Black cohosh, Vitamin E, dong quai, soy, red clover, wild yam. Women's heads are swimming from advertisements for natural alternatives to hormone therapy after a second trial was suspended in February by the National Institutes of Health. The estrogen-alone study showed an increase in risk of stroke. A NIH estrogen-plus-progestin study was stopped in 2002 because the risk for breast cancer, coronary heart disease, stroke, and blood clots increased.
Dr. David Brownstein stopped prescribing hormone therapy 10 years ago when research evidence began mounting on potential harm. His patients come to the Center for Holistic Medicine in West Bloomfield looking for alternatives to relieve hot flashes, fatigue and other menopausal symptoms.
"I tell them to get their hormonal system balanced. Change their diets; get refined sugar and carbohydrates out of their diets. Eat whole foods," said Brownstein, a doctor in family practice. "Make sure they get the appropriate vitamins and minerals. The biggest thing is getting their diet cleaned up, drink enough water. It helps to balance the hormonal system. If need be to use natural hormones Ð natural progesterone, testosterone and estrogen. I try to individualize the therapies. Exercise is a help to everything, walking. Getting the lymph system moving allows people to detox their bodies."
Dr. Michael Seidman has seen hot flashes eliminated or reduced in women taking a combination of herbs he formulated from dong quai, red clover, soy isoflavones, wild yam, and chasteberryfor Body Language Vitamin (www.bodylangvitamin.com). Seidman regularly recommends it to patients at Henry Ford Health System's Center for Complementary and Integrative Medicine in Novi where he is director. The center treats women in menopause with a combination of traditional Chinese herbs, acupuncture, holistic medicine, and nutrition. Like Brownstein, Seidman believes diet plays a major role. He suggests increasing soy intake and phytoestrogens in whole grains, fruits, vegetables, flax seed, millet, rye, and legumes, and avoiding processed and high fat foods."There's so much evidence already out there that it makes sense to try some of these alternatives," said Seidman, an ear, nose and throat surgeon for Henry Ford Health System. He's currently researching the effects of a red wine extract on aging. "I've seen outstanding results. The average physician is going to say there is no evidence of its effectiveness, until there is to tread carefully. Natural alternatives are lower doses and safer and effective in many cases."
Safety and efficacy of herbs remains to be determined. Dr. Phil Stella and researchers at St. Joseph Mercy Hospital are working with Mayo Clinic and the North Central Treatment Group to find a remedy for hot flashes. They recently finished a study on black cohosh but won't have results until fall.
"There's so much money spent on complementary therapy, these things need to be tested," said Stella, director of the cancer program at St. Joseph's in Ann Arbor. "Reports from Germany, the Mayo Clinic, suggested black cohosh might be effective for hot flashes so we did the trial. Vitamin E we did a study that showed a slight benefit, a 39 percent reduction."
Dr. Dan McMurtrie calls results from the Women's Health Initiative study a boulder on the scale tipping towards alternatives. He offers a variety of approaches to patients at the Menopausal Clinic in the Women's Health Center at St. Joseph Mercy Hospital in Ann Arbor.Some of McMurtrie's patients get relief from black cohosh, some don't. Red clover is another option but there's not as much evidence that it works. Others find relief with soy isoflavones.
"Depending on symptoms they can make lifestyle changes, avoiding triggers like hot drinks, alcohol, heat and cold extremes. Caffeine enhances flushing," said McMurtrie, chairman of the OB_GYN department and director of the Menopausal Clinic at St. Joseph Mercy Hospital. "As for nonprescription remedies sold over the counter there are only two that have some efficacy. There are many studies with conflicting results on black cohosh with the most evidence to support effect, but it's unknown about long term risk."
Dr. Yuvelle Eaton-McFarland gives patients at Integrated Health Associates in Canton a choice that includes hormone therapy. Conventional medicine's current recommendation is to use the lowest dose for the shortest time needed, and not to use as a preventative for heart disease but only to treat severe menopausal symptoms.
"Some women go with black cohosh or soy. We don't know about these. They're not studied as in depth but if it works for them. I don't know of any studies that increase the risks," said Eaton-McFarland, an obstetrician-gynecologist at St. Joseph Mercy Hospital.
"For all women I recommend annual checkups, eating healthy, exercising 20 to 30 minutes three days a weeks, and have fun. Enjoy every moment."