Is Hormone Replacement “Therapy”?

During the third week in July of 2002, The Journal of the American Medical Association reported that a large scale clinical trial on hormone replacement therapy (HRT) had been halted five years into the study.¹  Researchers at 40 clinics across the country had recruited 16,608 healthy volunteers, ages 59-79 (not at high risk for either heart problems OR breast cancer), and randomly assigned them to either Prempro or a placebo.  Chances of suffering a heart attack or pulmonary blood clot were elevated throughout the study, and stroke risk was high as early as the second year and remained high throughout the study.  That alone was not reason enough to halt the study, especially since hip fractures and colon cancer had decreased.  However, five years into the trial, it was clear that the development of invasive breast cancer was increasing and, combined with the cardiovascular outcomes, “It became very clear that the risks of treatment exceeded the benefit.”²

Estrogen Dominance

The female organs produce estrogen and progesterone in what sometimes seems to be a “tug of war”—during a woman’s cycle, concentrations of each hormone fluctuate at different times.  Since estrogen prevails for most of the cycle, it creates a condition commonly referred to as “estrogen dominance”.  This imbalance happens both in PMS and in menopause, when estrogen replacement therapy (ERT) is given.  Symptoms of estrogen dominance include, “water retention, breast swelling, fibrocystic breasts, pre-menstrual mood swings and depression, loss of sex drive, heavy or irregular periods, uterine fibroids, craving for sweets, and fat deposition in the hips and thighs”.³  Progesterone is an important hormone that balances estrogen.  When synthetic progesterone is given with ERT, it is called hormone replacement therapy (HRT); however, the synthetic version cannot be attributed with the beneficial effects of the natural progesterone.
Synthetic progesterone has been likened by Dr. John Lee, who has researched and written a book on natural progesterone, to a cook who needs eggs for a recipe and is given cheese—the effects just aren’t the same!

The Good News about Natural Support:
Natural Progesterone

“A growing number of doctors believe that if natural products were used, medical risks and side effects would be considerably lessened.  Research using hormones from natural sources have the benefits of synthetics, but fewer side effects.  A significant finding showed that the adverse effects of the synthetic progestins on blood-fats and cholesterol levels were eliminated with natural progesterone.”⁴

Phytoestrogens

Plant phytoestrogens do not carry the risks of estrogen replacement therapy, and yet they have the ability to exert a weak estrogenic activity when they bind to estrogen receptors.  Phytoestrogens are found in some 300 foods, (including flaxseeds, tofu, cabbage, alfalfa, and fennel) and in some herbs, such as dong quai, red raspberry, black cohosh, chaste-tree berries (vitex), red clover, wild yam and licorice root. (*Dong Quai, black cohosh, and several other female herbs are contraindicated during pregnancy.)  Since the plant hormones have weak estrogenic activity, they are able to eliminate some of the symptoms of menopause and decrease the risk of osteoporosis that is associated with a lack of estrogen.  Used together synergistically, they are even more powerful.⁵
If plant estrogens provide weak activity where there was none before, does that increase risk for breast cancer?  There is no conclusive evidence that they do.  That could be due to the natural quality of the estrogen and, also, the fact that the plant estrogens may be exerting other beneficial effects.  For instance, these plant estrogens bind to an enzyme called estrogen synthetase, thus inhibiting production of the estrogen in the body, and offering additional protection in this manner.⁶
It is interesting to note that estrone, which is the main estrogen produced by the body after menopause, has been shown to be carcinogenic.  Estrone is one of three estrogens produced by the body.  Estriol is a weaker form (major hormone of pregnancy) that has not been proven to be carcinogenic, but is not used in HRT.  Estradiol (twelve times more potent than estrone, and eighty times more potent than estriol) is used in HRT, and is also correlated to cancers—the blocking of this estrogen by the phytoestrogens may explain the supposed protection that the phytoestrogens offer in premenopausal years.
It is also possible that, by binding the receptors, plant estrogens prevent the binding of xenoestrogens, highly toxic and carcinogenic substances in our environment suspected of causing breast cancer.  Xenoestrogens not only bind the receptors, but negatively affect the DNA of the cell.  In 1978, Israel banned several chemicals determined to be correlated with breast cancer—the incidence of breast cancer dropped 30% in women under 44 years old, even though it rose 4% overall worldwide.⁷  In contrast, the phytoestrogen-receptor complex that is formed does not bind to DNA as strongly as human estrogen.⁸  Additionally, phytoestrogens exhibit antioxidant, radical scavenging, hypolipidemic and serum cholesterol lowering properties.⁹

