Alternative hormone therapies abound

By Beverly Creamer and Tanya Bricking
Advertiser Staff Writers

•	Resources on the Web To find out more about the hormone replacement therapy study and what it means, check out these online sites: National Institutes of Health Women's Health Initiative Journal of the American Medical Association Kaiser Permanente Center for Health Research Mayo Clinic

Just wait. Things are about to become even more complicated as alternative approaches aimed at women approaching menopause flood the market.

Since the release this month of a government study that found hormone replacement therapy does more harm than good, nontraditional remedies are taking off.

"It seems so easy to take one little pill every morning and just be done with it," said Liz Lipski, a clinical nutritionist on Kaua'i, who has long held reservations about hormone replacement. "But in my view, it's more like a Band-Aid. I'd rather look at lifestyle. Menopause is supposed to be a transition period, a time of introspection."

For hormone-pill critics such as Lipski, fighting the symptoms of menopause means looking at everything from diet to taking time to meditate or go for walks. She considers research on everything from multivitamins to herbal mixtures and acupuncture.

"When we have a symptom in our bodies, it's our body's way of saying we're out of balance," she said. "We need to ask if there is something nutritionally or in our lifestyles to bring us back into balance."

Though some of her ideas stray from the mainstream, they're not that far off from doctors' advice.

Dr. Laura Weldon Hoque, medical director at Kapi'olani Breast Center, has heard patients talk about trying herbal remedies such as black cohosh to combat hot flashes.

As a doctor, her best advice is for patients to learn as much as they can and ask their doctors before experimenting.

"I like to tell people that a lot of them (herbal remedies) contain some type of estrogen, and they have to be aware of that," she said. "Some of them actually go to the point of measuring their estrogen levels on these products to see if they are up or down. But I think you have to go into this really knowledgeable. The women who tend to seek out these natural forms are generally fairly well-read on the subject."

Remedies fall into two categories: estrogen-based types, such as soy, Hoque said, and nonestrogen products, such as a low dose of antidepressants.

While researchers have done scientific studies on some natural approaches, most are largely uncharted. Unlike pharmaceuticals, vitamins and herbs are loosely regulated by the federal government. And most insurance policies do not cover the cost of the products.

About 30 percent of menopausal women use some kind of alternative therapy, including acupuncture, herbal supplements or so-called phytoestrogens, estrogen-like substances found in plants, according to the North American Menopause Society.

Among the most common alternatives:

• Black cohosh: Studies have indicated it reduces hot flashes, and its effect on bone and heart health and mood are still being studied.
• Soy: Studies say it reduces cholesterol. It also may help reduce hot flashes and promote bone health, but some doctors are concerned that long-term consumption of large amounts could increase risk of breast cancer.
• Dong quai: Also called tang kuei, this is widely used in Asia to reduce hot flashes, but little is known scientifically about the benefits. It also can cause bleeding and sensitivity to the sun. Acupuncturists who recommend it say it's best to use it in combination with other herbs in formulations such as "Three Immortals" or "Women's Balance."
• Chaste tree berry: Also known as vitex, and found at health food stores, helps alleviate symptoms. Try 100 milligrams twice a day, and always buy a standardized extract of herbs to make sure you're getting quality, said naturopath Dr. Laurie Steelsmith.
• Natural progesterone such as emerita is available through a naturopath or from a compounding pharmacy such as Women's International Pharmacy in Washington state. (A prescription is needed.) At this point, there are no clear answers whether natural progesterones carry the same risks as the synthetic product used in the Women's Health Initiative study, but there are studies showing the effects are not the same, said Steelsmith. She suggests any woman using natural progesterone should have her hormone levels monitored by her doctor.
• To combat skin aging or wrinkles, Steelsmith suggests a retinol cream, available through dermatologists.
• For vaginal dryness, there are vitamin E suppositories, or estriol vaginal creams, available through a doctor or naturopath. They don't appear to carry the same risks as hormone replacement therapy.