Every human being is the author of his own health or disease.
—Buddha
When it comes to treating perimenopausal/menopausal symptoms, can—or should—you bypass prescription medications and instead find effective natural approaches? The answer really depends on the severity of your symptoms, as well as your risk factors.
If your symptoms are not especially severe, you may want to try natural approaches, to see if you get any relief and are able to get symptoms under better control so that they are not interfering with your overall quality of life. If you have issues in your medical history that should make you think twice about prescription hormones (for example, a higher risk of breast cancer), then you also may want to try natural approaches, and evaluate the results, before committing to riskier prescription hormone therapy.
The overriding question is this: are natural approaches effective for perimenopausal/menopausal symptoms? The evidence is mixed. But in practice, whether due to each woman’s individual physiology or the skills of the practitioner, some women do find relief from symptoms using complementary, herbal, and other alternatives. So even though we don’t have conclusive evidence proving the effectiveness of some of these approaches, that does not mean you should rule them out.
Natural Supplements
One piece of advice about supplements that I think is important to keep in mind comes from holistic hormone expert Uzzi Reiss, MD. According to Dr. Reiss, we should always try supplements one at a time and give them a few weeks. That way, we can see if the supplements are working or, while rare, if they are causing any side effects.
Ob-gyn and menopause expert Jan Shifren, MD, hasn’t seen any studies that show that natural approaches are effective for menopausal symptoms, although she says that women certainly can try them.
At the end of the day, though they’re not FDA-approved or monitored, most natural approaches are probably safer than hormones, or antidepressants like Paxil or Effexor. They may be no more effective than placebo, but they are likely safer than the things I can prescribe. I have no concerns about women trying these products, as long as I’ve informed them of the data. Typically, if a woman wants to try natural approaches, I say, “Why not give it a try?” I see them three months later, and if it wasn’t effective, then they can go to prescription therapy.
As many as half of all American women seek alternative or complementary treatments for menopausal symptoms, but reviews of more than seventy different trials and studies have found little to no improvements using herbs, soy, mind–body techniques, magnets, electrical nerve stimulation, homeopathy, or naturopathy.
The key, however, is that the trials of alternatives are usually quite small, and they do not operate in the same way that herbal and natural treatments are given to women by holistic or naturopathic physicians and practitioners, which may be the real key to success. But in order for researchers to “prove” something is effective enough to recommend, they need larger studies and more data. At the same time, the studies usually don’t prove that the therapies don’t work at all. It’s clear, then, that some—but not all—women experience benefits, but you may need to employ a trial-and-error process to see if natural options are right for you.
MACA
Maca (Lepidium meyenii), while not well known, is my favorite natural remedy for perimenopausal/menopausal symptoms in thyroid patients. Since the late 1980s, Viana Muller, PhD, an anthropologist and expert in South American medicinal herbs, has been making rain forest herb collecting and study trips to the Amazon river basin and the high Andes of Peru. Since that time, Dr. Muller has single-handedly championed American interest in maca, a vegetable grown in South America.
Maca is a cruciferous root from the same botanical family as the turnip and broccoli. It grows at 12,500 to 14,500 feet above sea level in the high Andean plateaus of central Peru and is the highest growing food plant in the world. It is believed to be one of the earliest domesticated food plants of Peru, along with the potato.
For centuries maca has been used by the native people of Peru as a highly nutritional food, as well as a remedy for hormone issues like fertility, sex drive, premenstrual syndrome (PMS), and menopausal symptoms. It is rich in essential minerals, especially selenium, calcium, magnesium, and iron, and includes fatty acids, such as linolenic, palmitic, and oleic acids, as well as polysaccharides. Maca is an adaptogen, which means it does not increase or decrease hormone levels, but rather helps the hormonal system adapt and balance itself.
Dr. Muller has been actively involved in researching, growing, harvesting, propagating, and distributing a specialized organic and wild-crafted form of maca known as Royal Maca. According to Dr. Muller, native medicine practitioners and herbalists specifically recommend Royal Maca to
Royal Maca appears to work through the pituitary, helping to balance all of the endocrine and reproductive glands. Says Dr. Muller:
The alkaloids in the maca root stimulate the hypothalamus and pituitary to produce more precursor hormones, which then impact all of the endocrine glands—the pineal, adrenals, ovaries, testes, pancreas, and thyroid gland. So maca appears to be stimulating the body to produce its own hormones more adequately rather than supplying hormones from an outside source.