Phytoestrogen Support…

Dong quai is a Chinese herb high in phytoestrogens; it relieves hot flashes, vaginal dryness, and depression.¹⁰  “Scientific investigation has shown that dong quai produces a balancing effect on estrogen activity and a tonic effect on the uterus.” ¹¹
Black Cohosh has a high phyto-estrogen content, and is recommended frequently for support of all female ailments.  In some clinical trials, black cohosh has been shown to be equally as effective as synthetic estrogen replacement therapy.¹²  It lowers blood pressure,¹³ and a review of eight human clinical trials found black cohosh to be “a safe, effective alternative to estrogen replacement therapy”.¹⁴
Wild Yam Root is a good source of phytoestrogens, and sterol compounds similar to progesterone.  It contains a natural steroid called dehydroepiandosterone (DHEA).  The root is used in the treatment of menopause-related symptoms.  It helps relax muscle spasms and is said to be beneficial for many female disorders, helping to relieve mood swings, depression, irritability, insomnia, headaches, and cramps.
Chaste Tree (or Vitex) has hormone balancing effects, helps alleviate hot flashes, and is used in the treatment of fibroids in uterine tissue, fibrocystic breasts, and endometriosis.
Red raspberry is full of phyto-estrogens, and is helpful in treating menopause, and associated symptoms such as hot flashes.¹⁵  It is one of the safest herbs and can be taken during pregnancy.
Red Clover has phytoestrogens and is also a rich source of bioflavonoids, isoflavonoids, folic acid, biotin, choline, inositol, pantothenic acid, vitamins A, B1, B2, B3, B6, B12, C, and minerals such as copper, magnesium, manganese, selenium, and zinc.
Flaxseed is mildly estrogenic (contains phytoestrogens) and is rich in minerals needed by postmenopausal women.  Flaxseed is also high in essential fatty acids (EFA’s)—deficiency of EFA’s is partly responsible for skin, hair, and vaginal dryness, as well as the dryness of other mucous membranes. 
Other female nutrients helpful in menopause include burdock root, motherwort, damiana, gotu kola, Panax ginseng, and avena sativa.
Bioflavonoids and vitamin C:  In a clinical trial, subjects received a supplement containing a hesperidin bioflavonoid combination with  vitamin C.  “The bioflavonoids were markedly superior to the other preparation’s relief of the hot flashes.  Bioflavonoids appear to restore the endothelium to a normal structure and help reduce the hot flashes and vasodilation.”¹⁶  Additionally, bioflavonoids are high in the phytoestrogens that can relieve symptoms.

Natural Support for Osteoporosis

One of the reasons that the large scale trial was not halted earlier was because hip fractures were decreased with estrogen.  Both phytoestrogens and natural progesterone can support healthy bones.  The bioactivity of several phytoestrogens in preventing bone loss “has been demonstrated in a well-recognized model of postmenopausal bone loss”.¹⁷
Jerilynn Prior, MD, of the Endocrinology and Metabolism Division of the University of British Columbia, notes that, “Progesterone acts on bone, even though estrogen activity is low or absent.  Because progesterone appears to work on the osteoblasts to increase bone formation, it would complement the actions of estrogen.” (Estrogen decreases bone breakdown.)  Another MD notes that osteoporosis has been reversed in women as much as 16 years past menopause, using natural progesterone in combination with other dietary factors and exercise.¹⁸
Phytoestrogens and natural progesterone cream can offer a lot in the way of support for women, both pre- and post-menopausally.  Over 16,000 women have been studied and have blasted the theory that HRT is a wonder drug for women in menopause.  The natural alternatives certainly do not carry the risks that come along with the medical hormone replacement, and more and more women these days want a healthier alternative. TAC

References

1. JAMA July 17, 2002
2. Marcia  Stefanick, chair of the Women’s Health Initiative’s Steering committee; Newsweek July 22, 2002:38-41
3. Null, G. The Woman’s Encyclopedia of Natural Healing.  Seven Stories Press, NY, NY. 1996
4. Hargrove J et al., Menopausal Hormone Replacement Therapy with Continuous Daily Oral Micronized Estradiol and Progesterone. Obstetrics and Gynecology. 1989;73:606, as cited in:  Ojeda, Linda, PhD.  Menopause without Medicine.  Hunter House Publ., Alameda Ca. 1989, p. 107
5. Murray, M. Menopause. Prima Publ. Rocklin, Ca. 1994
6. Lark, S. Fibroid Tumors & Endometriosis. Celestrial Arts, Berkeley, Ca. 1995;  p.125  
7. Westin J & Richter E. Ann NY Acad Sci 1990;609:269-279
8. Draper CR et al. J Nutr. 1997;127:1795-99
9. Franke et al. 1994
10. Balch, J.F., M.D. and Balch, P.A., C.N.C.  Prescription for Nutritional Healing.  1990.  Avery Publishing, Garden City Park, NY, p. 241
11. Murray, M.T., N.D.  Natural Alternatives to Over-the-Counter and Prescription Drugs.  1994.  William Morrow and Company, Inc.  NY, NY
12. Zen BL Gynakol 110-61, 1998
13. Mowrey, DB. The Scientific Validation of Herbal Medicine.  Cormorant Books, 1986
14. as cited by Lieberman, Shari, Journal of Women’s Health. 1998;7(5):525-529
15. Balch, J.F., M.D. and Balch, P.A., C.N.C.  Prescription for Nutritional Healing.  1990.  Avery Publishing, Garden City Park, NY, p. 241.
16. Smith, CJ, MD. Non-hormonal control of vaso-motor flushing in menopausal patients, Chicago Medicine, March 7, 1964
17. J Nutr 1997;127:1795-99.
18. Christiane Northrup, MD.  Women’s Bodies, Women’s Wisdom.

Dr. Toohey received her Ph.D. in nutrition from Colorado State University in Ft. Collins, CO.  She has lectured to chiropractors and other health professionals across the country and also in Canada and Europe.  She has been invited by the Canadian MS Society to be a guest speaker at their annual convention in Vancouver (Nov.  16th).  Various lecture engagements have included speaking for the International College of Applied Kinesiology, the United Chiropractors of New Mexico, and the Florida Chiropractic Association.  You may reach Dr. Toohey by e-mail at [email protected].