My Dream: West Meets East…Someday

In 2005, a panel convened by the National Institutes of Health issued a statement emphasizing that menopause is not a disease. Yet, only yesterday, I ran across a newly-issued primer on menopause that is geared towards primary care physicians. In the introductory paragraph, I found the following statement:

“Managing menopausal health requires an ongoing effort to keep up with date with data on medical management of menopausal symptoms and treatments designed to prevent a number of disabling conditions associated with menopause and aging…”

Delving deeper,  I found only eight paragraphs devoted to alternative therapies (namely, phytogestrogens, black cohosh and bioidentical hormones). What jumps out on the one full page on which they are reviewed are statements such as:

“…controversy regarding long-term safety issues.” (black cohosh)

“…these same hormones are used in less expensive, FDA-approved estrogen products.” (bioidentical hormones)

“…evidence to date suggests that phytoestrogens do not ameliorate hot flushes or other menopausal symptoms. In addition there are not data to support the safety of long-term therapy with phytoestrogens and other herbal medications.” (phytoestrogens).

I’ve got a few bones to pick.

1. Historically, controlled studies with herbal preparations have been underfunded and undersupported by national institutions in this country, which is why the Western practitioner often claims “scant evidence.” Yet, if you do a search on alternative therapies on PubMed, there appears to be a growing interest in their utility and an increasing amount of time and resources devoted to studying them. Studies are published regularly in peer-reviewed journals such as Menopause. I’ve blogged about controlled evidence on a regular basis for months now. And, even the Nationa l Institutes of Health is in on the act; with trials currently underway evaluating the role of meditation, soy estrogens, herbal alternatives (e.g. black cohosh, red clover) for menopausal symptoms.
2. The controversy over long-term safety issues and black cohosh is being seriously addressed. I blogged about this only a week ago, noting that the National Institutes of Health Office of Dietary Supplements has publicly stated that millions of individuals have safely used black cohosh with no ill effects.
3. The North American Menopause Society-sponsored monograph highlights several advantages that bioidentical/compounded hormones might offer over conventional products, including greater dosing flexibility, lower doses for women who are especially sensitive and the avoidance of potential allergens.

The primer to which I refer was developed specifically to help primary care physicians understand the challenges that their menopausal patients face so that they can provide better care. However, the monograph does a great disservice by its sole emphasis on Western medical approaches verses Eastern whole-body approaches.

Physicians- if you’re listening, hear this:

MENOPAUSE IS NOT A DISEASE AND SHOULDN’T BE TREATED OR APPROACHED AS ONE.

A few thoughts:

• Please review your data, read alternative peer-reviewed journals and educate yourselves about  alternatives for your patients who have been scared off by the negative findings surrounding HRT and antidepressants and other pharmaceuticals.
• Pay attention to the fact that well-respected journals such as Menopause and Climacteric and the Journal of the British Menopause Society actually devote pages to alternative therapies that have been evaluated in well-controlled studies.
• Embrace multidisciplinary collaboration and invite educated and credentialled alternative practitioners into your fold who might be able to offer you and your patients important solutions when Western ways fail.

Over 5,000 women enter menopause daily. Many of these women are going to call on your for help with managing this very natural transition that we call the menopause. Why not take a moment and meet the challenge without pigeonholing it?

Thoughts anyone?

Bones Bones Bones…Again!

Something is in the air. Is it the moon moving into Virgo? The end of August, when fruit is ripe and bursting on the vine? What IS IT about late summer that makes me want to hold onto the old and challenge the new?

I’ve uncovered more news about bone loss as it relates to menopause. Early data suggest that fruit, namely Korean raspberries (better known as Rubus coreanus) may hold an important key to preventing bone loss.

Results of a study in rats that appears in the Menopause journal suggests that Rubus coreanus extract prevented bone loss caused by estrogen deficiency by enhancing the function of cells the form bone (osteoclasts) and promoting the death of cells (osteoclasts) that cause bone to break down.

The researchers caution that more study is needed but point to the mineral compositon of Rubus coreanus, which contains potassium, magnesium, and vitamins D and B2. They also suggest that Rubus coreanus extract improves bone density through an antioxidant effect.

A bit of wisdom goes a long way

I went up to Philly to visit an old friend this weekend. She turned me on to this book, a pretty amazing overview of menopause. What I like most about it is that its author, Dr. Christine Northrup, is an MD who isn’t afraid of holistic and Chinese medicine. Personally, I’m fortunate because my gyno is open to alternative medicine and in fact, recommended topical progesterone before my acupuncturist did. But not every MD is well-versed in East meets West and as a result, many patients are short-changed on strategies that might help them.