Maca also appears to have an adaptogenic effect on the immune system, without stimulating the immune system. Research has shown that maca works in an entirely different way than plant hormones/phytoestrogenic herbs/isoflavones like soy, black cohosh, and red clover. Instead, its action relies on plant sterols, which act as chemical triggers to help the body itself produce a higher level of hormones appropriate to the age and gender of the person taking it.
Royal Maca also reportedly helps with thyroid function for people with Hashimoto’s disease and hypothyroidism. According to Dr. Muller:
I was surprised to receive feedback from hundreds of women with hypothyroid issues who have benefited from taking Royal Maca. Most of them were having other hormonal imbalances, such as PMS, perimenopausal or menopausal symptoms and discovered “accidentally” how much better they felt when combining Royal Maca with their thyroid medication.
Since introducing maca to the United States in the 1990s, Dr. Muller has seen a dramatic increase in the use of this medicinal herb by holistic practitioners. She has also personally worked with many women who have used Royal Maca for perimenopausal/menopausal symptoms, hypothyroidism, or both.
The Specifics on Royal Maca
Typically, to support the thyroid, Dr. Muller recommends taking one or two Royal Maca capsules daily with breakfast. (She also does not recommend taking Royal Maca along with prescription hormone therapy, like estrogen.) Some women are concerned that maca, being a cruciferous, goitrogenic root vegetable, could slow down the thyroid. But the precooking process in preparing Royal Maca capsules removes the goitrogenic properties, and there are no reports of goiter promotion from maca usage.
According to Dr. Muller, combining Royal Maca with other hormonal treatments can worsen hot flashes, irritability, sleeplessness, or headaches. Women who want to take maca for perimenopausal/menopausal symptoms should, therefore, not take prescription estrogen treatments, estrogenic herbs like black cohosh and red clover, hormone precursors like pregnenolone, human growth hormone (HGH), soy isoflavone supplements, or adaptogenic treatments like ginseng. Dr. Muller recommends that women wait at least four weeks after taking these medications or treatments before beginning maca. She says that progesterone does not need to be stopped, but that women may find they need less, or can even stop it.
For women who are suffering from perimenopausal/menopausal symptoms who are not taking any prescription estrogen or phytoestrogen supplements, Dr. Muller recommends that you start with one capsule a day (or two, if symptoms are especially acute). After a week, gauge your symptoms; if they’re not substantially better, add a capsule. When you feel that your symptoms are about 80 percent improved, you should remain at that dose, because Royal Maca typically has a cumulative effect over time.
If you go off prescription hormones to start maca, Dr. Muller recommends going “cold turkey.” According to Muller:
If you had hot flashes before you started taking hormones, they will probably return. So after two weeks of taking nothing, you can start taking one capsule a day of Royal Maca. At the beginning of the fourth week, you can take two capsules a day. You will probably continue to experience your hot flashes, however. After four weeks of no hormones, you can increase your dosage of Royal Maca as follows. If your hot flashes are mild (1 or 2 a day), take 3 caps a day. If your hot flashes are moderate (3 to 5 a day or night sweats), you can start with 4 a day. Evaluate after a week. Increase to 6 capsules daily if your hot flashes are not 80% better. If your hot flashes are severe (more than 6 daily and frequent night sweats), start with 6 capsules a day for 5 days. Then, if necessary, increase to 9 a day for another 5 days.
According to Dr. Muller, some women may need even more, but at that point, they may might take 2 teaspoons of Royal Maca powder daily, because it’s more economical. (One teaspoon of powder equals six capsules.)
(Note: Women who are petite or highly sensitive to small amounts of herbs or pharmaceutical drugs should typically cut the dosage in half.)
Another formulation of Royal Maca adds diindolylmethane (DIM). DIM is a compound from plants that can help shift the balance of sex hormones; in particular, it helps stimulate more efficient estrogen metabolism. This allows estrogen to be broken down, or metabolized, into good estrogen metabolites, rather than the forms of estrogen that are responsible for cancer. When estrogen metabolizes too slowly, or metabolizes to “bad” estrogens, women can suffer from breast pain and tenderness. Dr. Muller recommends Royal Maca with DIM for women who have symptoms that suggest inflammation or who have had problems with periods, ovarian cysts, or fibroid tumors.
