women's Health Initiative. Information and resources on findings
from the Women's Health Initiative.
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