Hot flashes and Japanese herbal medicine: the lowdown on TU-025
Women who choose to go the alternative route for menopausal hot flashes have few evidenced-based options. Although acupuncture and standardized black cohosh have been shown to be effective in ameliorating hot flashes, others, including red clover and even soy, have been less successful. Consequently, herbal practitioners often turn to Traditional Chinese medicine (TCM) herbal formulations or the lesser known (in the U.S.) Japanese multiherb medicinal formulations known as Kampo. Interestingly, the term Kampo refers to ‘the way of China” and the practice which is several thousand years old is based on TCM.
Kampo is prescribed by over 90% of Japanese gynecologists and is regulated by the Japanese Ministry of Health to insure manufacturing standards and product stability. One of the most popular Kampo agents for perimenopausal hot flash management is an 1,800 year old formulaton known as “keishibukuryogan” or in the US, as TU-025. Comprised of a combination of cinnamon bark, peony root, peach kernal and mountain bark, it active ingredient remains unknown. Japanese data from both the government and the manufacturer demonstrate a very low incidence of side effects and no estrogenic activity, which means that theoretically, it could be safely used by women who have had breast or gynecologic cancers. Nevertheless, its utility in American women has not been known, at least until now.
In a study published in the August issue of Menopause, 178 postmenopausal women were randomly assigned placebo, 7.5 g/daily TU-025 or 12.5 g/daily TU-025 for 12 weeks. All participants reported 28 or more hot flashes a week, had been in menopause for at least a year, had stopped using hormones for at least 8 weeks if they were already using them, smoked less than 10 cigarettes a day and most were slightly overweight or obese (based on body mass index). None were using antidepressants (which studies have shown may help alleviate hot flashes), nor did they have a history of breast or uterine cancer. While the 7.5 gram daily is the dose taken most often by Japanese women, the researchers upped the dose to 12.5 gm daily to account for a larger sized American woman.
Read MoreMeditation in motion: Tai Chi and the ‘pause
I’ve written about yoga and meditation/mindfulness training and how both may help with menopausal symptoms in terms of alleviating stress and improving overall wellbeing. However, what about Tai Chi?
Tai Chi is an ancient Chinese martial arts practice that uses a self-paced system of soft flowing movements to improve respiration and deep relaxation. It has also been shown to boost muscle strength, coordination and physical condition, improve balance and like yoga and mindfulness training, benefit overall wellbeing. On the health side, it’s been linked with better sleep quality and duration, enhanced circulation and in fact, is considered a weight-bearing exercise akin to aerobic exercise of moderate intensity. As such, it may even help prevent osteoporosis. Yet, unlike regular strength training Tai Chi appears to offer an important means by which risk of metabolic heart disease during menopause may be reduced.
For women specifically, hormonal changes – namely a steeply progressive increase in testosterone — can contribute to a risk of developing metabolic syndrome (i.e. the cluster of risk factors — abdominal fat, high blood pressure and cholesterol levels and insulin resistance –that increases the likelihood of developing heart disease and diabetes). Moreover, as women age, the ability to effectively metabolize blood fats and maintain ample antioxidant defenses in their bodies requires higher maximal aerobic capacities (which inherently decline with age). Conversely, being sedentary deteriorates the efficiency by which fats are burned or utilized by the body and also negatively affects antioxidant defense lines and their ability to adapt to sudden or chronic exposure to oxidative imbalances in our bodies that can wreak havoc on cells and lead to build up of plaques and heart disease.
Where does Tai Chi fit in?
Yogic pranayma breathing has been linked to improvements in antioxidant capacity and in lower oxidative stress markers. Moreover, it may also improve cardiorespiratory function. Tai Chi combines postures with slow, deep breathing (i.e. 6 breaths per minute) and may also convey the same benefits. In a recent study published in the Journal of Aging Research, 8 premenopausal and 7 post menopausal sedentary women were asked to participate in an 8-week Tai Chi program that involved the following:
- 75 minute training sessions twice weekly consisting of a 5 minute check in, 10 minutes of stretching/warm-up, and 60 minutes of a modified 18-posture Tai Chi and Tai Chi fan style. The Tai Chi routines coupled breathing to music, took a minute to a minute and a half per motion. The women learned five to 10 postures per week and the complete set was practiced for two weeks. Instructors were also sure to monitor and correct postures during each class.
- Twice-weekly, 60 minute at-home practice that also included completion of a log that detailed the practice (to insure compliance).
- Measures of body weight, diet, physical fitness, balance, flexibility, muscle strength, maximal aerobic capacity and blood samples.
Not only did 8 weeks of Tai Chi practice significantly improve balance, muscle strength and flexibility in both groups, but also produced as much as an 18% decline in a major marker for heart disease risk (i.e. plasma total homocysteine). Additionally, Tai Chi combined with measured, slow deep breathing improved the activities of antioxidant markers in the bloodstream that play a role in defending cells against damage from oxidative stress.
Although this study is quite small and bears repeating with significantly higher numbers of women, the findings do imply that Tai Chi and slow deep breathing have the potential to play an important role in improving functional/physical declines that occur during menopause and equally if not more importantly, improve antioxidant defenses against metabolic diseases, especially heart disease. Tai Chi is not only low impact, low-velocity and safe, but within the framework of menopause, it may prove to be a golden ring amongst alternatives to prevent disease. Meditation in motion, indeed.
Read MorePuffing away the years: smoking and early menopause
A few years ago, I wrote a post linking cigarette smoking to early menopause. And yet, questions remained about duration of smoking and the quantity of cigarettes in terms of their influence on timing. Hence, I thought that it might be worthwhile to take a closer look at the issue and see if there was more information.