Maca is considered very safe and rarely has side effects. In a woman taking regular Royal Maca, side effects including breast tenderness, insomnia, jitteriness, and slight depression may indicate some estrogen dominance, in which case the formulation with DIM may help. If the original symptoms return, that may be a sign that a woman has gotten too high a dose and needs to cut back slightly.
As for long-term safety concerns, various clinical trials and animal studies have not found any evidence of adverse reactions or toxicity. As a food product in use for centuries, experts believe that maca has a low potential for toxicity. Studies have not been done, however, that demonstrate the long-term safety in women. Very rarely are people allergic or sensitive to maca. One caution, however: Dr. Muller does not recommend that women with estrogen-dependent cancers or who are on any estrogen-blocking drugs, like tamoxifen, use maca.
It’s important to be aware that low-cost and mass-produced maca may be grown in areas outside the high Andean plateau, cultivated using chemical fertilizers and pesticides, and heat-processed in nontraditional ways that make it ineffective.
My Own Story
In my own case, I took Royal Maca periodically in early perimenopause, because my cycles were becoming shorter and my periods were coming more frequently. After I started taking Royal Maca, I found that my periods weren’t coming as frequently and that the cycles normalized for quite a while.
Later into my perimenopause, my cycles became classically unpredictable, with long gaps (as much as forty to sixty days) between each period. This is also when I started to develop hot flashes. I did not have what I consider severe hot flashes: I usually had two or three a day, more often in the evening around bedtime. (But I was not waking up with night sweats, and I didn’t have rapid heartbeat or other issues associated with hot flashes.) Remembering how Royal Maca had worked to help regulate my periods, I started taking it again. Much to my surprise, within a few days, my hot flashes stopped. As I go to press, I am still in perimenopause, and I am still on Royal Maca. (I’ve been able to get hot flash relief at two capsules a day, but to avoid breast tenderness I was getting as a side effect, I eventually switched to the Royal Maca with DIM.)
MELATONIN
Many women are aware of the benefits of melatonin as a sleep aid, but what you may not realize is that melatonin can have powerful hormonal effects for women in perimenopause and menopause.
Melatonin is a hormone produced by the pineal gland, which is located in the brain. The pineal is the master controller of our body’s clock, including our day-to-day circadian clock that tells us when to sleep and when to wake and the biological clock that decides on bigger hormonal issues, such as when we enter puberty and menopause.
The pineal gland controls the circadian rhythm—our daily cycle of sleeping and waking—by releasing a hormone called melatonin, produced primarily at night. Melatonin synthesis and release are stimulated by darkness.
The pineal also contains thyrotropin-releasing hormone (TRH), which the pineal uses to tell the pituitary to produce thyroid-stimulating hormone (TSH). Melatonin is also apparently instrumental in the breakdown of thyroxine (T4) into triiodothyronine (T3), creating heat and energy.
Based on its role in circadian rhythm and sleep, melatonin has become well known as a helpful sleep aid, as a treatment to help prevent jet lag and reset the body clock to a new time zone or to help night shift workers who have difficulty sleeping.
It was as a sleep aid that I first started using melatonin nightly, at one point over a year ago. I had been waking up more frequently and found myself often unable to fall back asleep. Then, when I woke in the morning, I felt fuzzy-brained and tired, even after eight or more hours of sleep. I started taking a low dose of melatonin (3 mg), which I took around 11:00 p.m., about an hour before I usually fell asleep. What I found was that I woke less frequently, and when I did, I was able to turn over and fall back asleep easily. Even better, I was waking up in the morning feeling refreshed and energetic, in a great mood. Even more surprising, I was actually waking up a few minutes before my alarm. (This is definitely not characteristic, as I typically was one of those people who hit the snooze bar multiple times, and only then begrudgingly dragged myself grumpily out of bed. So waking before the alarm and feeling great was quite uncommon.)