If you are looking for an alternative path, check out the book. It’s definitely a must-see.

Fasten your seatbelts

Are extreme mood swings that occur primarily in perimenopausal women solely the result of fluctuating and declining ovarian hormones?

Experts disagree over the cause of mood issues during the menopause, and raise questions about the role of co-stressors, such as empty nest syndrome, aging, work, assessment and expectations about goals and achievements, and of course, vasomotor symptoms and associated problems (e.g. hot flashes/night sweats/sleep disturbances/cycle changes, etc).

Of late, a lot of attention has been focused on the link between depression and menopause. Yet, research suggests that a history of PMS and depression earlier in life as well as other psyschosocial and cultural factors, actually account for depressed mood and depression among menopausal women.  Other study findings have shown that PMS and perceived stress are significantly linked to irritability and mood swings.

The good news is that across the board, studies show that mood disturbances tend to diminish as one moves through the menopause. However, what should you do when the blues/anger/irritability/fatigue/crying spells hit?

In previous posts, I’ve discussed the potential benefits of exercise, meditation, red wine (!) and St. John’s wort. I’ve also run across a few things written about the benefits of phytoestrogens (plant-like compounds that act in the body like estrogen). However, presently, a preponderance of evidence appears to support a greater role for phytoestrogens for bone and heart than for mental health.  I’m committed to searching the literature for additional interventions but in the interim, I welcome your feedback and personal experiences.

News flash! A new alternative alternative therapy!

As promised in my post last week, I tracked down Denise Polacek, Ph.D., Founder and CEO of Life Quality Technologies to learn more about the device for hot flashes that she is developing. We chatted about how and why she invented the product and more importantly, what it means for women in menopause who for one reason or another, don’t want to take hormone replacement therapy.

Her background? Denise has not spent her lifetime as a career inventor but she has spent years in a field called technology transfer (assisting scientists with patenting and commercial licensing of inventions). So she understands the ins and outs of development. What’s more, she has a broad scientific research background and a few patents under her belt already, although she says that these are based in cardiovascular genomics and not targeted to her current interests.

No stranger to hot flashes, a few years ago Denise found herself attacking the thermostat in meetings every time her internal thermostat rose a degree. “After about the fifth time, a colleague pulled me aside and suggested that the problem was me,” she explained. “So, I went to the gynecologist and immediately started hormone replacement therapy.”

While the hot flashes stopped within 24 hours, her interest in research didn’t. She felt that if she was going to take hormones, she better understand what she was taking. While delving deeper into the published literature, she learned about the association between HRT and incidence of blood clots and heart attacks. The cost-benefit ratio was not worth it, she says. So she stopped the drugs immediately. And became a guinea pig for her own experimentation with thermoelectric cooling.

Denise likens her own patented invention to a cooling fan in a computer; when the compressor starts overheating, the fan kicks in. She says that she soon realized that as soon as she got into the cold, her hot flashes would stop and that she could attenuate the symptoms within seconds. “I used those blue ice paks commonly reserved for injuries,” she says. And by experimenting on different parts of the body, she discovered that certain areas were more sensitive to cold than others and could literally halt the flash in a very short period of time.

Although the new device does not have a name or a final design as of yet, there is a prototype that’s been tested successfully on numerous colleagues. The results thus far have been exciting. “Cooling is mostly immediate and instantaneous” she says.

Denise expects the yet unnamed device to be on the market sometime in 2009. She emphasizes that the final product will be lightweight, portable, discreet, and worn under clothing near the waistline, “like lingerie.”

This is a lady who was not afraid to take some risks and follow her own path when the path in front of her has too many potholes. She’s networked like crazy and her efforts are paying off – not just for herself but those perimenopausal and menopausal women for whom drugs are not the answer. Denise told me that while she has a few other ideas for her new company, she is first and foremost dedicated to menopausal women and breast cancer sufferers plunged into premature menopause. “Menopause is not a disease,” she says, and “shouldn’t be treated like one.”

The possibilities are endless. And here’s a new pioneer who’s created innovative solution for millions of women who suffer from hot flashes. Cool!

Dazed and Confused

A gal pal mentioned to me this morning that she often feels so confused about study findings proving or disproving the value of certain medications or herbs that she often just throws up her hands and does nothing. Many of us are as dazed and confused as she is so that I thought that a few key points about clinical studies might help.