A few facts:
It’s estimated that by the year 2030, there will be over 1 billion menopausal women in the world, with roughly 47 million women entering menopause annually. Yikes! That’s a whole lotta hot flashes, night sweats, mood swings and the like. And, what this means is that information is power (and empowering). Importantly, research has also shown that early menopause is associated with greater mortality, heart disease cases and osteoporosis. In fact, for every year that menopause is postponed, there is a 2% reduced chance of death due to heart disease. On the other end of the spectrum is late menopause, which is also associated with health issues, including an increased risk for breast, ovarian and uterine cancer.
So, what are the factors that appear to determine the timing of menopause? Well, things like obesity, alcohol consumption, mother’s age, social class, long menstrual cycles, multiple childbirths, oral contraceptive use and even exposure to pesticides have been linked to later menopause, while smoking has been shown in multiple studies to increase the likelihood for early menopause. This issue may be even more relevant for the late Boomer generation who came to age in the 70s, a time when cigarette and marijuana smoking were the norm and not the exception. That generation, by the way, is my generation.
Here’s what we know:
In a thorough review of 109 published studies, researchers have found the following:
- Current smokers appear to enter menopause anywhere from 2.5 months to 2.5 years earlier than non-smokers and have 1.3 to 1.7 times greater odds for early menopause
- Former smokers appear to start menopause as much as 2 years earlier than non-smokers, with the risk ranging from 30% to as high as 80%
- Although there is not a lot of information on the severity of smoking habit and menopause (i.e. number of cigarettes smoked daily), there is some indication that women who smoked more than 20 cigarettes daily were likely to start menopause as much as 2 years earlier than women who smoked 11 to 20 cigarettes daily
- The relationship between number of years having smoked and early menopause is unclear
There are numerous reasons why smoking may lead to earlier menopause, including interference with estradiol levels, an increased loss of eggs and an increase in the levels of androgen hormones, which counteract activity of estrogen in the body. And, despite the differences between the studies that the researchers examined, they say that a clear link was demonstrated between smoking and starting menopause at an earlier age. The impact of quantity and time (or years) smoking is less consistent and still not completely clear.
The overriding message is that if, like me, you are a former smoker, you might find yourself in a position of starting menopause a wee bit earlier than expected. Consequently, there’s no time like the present to start taking preventive measures, like increasing calcium intake, changing your dietary habits or improving your exercise regimen. Mind-body exercises like meditation or yoga can ameliorate stress and improve overall wellbeing. And black cohosh? Personally, I swear by it. In concert, these steps might shut down or at least keep the magic menopause dragon at bay.
Read MoreFeeling anxious? It may be those hot flashes!
Researchers say that there may be a link between hot flashes and certain types of anxiety. In fact, hot flash symptoms — increased heart rate and feeling flushed — have been shown to mimic feelings associated with somatic anxiety, i.e. butterflies in the stomach and tension (as opposed to affective anxiety, which people feel panicked or afraid or nervous).
Importantly, data have shown that as much as 8 months before premenopausal women start experiencing or reporting hot flashes, their scores on an anxiety index are off the charts, which means that constant butterflies or tension may be predictive of the move into menopause. The reason this is important is that they may be steps you can take now to address symptoms as they start to emerge, yoga and deep breathing for example, which not surprisingly, are often recommended to address anxiety symptoms.
The latest bit of information to hit research circles involves a study of 80, healthy, well-functioning menopausal women who were asked to keep a daily diary on hot flashes or night sweats (defined as a feeling of warmth or heat accompanied by sweating, pressure or rapid heartbeat occurring while awake or during sleep). In the diary, participants were asked to record how often hot flashes occurred over a one-week period as well as their severity. They were also asked to rate any symptoms of anxiety based on how often they occurred.
The results?
Higher scores of anxiety related to tension and butterfly-like feelings but not to panic or nervousness were significantly associated with more severe and frequent hot flashes or night sweats, even when factors such as sleep quality, age and education levels, all which might affect anxiety levels, were factored in. Age in particular is important because hot flashes tend to wean through the menopause as women grown older.
The reason this preliminary research is important is that it is possible that anxiety that women experience during menopause is actually related to hot flashes, rather than a specific mood disorder. By shifting the viewpoint to the true culprit, healthcare practitioners and women alike, might be able to better diagnose and more appropriately address anxiety symptoms, rather than leaning towards prescription mood treatments that are uncalled for.
At the same time, more research is needed. This was a small group of healthy, white women who were asked to self-report hot flashes/night sweats and anxiety symptoms. Although most of the research on hot flashes does rely on self-report, objectivity can be lost. What’s more, because these women were psychologically healthy, it’s hard to apply any conclusions to older women who might be seeking assistance specifically for anxiety.
So, are you feeling anxious? Depending on your age and menopausal status, it might be a harbinger of the flash or due to the flash. Either way, it’s worth considering.
Read MoreHot Flasher
[youtube=http://www.youtube.com/watch?v=glAPFCKiB6g]
[Disclosure 1: just substitute the words “hot flasher!” Disclosure 2: This song has been on my mind lately so needed to find a way to work it into the blog – thanks for indulging me!]
A new study published in the online edition of Menopause Journal has shown that hot flashes influence sleep in a stepwise or graduated fashion.
In this study, researchers analyzed data from 217 postmenopausal women between the ages of 40 and 60 years; information about hot flash frequency and severity was recorded in a daily diary, and sleep-wake patterns measured over an average of seven 24-hour periods in a subset of 112 women.
The results showed an association between moderate to severe insomnia frequency and severity of hot flashes and:
- Greater nighttime wakefulness
- A higher number of long wake episodes
So what can you do?
I’ve posted previously about the wonders of yoga to both sleep disturbance and flashes. Acupuncture might also help. And of course, that old black magic…cohosh.
Short of that…well, nothing like a little Pat Benatar…
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