When I started taking melatonin, I was also well into what I thought was menopause. My last period had been more than five months earlier, and even before then, they’d become erratic again. I had weathered a period of hot flashes (using the maca, as mentioned earlier), and the hot flashes were gone. I’d seen my physician, who found that I had extremely high levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH)—markers that can confirm menopause in a woman who isn’t having any more periods—and my estrogen and progesterone levels were low. So my doctor and I both assumed that I was in menopause; all I needed was to go the full twelve months without a period, and it would be official. And so what happened next surprised me.
About two months after I started taking melatonin, my periods came back. And when they came back, they were very normal. They weren’t unusually heavy, as they had been before. The color was red, not brown, as they had been six months earlier. And, perhaps most surprising of all, they started coming regularly every twenty-eight days.
I didn’t immediately connect the melatonin with the return of a normal menstrual cycle. But with nothing else changed in my regimen, I had to wonder if a normalized menstrual cycle in perimenopausal/menopausal women was a known side effect of melatonin. I delved into the research. That’s when I discovered Dr. Walter Pierpaoli and his ground-breaking research on melatonin.
Melatonin and Our Hormones
Walter Pierpaoli, MD, created a sensation back in 1996 with the release of his book, The Melatonin Miracle: Nature’s Age-Reversing, Disease-Fighting, Sex-Enhancing Hormone. The book was a bestseller, and Dr. Pierpaoli’s Melatonin Miracle introduced Americans to melatonin, which had just become available over the counter in the United States a few years earlier, and its roles as sleep aid, jet lag remedy, immune enhancer, antioxidant cancer fighter, stress reducer, and cure for low libido.
But the book was not a one-time effort by Dr. Pierpaoli. For decades, he has been researching and studying melatonin and its effects, and he continues to do so today.
I had the opportunity to read Dr. Pierpaoli’s book, as well as an article in the December 2005 Annals of the New York Academy of Sciences, which was titled “Reversal of Aging: Resetting the Pineal Clock.” This edition of the Annals featured numerous articles and research findings related to melatonin, including several reports from Dr. Pierpaoli. I also had the pleasure to speak with Dr. Pierpaoli personally, to learn more about his ideas about melatonin and reproductive and thyroid hormones.
In all this research, I learned that melatonin is much more than a sleep aid. Rather, the pineal gland controls our body clock, and its chief product, melatonin, is not a classic hormone, like endocrine hormones, but more of a chemical mediator that operates in ways we don’t completely understand, but that Dr. Pierpaoli is extensively studying.
What Dr. Pierpaoli explains in his book and research findings is that the pineal gland produces less and less melatonin as we age, but if melatonin supplements are taken when levels are naturally declining, some of the effects of aging can be slowed, stopped, or even, says Dr. Pierpaoli, reversed. Dr. Pierpaoli also has found that melatonin can resynchronize not only the circadian rhythms of the wake-sleep cycles, but the endocrine system overall.
Dr. Pierpaoli believes that providing supplemental melatonin, in a dose of 3 mg nightly, allows the pineal gland to “rest,” so to speak, and protects it from aging, which then slows down the aging process for other glands and organs. It’s a controversial theory, but Dr. Pierpaoli and others have conducted some intriguing studies that suggest he is on to something.
Animal studies conducted by Dr. Pierpaoli found that older animals treated with melatonin returned to normal daily cycling of thyroid hormones. Mice who were twenty-four months old and treated with melatonin (twenty-four months is the mouse equivalent of seventy-five years for humans) had ovaries that were double the size of untreated mice, suggesting more youthful sexual function. Dr. Pierpaoli also transplanted the pineal glands of aging mice into young mice, and vice versa. The young mice with the old pineal glands developed all sorts of ailments associated with aging, became less vigorous and fertile, and died far younger than normal. The old mice with the young pineal glands regrew hair, gained energy, developed a renewed sex drive, and lived, on average, so long that if they were people, they’d have been energetic, active, healthy, and sexually active well past one hundred years of age.
But what explained my own surprising return of normal menstrual cycles was an Italian study of perimenopausal and menopausal women ages forty-two to sixty-two, evaluating the effects of a daily dose of 3 mg of synthetic melatonin over six months. That study found that the melatonin increased estrogen levels and improved thyroid function. The women under fifty using melatonin also had reduced levels of LH and FSH as a result of the melatonin. In some of the younger women, normal menstrual cyclicity was restored. Surprisingly, a number of women who were already postmenopausal even returned to normal menstrual cycles. Basically, according to Dr. Pierpaoli and his fellow researchers, low-dose melatonin was delaying or, in some cases, apparently reversing characteristic endocrine changes that occur during menopause.
