Menopause

Menopause

Here is an excerpt from a letter I received in 1991: "I am a 59-year-old woman who has gone through menopause. As a result, my skin has become extremely thin, and my hair has thinned as well. I would like to inquire if there are any natural alternatives to hormone replacement therapy (HRT). I feel very unsure of HRT and don't want to take it. I fear it has too many risks."

This is just one of the more than 10,000 letters I received that year, which was a bumper-crop year for mail because I did a three-minute spot on food pharmacy on the CBS national morning show. The phones rang off the hook at the U.S. Department of Agriculture (USDA), where I worked at the time. And all of the USDA secretaries, mail staff and operators--as well as the bosses--regretted my three minutes of fame. Of course, I didn't. It was another chance to get people excited about herbs and other natural medicines.

The Big Hormone Question

I, too, have misgivings about HRT. Although the female sex hormone estrogen evidently relieves hot flashes, vaginal dryness and other discomforts of menopause, a good deal of research shows that it may increase a woman's risk of getting breast cancer. (Researchers have found that including progesterone as part of the therapy may reduce the risk of breast cancer.)

I like to quote Andrew Weil, M.D., an herb advocate who teaches at the University of Arizona College of Medicine in Tucson and author of Natural Health, Natural Medicine, who warns friends contemplating HRT: "You should avoid estrogen replacement altogether if you are at increased risk of cancer of the breast or reproductive system, including having a personal or family history of these cancers or ovarian cancer. If you do decide to take replacement therapy, use a low dose of estrogen (1.25 milligrams a day, maximum) and never take it without progesterone for at least part of the monthly cycle." This sounds like good advice to me. In fact, it's not unique to Dr. Weil. Many gynecologists also take this approach.

I know a naturopath who is very opposed to HRT and instead recommends eating lots of veggies and legumes high in phytoestrogens, which are estrogen-like compounds. He says, "If you add up all the warnings, cautions, contraindications and side effects, the number comes to over 100." My friend is amazed that any physician would prescribe this therapy. Still, the vast majority of doctors do prescribe HRT.

Why? Mainly because HRT also reduces the risk of heart disease and osteoporosis, which pose a greater risk to many women than breast cancer. But in my humble opinion, there are better ways to reduce these risks than taking HRT.

Many doctors disagree with me, though. This is a decision that you'll have to make yourself, and I suggest that you get the full picture--pro and con--from your own gynecologist. (For more details on heart disease, see page 242; for more on osteoporosis, see page 339.)

When there are alternatives to dangerous drugs, those approaches should be given a chance before you resort to more drastic, expensive approaches that have the potential to cause damaging side effects. I fear that for economic reasons the pharmaceutical firms are not interested in proving that natural approaches to menopause, or anything else for that matter, are safer and more effective than synthetics. I personally believe that the natural approaches are better, and I'm not alone in that opinion. Unfortunately, few doctors share it.

Midlife Discomforts

Menopause means the cessation of menstruation. Most women experience menopause during their late forties and early fifties. Sometimes it happens quickly. More frequently, it takes a few years for menstrual periods to cease.

As menopause develops, estrogen production declines, often causing one or more discomforts: anxiety, breast tenderness, depression, dry skin, headache, hot flashes, incontinence, insomnia, irritability, nervousness, night sweats and vaginal dryness.

Of this list, hot flashes are most common, affecting about 85 percent of menopausal women. Hot flashes usually occur without warning, but some women notice that emotional stress, exercise, alcohol and certain foods may trigger them.

The Fabulous Phytos

Let me remind you that as a botanist, I cannot and do not prescribe. However, I believe it within my botanical prerogative to outline the research on herbal and nutritional approaches to menopause that I would not hesitate to suggest to my wife or daughter.

But before I mention specific herbs that can offer help, let me make an important point about diet. Hot flashes and other menopausal symptoms are rare in vegetarian cultures, especially among people who consume a lot of legumes, like black beans, mung beans and soybeans.

Why? Because beans and many other plants have mild estrogenic activity, thanks to phytoestrogens. These compounds include isoflavones, lignans, phytosterols and saponins.

In addition to acting like estrogen in women whose own sex hormone production has declined, phytoestrogens also appear to reduce the risk of estrogen-linked cancers such as breast cancer. Animal experiments show that phyto-
estrogens are extremely effective in preventing tumors of the breast tissue.

The Soy Factor

We used to think that Asian women had a low rate of breast cancer simply because they eat a low-fat diet. Now it looks as though their substantial intake of legumes like soy and bean sprouts is also a reason. How is it possible for phytoestrogens to help prevent menopausal symptoms and at the same time also help prevent illnesses associated with estrogen?

Phytoestrogens are weaker than the body's own estrogen. In premeno-pausal women, phytoestrogens compete with women's own, more potent estrogen, reducing the total effects of estrogen. But as women's estrogen production falls, phytoestrogens supplement this hormone.

