Alternative medicine and the ‘pause: what your gynecologist is thinking
Women rank among the highest consumers of complementary and alternative medicine for their healthcare, and according to the National Center for Complementary and Alternative Medicine, age matters. In fact, the largest percentage of adults reporting that they use alternative medicine strategies are 50 to 59 years old, and as many as 42% discuss their use with their doctors. However, what does your gynecologist think about complementary and alternative medicine use? Is she or he supportive and what modalities tend to rank highest in terms of recommendations or endorsements? Moreover, how do gynecologists differ in their opinions?
In the U.S., most ob/gyns appear to believe that convention medicine practices for reproductive issues might benefit by the integration of complementary strategies. However, most of the positive beliefs focus on biofeedback, chiropractic, acupuncture or meditation. Conversely, the doctors report that they would not recommend dietary changes or Traditional Chinese Medicine and a majority were not strong supporters of herbal medicine. This is in direct conflict with German gynecologists. But why should we care about the Germans and what they think!!!?
To digress, I don’t know how many of you are familiar with the Commission E Monographs but, they comprise the world’s leading scientific summaries on the use of medicinal herbs in health and disease. In the late 1970s, the German Ministry of Health established Commission E, a panel of experts charged with evaluating the safety and efficacy of the herbs available in pharmacies for general use. In all, the group published 380 herbal monographs that are considered “the most accurate information available in the entire world on the safety and efficacy of herbs and phytomedicines.” Hence, the Germans definitely have a leg up when it comes to alternative medicine, at least when it comes to the use of herbal alternatives.
So, let’s take a look at a similar survey experience newly published in Complementary Therapies in Medicine, in which over 2,500 respondents indicated a familiarity with the use of alternative medicine specifically for menopausal symptoms. Almost all of the gynecologists had some experience with black cohosh, chaste tree berry and St. John’s Wort and believed them to be effective. And the modality that they felt was most effective? Lifestyle changes and alteration (think: change in dietary habits, physical activity, reduction of stress, etc). The least effective strategies, at least in the eyes of German doctors, were yoga, acupuncture and homeopathy.
The researchers point out that the viewpoint of German doctors is important because these practitioners play an important and consistent role counseling women who complain of menopausal symptoms. The same is true for their U.S. counterparts. And yet, despite the wealth of data in the Commission E monographs, many doctors still continue to question effectiveness and scientific evidence supporting the use of alternatives.
Will this make a difference with regard to the choices that women are making? Probably not, because as I’ve been writing for years, one size does not fit all, especially when it comes to weighing the benefits versus the risks of hormone replacement.
The next time you have your annual with your gynecologist, find out what she or he thinks of complementary and alternative and strategies and most of all, ask why. What she or he is thinking might not be aligned with what you find works best for you.
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Wednesday Bubble: herbs and breast cancer
Can herbal medicines used for hot flashes, namely black cohosh and phytoestrogens, be safely used in women who’ve had breast cancer?
If you’ve had breast cancer, you’ve probably been told to stay away from herbal medications, right? Yet, women who’ve had breast cancer know that hot flashes are a common side effect of many cancer therapies. Research also suggests that the older a woman is at the time she receives chemotherapy, the more likely she is to develop menopause as soon as treatment stops. Moreover, roughly 80% of women taking Tamoxifen have hot flashes and about a third of those women rate them as severe. Hormones are not even an option due to the increased breast cancer risk.
The good news is that an extensive analysis of scientific studies shows that black cohosh might be safe for women who have had breast cancer. Although the researchers note that the evidence for the effectiveness of black cohosh for alleviating hot flashes is mixed, they cite research from the National Institutes of Health and other reviews that suggest that use of black cohosh in former breast cancer patients requires only standard screening. They also report that there is “little reason for excluding patients with estrogen-responsive tumors from using black cohosh.” In fact, recent laboratory studies, although not yet carried out in humans, suggest that black cohosh may actually protect the breast from developing tumors.