Mike Clarke from the School of Nursing and Midwifery at Trinity College in Dublin wrote a great article last year about the need to standardize results of studies for a specific disease ( in this case, rheumatoid arthritis). He defined the problem as follows:

“Every year, millions of journal articles are added to the tens of millions that already exist in the health literature, and tens of millions of web pages are added to the hundreds of millions currently available. Within these, there are many tens of thousands of research studies which might provide the evidence needed to make well-informed decisions about healthcare. The task of working through all this material is overwhelming enough without then finding the studies of relevance to the decision you wish to make…”

So what do you do? A few key points:

• Consider that every study has the potential for bias. Perhaps researchers are using 7 instruments to measure depression and only highlight findings from 3 of these in order to preserve the most positive or significant results. Clearly, the reader is being led towards certain outcomes and away from others.
• Study designs, types of patients studied, age of patients studied, gender, you name, can differ so it’s difficult, if not impossible to draw definitive conclusions when comparing results of one to another.
• Another issue of great interest to practitioner of Western medicine is whether or not a study is controlled. This means that two groups are compared that are identical in every way except one group is given an experimental treatment and the other, a placebo or standardized treatment. Note that often, real world conditions are often recreated rather than conducted in a real world setting and many studies are not controlled, meaning that the science behind the findings is questionable.
• Alternative and complementary medicines are still incompletely understood among many practitioners of Western medicine. What’s more, products are not regulated as carefully as medicinal agents and manufacturing practices vary. Consequently, studies of these agents or modalities are often inconclusive. And of course, often underfunded and under-appreciated.

No wonder we all feel so dazed and confused!

I’ve written several times about the importance of consulting a practitioner or medical expert before embarking on any regimen for perimenopausal symptoms. Even if you only see someone once, at least that dialogue may be useful for defining a regimen that may work best for you and what you’re going through. And if you live off the beaten track without access toa good practitioner, well then excellent resources like Medline or the American Botanical Council may be be of help in discerning what’s what.

The short answer is that there are no short answers. But with careful guidance and a bit of prudence, you may just be able see the light and smooth out the bumps on this rollercoaster ride we’re all on.

Let it flow and flow and flow

My college roomie and I had a teacher’s assistant in college for our “Women and their Bodies in Health and Disease” class. At end of the one of her sessions, we gathered in an upstairs room in the Union and meditated to increase our chi. At the time, it certainly became the brunt of many jokes but a recent post on Becoming Your Stellar Self on the increasing role of reiki in hospitals kickstarted my brain; could reiki be helpful for menopausal symptoms?

Since Reiki is used to balance various systems, one has to wonder if it might be helpful for balancing hormones that have run wild?

The National Center for Complementary and Alternative Medicine is currently studying reiki in five clinical trials. Of particular interest is a trial on the effect of reiki on stress.

A woman’s adrenal glands go into overdrive during menopause, taking over the role of producing hormones from the ovaries, creating a perfect recipe for an overtaxed system. Factors like stress and lack of sleep create additional demands on the adrenal glands. So it makes perfect sense to engage in practices that help relax our minds and body, and alleviate the excess stress brought on by perimenopausal and menopausal symptoms.

As Kate, the TA used to say….let it flow and flow and flow. If reiki is a means to achieving a better balance during a time when our bodies are anything but balanced, well, I’m all for it!

Mama’s Little Helper

There’s a new cocktail in town! Won’t necessarily do its wonders for ‘all that ails’ but it’s a good start and worthy of consideration, even for the toughest constitution. Hmmm, I can only imagine eyes popping and chattering as all you Sixties love children excitingly talk about Ms. V and so sorry to disappoint. I’m actually referring to black cohosh, rhodiola, and three immortals with a twist (i.e., topical progesterone cream ). Sounds strange, eh?

True confession time. I started having major night sweats about four months ago. Drenching night sweats. Talk about a wet dream! My MD suggested a regimen of topical progesterone combined with a low-dose topical estrogen. Progesterone? Okay. But, estrogen and me haven’t done too well in the past.

So, Flashfree might be a blogger by night but by day, I’m a medical writer/health reporter so I read and read and read and write and write and write. And while I live and breathe and eat in the Western School of Medicine, I honestly subscribe to the East meets West way of life.

Mind you, I’m not recommending that you go out for happy hour. But what I would like to convey is that there may be an effective allternative if you are hormone-shy like me, provided that you consult the healthcare professionals in your life that are ‘in the know.’

Couple rules of thumb – standardized formulations rule the day, don’t try this at home without speaking to an expert first, and shaken, not stirred!

Any other combos you’d like to share? Experiences? Tell me more!