Put another way, when women have too much biological estrogen, phyto-
estrogens lower the burden; when they have too little, phytoestrogens pinch-hit.

I know of no evidence that phytoestrogens in moderation cause harm. One cup of soybeans (about 200 grams) provides about 300 milligrams of the most important class of phytoestrogens, isoflavones. That amount could provide about the equivalent of one tablet of Premarin, the commonly prescribed synthetic hormone used in ERT.

Studies show that women who regularly eat soy foods have few hot flashes, and they have more cells in their vaginal linings. These extra cells offset the vaginal dryness and irritation that are so common in postmenopausal women.

Soybeans are not the only beans high in isoflavones. Most beans and many other legumes contain reasonable amounts. I feel that little harm can be done by enjoying a diet rich in a diversity of beans unless you're allergic to them or strenuously object to the flatus they cause. (I don't, but if you'd like some techniques for reducing the gas-producing effects of beans, see page 200.)

Green Pharmacy for Menopause

In addition to a high-phytoestrogen vegetarian diet, a number of specific herbs can help relieve many symptoms associated with menopause. Here's my selection.

Black cohosh (Cimicifuga racemosa). Long recommended for "female complaints," this herb contains estrogenic substances that help relieve menopause discomforts, especially hot flashes. In one study of 110 menopausal women, half were given black cohosh root extract, while the other half took an inactive preparation (a placebo). After eight weeks, blood tests showed significant estrogenic activity in the women taking the herb.

In another study, women with vaginal dryness due to menopause experienced similar relief whether taking black cohosh or pharmaceutical estrogen.

Black Cohosh This herb grew wild in the Ohio River valley and was used by American Indian women for gynecological complaints and childbirth.

Licorice (Glycyrrhiza glabra). Licorice contains natural estrogenic compounds. Like the isoflavones in soy, glycyrrhizin, the active ingredient in licorice, appears to reduce estrogen levels in women when they're too high and increase the levels when they're too low.

Could licorice candy help women with menopausal discomforts? Possibly, but read the label. Most American licorice contains extracts of licorice plus anise, which contains a chemical (anethole) that is less estrogenic than glycyrrhizin. Many health food stores carry candies made from pure licorice.

Licorice and its extracts are
safe for normal use in moderate amounts, but long-term use or ingestion of larger amounts can produce headache, lethargy, sodium and water retention, excessive loss of potassium and high blood pressure. A safe daily dose of a true licorice confection is said to be five grams, or less than a quarter-ounce. It's hard to stop when something tastes that good, but you'll just have to control yourself.

Alfalfa (Medicago sativa). Alfalfa has demonstrable estrogenic activity. The leaves make a pleasant-tasting tea. If you have lupus or a family history of lupus, however, steer clear of alfalfa sprouts. There's some evidence that they may trigger lupus in sensitive individuals.

Chasteberry (Vitex agnus-castus). This herb has been endorsed as a normalizing herb for female sex hormones and is thought to be especially beneficial during menopausal changes.

The biochemistry is complicated, but basically chasteberry regulates hormones involved in the menstrual cycle: It increases luteinizing hormone production and inhibits the release of follicle-stimulating hormone. All of this translates into a beneficial estrogenic effect.

Chinese angelica (Angelica sinensis). Also known as dang-quai, Chinese angelica has an age-old reputation as a women's tonic. Believers swear that it relieves hot flashes and vaginal dryness and irritation, thus aiding women during menopause. While there is no scientific backup for this assertion, the herb does have centuries of folk use going for it. I wouldn't hesitate to recommend it to family members and friends.

Red clover (Trifolium pratense). This herb contains 1 to 2.5 percent isoflavones. In one study, postmenopausal women who ingested clover, flaxseed and soy for two weeks had demonstrably higher estrogen levels, which declined when they went off the special diet. Some clovers are so estrogenic that they cause spontaneous abortion in cattle that overgraze on them. Red clover makes a pleasant-tasting tea.

Strawberry (Fragaria, various species) and other foods containing boron. There's more to estrogen activity than the hormone itself. USDA research shows that taking as little as three milligrams of boron can double blood levels of circulating estrogen. So I'd recommend that postmenopausal women and those approaching menopause eat foods high in this mineral.

According to my database, the top boron-containing foods, in descending order of potency, include strawberries, peaches, cabbage, tomatoes, dandelion, apples, asparagus, figs, poppy seeds, broccoli, pears, cherries, beets, apricots, currants, papaya, dill and cumin seed.

Working with all the estrogenic and boron-containing plants and herbs, you can concoct some interesting salads and vegetable dishes.

Assorted herbs. A number of other herbs contain phytoestrogens that could prove useful in helping with menopause. These include apples, celery stalks, dates, elder, false-unicorn root, fennel, Honduran sarsaparilla, lady's slipper, liferoot, Mexican wild yams, passion flower, pomegranates and sassafras.