September 1974 was an exciting time for me. I had just started medical school at Jefferson Medical College in Philadelphia. I recall sitting in a biochemistry lecture thinking to myself that in the next four years I was going to learn the secrets of the human body, information offered to very few people. I was in awe of American medicine at that time thinking that doctors could do no wrong. American medicine was second to none.
Unfortunately over time, those ideas and conceptions I had about American medicine have radically changed. Physicians all too often do not have the answers although they think that they do. Gynecologists and general practice medical doctors for the last many years have been routinely recommending hormone replacement therapy (HRT) for their post-menopausal patients. They had a high level of confidence in estrogen/progesterone replacement, believing that not only did this therapy protect the post-menopausal woman’s heart but also her bones and even her brain.
A rude awakening came to American medicine last year when Journal of the American Medical Association (JAMA) reported on a several year study involving over 2,700 post-menopausal women. It was found in the study that hormone replacement did not have any overall cardiovascular protective effect compared to the placebo group. As a matter of fact, in the first year, patients taking hormone replacement actually had a two-fold increase risk of developing cardiovascular disease compared to the placebo group. It was concluded that post-menopausal hormone therapy should not be used to reduce the risk for cardiovascular heart disease.
When I read this study last year, I just shook my head. It was once considered an absolute certainty in the eyes of the medical community that hormone replacement therapy did have a beneficial effect for cardiovascular disease. I was equally shocked to read about another negative study about hormone replacement therapy published this week in the JAMA. This study was an offshoot of last year’s published study. It was reported that women who took hormone replacement therapy for an average of more than four years actually doubled the risk of developing Alzheimer’s disease and other forms of dementia compared to those individuals taking placebo. The figures worked that in one year for every 10,000 women taking the combination estrogen and progesterone therapy, 23 more cases of dementia developed as a result of this hormone replacement therapy. The cause of this is uncertain although it is suggested that hormone replacement therapy increases the risk of stroke and brain damage which can lead to or cause progression in dementia.
I am sure the doctors that have prescribed hormone therapy to the millions of women in this country had no intention of causing any ill effects. Based on the available medical information at the time, hormone replacement therapy was considered essential for post-menopausal women. Those days are over. It seems to me, based on these two studies that it will be the rare post-menopausal women that will continue taking this therapy.
So what about those women suffering with post-menopausal symptoms of hot flashes, sweats, irritability, etc. There is another option… natural or plant based estrogens known as phytoestrogens. People have been consuming plant estrogens in the form of soy for decades without any apparent ill effects. As a matter of fact, there have been several recent studies in the medical literature indicating the beneficial effects of soy phytoestrogens. In one study published in October 2002 in the journal Diabetes Care, a group of post-menopausal women with Type II diabetes mellitus were randomized to receive 132 mg daily of soy isoflavones versus placebo for twelve weeks. At the end of the study, those women on the dietary supplementation favorably altered insulin resistance and blood sugar control along with improving the ratio of total cholesterol to HDL cholesterol.
In another study published last year, genistein (a natural isoflavone phytoestrogen) showed positive effects on bone loss. There was even a small study published in 2001 indicating that foods rich in isoflavone phytoestrogens could have a beneficial effect on memory. Student volunteers were randomly assigned to receive either 100 mg a day of isoflavones or 0.5 mg isoflavones daily for ten weeks. Students receiving the high isoflavone diet showed significant improvement in short term and long term memory. These improvements were noted in both males and females.
For women currently taking hormone replacement therapy, I recommend a natural alternative. One capsule of this product contains soy extract standardized to 40% isoflavones providing 150 mg of isoflavones. In addition, it contains dong quai extract at 100 mg. This particular herb has been shown to help with pre-menstrual syndrome and cramps. The product also contains black cohosh and gamma oryzanol which have been used successfully by women with hot flashes.
Other nutrients I recommend to women include omega-3 essential fatty acids (EFA), magnesium, B-complex vitamins, calcium citrate malate, vitamin D and magnesium. The optimal levels of B-complex vitamins are much greater than the DV/RDA levels in most multivitamins. Most people consume far less than optimal levels of calcium (1,200 mg is optimal while you diet only supplies about 700 mg) magnesium (400 – 500 mg day is optimal) and EFA (500 mg – 2,000 mg per day is optimal). Numerous medical studies have shown that these nutrients reduce heart disease and stroke risk, PMS, menopause symptoms and even reduce cancer risk.
Unlike hormone replacement therapy, these natural nutrients are basically free of side effects making them the natural and safe alternative to hormone replacement therapy. As always, we recommend consulting your doctor before taking any nutritional supplements, especially if you are taking any prescription medications.
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