Controversies about the Value of Natural Medicine for Women’s Health

Introduction
There is no doubt that millions of women are using alternative strategies to deal with menopause and menstrual dysfunction but argument continues about the value of these alternative strategies. In any review of literature on the many disciplines of alternative medicine, one can find many suggested treatments for menopause or PMS. These alternative medical disciplines can be simply classified into evidence-based, e.g., nutritional care, homeopathy, acupuncture and chiropractic medicine, or of anecdotal benefit, e.g., music therapy or crystal therapy. It is not possible to summarize the value of many of these different non-conventional management strategies for PMS or menopause. I am of the opinion that any safe and gentle, natural option that may improve health and well-being in the menopause or PMS is worthy of exploration. There is no doubt that the many methods of inducing a “relaxation response” are valuable e.g. meditation, Yoga etc.

Continuing Controversies About Natural Medicine
In 2005, the National Institutes of Health (NIH) convened with a panel of “experts” on the management of menopausal symptoms. While this panel was composed of medical and scientific “experts,” the background training and experience of this panel in the practice of natural medicine must be questioned. I question some of their position statements that concluded with a lack of evidence to support the use of botanicals, herbs, acupuncture, homeopathy, traditional Chinese medicine or other alternative “medicines” for menopause. These experts claimed that studies of alternative or natural ways to manage menopause were scarce, not performed with adequate scientific rigor or were non-existent. Perhaps some wider education in natural medicine may be required among this group.

On a bright note, the NIH panel acknowledged evidence that “botanical treatments” may be helpful for menopausal symptom control, but they denied that exercise improved symptomatology. These findings must be questioned when the NIH group described the inability of one quarter of all menopausal women to break their dependence on conventional HRT. A study performed by Kaiser Foundation researchers showed that of 377 women who tried to stop HRT, about 25 percent resumed HRT within six months. A clear case of HRT dependence with double jeopardy?

Managing menopause focuses too much on discussions about treating hot flashes. Conventional therapies for hot flashes with drugs possess many disadvantages. There is a general consensus opinion that estrogen is the most effective way of managing hot flashes—but at what risk? This knowledge makes some physicians cling to the use of HRT, but they often look towards only short-term low-dose estrogen treatments using partial mixtures of xenoestrogens (Premarin®). Unfortunately, short-term estrogen supplementation often leads to long-term estrogen replacement.

Drugs such as clonidine, tibolone, alpha-adrenergic agonists and antidepressants (SSRI), are not as good as estrogen at treating hot flashes; and in many cases, they are not as effective as well-formulated dietary supplements combined with lifestyle changes. Clinical trials of these second-tier drug treatments for hot flashes show common medication side effects and lack of compliance with medication.

Hormonal manipulation with androgens for hot flashes is effective, but perhaps not safe. Selective estrogen receptor modulating (SERM) drugs have a checkered history in treating hot flashes. If hormones are given for hot flashes, a reasonable choice is probably topical progesterone cream, but results can be variable. Overall, one can recognize many reasons to exercise the natural options for PMS and menopause as the first course of action.

Summarizing Some Women’s Health Issues in Natural Healthcare
Natural alternatives to conventional hormone-replacement therapy are being used by an increasing number of women with symptoms of the menopause or PMS. While dietary adjustments with soy and lifestyle changes can provide comfort around menstruation or menopause, benefits are often considered to be minor by many conventional physicians. Women should bear in mind the fact that many conventional physicians are not knowledgeable about natural medicine. Distorted perceptions about the value of remedies of natural origin should not turn women away from alternative treatments for PMS and menopausal symptoms, because there needs to be an educated approach to effective natural ways to women’s health and well-being. The commonest reasons why women seek remedies for menopausal symptoms are the occurrence of insomnia, hot flashes and sweating episodes. I believe strongly that these symptoms are often amenable to the correct use of remedies of natural origin and emerging research supports this point of view.

There is no doubt that conventional HRT or ERT are effective ways of suppressing unpleasant symptoms of the menopause, but the risks of the use of these agents often outweigh their benefits. The newer options of bio-identical hormone treatments are proposed as safer and perhaps more effective than conventional HRT, but debate continues (Chapter 4). One cannot assume that all natural alternatives are safe and some individuals have reacted against the use of combination products containing herbs, botanicals and nutrients. I believe in the synergy of certain dietary supplements and I disagree strongly with fickle opinions that question the beneficial use of multiple natural agents that can have additive benefits. This power of synergy in supplement formulations is to be applied when no adverse interactions are present among different natural components (Holt S, The Anti-Aging Triad, 2011, www.stephenholtmd.com).

Some nutritional scientists argue monotonously that concentrated components of food, such as soy isoflavones from soybeans, have not been investigated in long-term use. I find these arguments to be typical of armchair scientists who often talk about doing everything with diet rather than supplement use. Changing the dietary habits of the population is a monumental task. Therapeutic (treatment) components of foods, herbs or botanicals need to be taken with a degree of consistency in order to achieve the benefit. Even with the most meticulous approach to shopping and food preparation, it is impossible for the active adult to plan a diet with metered amounts of health-giving constituents derived from food. There is often little nutritional value in “convenient” foods sold in the average supermarket. This situation underscores the value of dietary supplements for health maintenance.

Perhaps the best example of support for the use of dietary supplements comes from the dietary application of soy foods containing isoflavones. Commercial soy foods are not standardized for their health-giving content of isoflavones. For example, high-quality soy milk contains anything ranging from about 4 to 14 mg. of total isoflavones per 100 ml. Commercial tofu varies in its isoflavone content greatly In order to obtain a sufficient dosage of isoflavones from some commercial forms of tofu, a woman many have to consume up to one pound of tofu per day. Deriving soy isoflavones in this way may result in many women “choking on the end of a spoon of tofu.” Therefore, concentrated supplements containing isoflavones are convenient and effective for many women, with a high degree of acceptability and safety (in dosages of less than approximately 100 mg. of total isoflavones per day).

I agree that much further research is required in the use of natural products for menopause or PMS relief, but I am not optimistic that this research will be rapidly forthcoming. Unlike pharmaceuticals, dietary supplements are not often proprietary and they cannot be subjected to the “exclusive, economic model of drug purveyance.”
Consumers are increasingly aware of the benefits of natural products for menopause and PMS relief and they are seeking evidence-based formulations. Many women are pausing and questioning who formulated the dietary supplement that they may have an intention to use? In the absence of reasonably comprehensive research information on dietary supplements, women are advised to use formulations that are proposed by individuals with biomedical training and clinical experience. Does the formulator of dietary supplements have medical training or patient-treatment experience? Does he or she have biomedical credentials? These are questions that are increasingly asked by informed users of dietary supplements.

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