The case for or against the use of phytoestrogens (e.g. soy, red clover, chaste tree berry and flaxseed) in women with breast cancer is not quite as clear as it appears to be for black cohosh. In one of the largest reviews examining soy or red clover for menopausal symptoms, the outcomes were equivalent to placebo. Other studies have shown that they might be beneficial for women with mild to moderate symptoms who start menopause early. Moreover, while red clover in particular does not appear to affect certain breast cancer risk markers, reports about phytoestrogens in general, especially in estrogen positive cancers is conflicting. Still, the American Cancer Society does not advise against eating soy-rich foods by women who’ve had breast cancer. Some studies have also showed improved prognosis.
If you are wondering if there are any drawbacks, one of the largest challenges is that there are not that many studies looking at herbal medications in women with breast cancer and the ones that do exist are mostly short in duration. The researchers point out that because herbs can take awhile to work, a three month study might be too short to form a conclusion.
Clearly, more study is needed. In the interim, it appears both black cohosh and soy might be safe to try if you’ve had breast cancer. As always, the most important consideration is to speak to a certified practitioner who is well versed in herbal medicine and make sure that she or he works with your oncologist.
Navigating the Maze, Part 2
In my last post, I wrote about navigating the maze of perimenopause symptoms and treatments. This is a continuation of an interview I had with NYC-based acupuncturist and Chinese Medicine Specialist, Elaine Stern.
When I last left off, we were discussing useful Western herbs for addressing perimenopausal symptoms.
Are there other herbs than black cohosh that are helpful for perimenopausal symptoms?
Chaste tree berry is a very useful herb for perimenopause since it targets the “luteal phase” of the menstrual cycle. It helps the body become more efficient in terms of ovulation and progesterone production, and may be useful for women experiencing irregular cycles or PMS symptoms.
You mentioned nutrition earlier. How is this different than herbal medicine? Afterall, we’re taking supplements, right?
Nutrition, like acupuncture and herbal medicine, is a fairly diverse field. However, unlike the literature has not caught up with its practice. It’s also confusing because we may read the newspaper one week and see a study saying we should take vitamin X, and then the next week, see that it’s been linked to cancer.
When it comes to nutrition, it’s important to understand the body’s physiology and biochemisty and focus on nutrients to increase natural function and actions. With regards to perimenopause, you may recall that we discussed the build-up of excess estrogen. Vitamin B6 has been shown to be very important in helping the liver clear the estrogen out of the body. While things like diet are undoubtedly the most efficient way to obtain B6, well, the way that we eat and the way that our food is grown can interfere with the ability to get as much as is needed. With a little extra, we can assist the body’s ability to clear the estrogen, thereby addressing water retention and other PMS symptoms.
Do women need to stay on treatment the entire menopausal transition?
Well, it’s important to stay on some sort of program for a period of time. This will vary from person to person.
What should women look for in a practitioner?
With Chinese medicine and acupuncture, the practitioner should be licensed and have national board certification. If their specialty is nutrition, it’s helpful to inquire about education and experience. And most of all, find out if the practitioner has a specific interest or area of practice that focuses on gynecology and internal medicine.
Anything else you’d like to add?
I want reiterate that herbal and nutritional products are completely unregulated and there’s a huge variety in quality. Whatever you can learn about the way that a product is manufactured and with what type of oversight, the better. So, I’d recommend that women look at the labeling for buzzwords like “standardized,” “good manufacturing of products,” things like that, but with the knowledge and understanding that there is no oversight with regards to the marketing of these substances. Again, this is a good reason to see a practitioner, at least to get started as he or she can be useful for creating a program and guide you to good sources for herbs and nutritional products.
Finally, this is medicine. Women need to understand that they are tinkering with their hormonal balance and even if the products aren’t toxic, it’s important to look beyond the symptoms and understand what’s going on physiologically. So, I truly believe in the importance of speaking to someone who can understand your individual changes and then recommend something. At the very least, women should see someone at least once to insure that they are on the right track.
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