With regard to the thyroid, the melatonin didn’t appear to change the TSH levels, but it did help facilitate conversion of T4 to T3, resulting in increased T3 levels. A remarkable 96 percent of women in the study who had taken melatonin also reported total disappearance of morning depression, a symptom that is common in perimenopausal and menopausal women. The women also had fewer complaints about hot flashes, fewer heart palpitations, and better quality and duration of sleep.
While this was not a large study, it was rigorously conducted and suggests that melatonin has a key role in hormonal regulation for perimenopausal and menopausal women, perhaps even more so for those with thyroid imbalances.
Interestingly, the pineal gland may actually be the link that establishes the well-known connection between menstrual cycles and the lunar cycle. (The majority of women menstruate at the new moon, and a woman’s highest melatonin levels are typically seen during the dark phase of the moon.) Melatonin also fluctuates with the monthly menstrual cycle.
Dr. Pierpaoli actually believes that the drop in melatonin that takes place in a woman’s forties may be the hormonal signal that tells the body to begin the perimenopausal transition. We know that in women from forty to forty-four, melatonin typically declines substantially. Interestingly, this is the point that is often the beginning of perimenopause. The next big significant point of melatonin decline is from fifty to fifty-four years, around the time that the menstrual period finally stops for good in most women.
Dr. Pierpaoli’s intriguing theory gained support with the findings of a 2008 study reported in the journal Menopause. That study found that the pineal gland, through melatonin, is involved in the mechanisms that regulate the onset of menopause, and by maintaining higher levels of melatonin, the onset of menopause can be delayed.
Dr. Pierpaoli is, without question, a zealous advocate for melatonin. His almost one-hundred-year-old mother-in-law, Emmy, who was diagnosed in her seventies with Parkinson’s disease, is still going strong, and Dr. Pierpaoli credits her daily dose of 3 mg of melatonin. Her Parkinson’s symptoms disappeared a few years after her diagnosis, also thanks to melatonin, says Dr. Pierpaoli. The doctor himself is a good advertisement for his antiaging approach, in his eighties, energetic, and keeping up a rigorous schedule of activities, research, speaking, writing, and traveling around the world. Dr. Pierpaoli said that if he could go back in time knowing what he knows now, he would have started taking melatonin at around age thirty.
Dr. Pierpaoli maintains that melatonin acts like a hormonal adaptogen, helping to moderate adrenal, thyroid, and reproductive hormones, and maintaining the day–night, monthly, seasonal, and lifetime cyclicity of hormones. He also believes that melatonin increases the density of estrogen receptors in target tissues like the breasts, uterus, and ovaries, and improves their sensitivity.
Some of the other effects of melatonin reported by Dr. Pierpaoli are
Says Dr. Pierpaoli:
Melatonin is not a hormone itself, but truly a “queen of all hormones,” which monitors and directs the whole “hormonal orchestra.”
OTHER DOCTORS ON MELATONIN
Dr. Pierpaoli is not the only advocate for melatonin in perimenopausal/menopausal women. Noted gynecologist and hormone expert Dr. Uzzi Reiss believes that many of us are suffering from low melatonin levels. Says Dr. Reiss:
We’re supposed to wake up with the sunrise, be outside till sunset. Instead, we wake up to a lighted house, we go in to an office with lights, come home and turn on lights. We get less natural light exposure during the day and less darkness at night—both negatively affect melatonin.
Holistic physician Molly Roberts suggests that we consider ways to naturally increase melatonin. Says Dr. Roberts:
We can dim the lights a few hours before bed and turn off the television before it’s time to sleep. These ideas may naturally help us raise melatonin levels.
Thyroid and hormone expert David Browstein, MD, feels that melatonin is “incredibly safe” for most patients. Says Brownstein:
Low-dose melatonin can be an incredibly helpful part of hormone balancing. Not only is it useful for sleep, but it’s also useful for helping the other hormones, and in particular, improved T4-to-T3 conversion.
Hormone and thyroid expert Richard Shames, MD, feels that melatonin can be useful, but he doesn’t necessarily feel that everyone needs the 3 mg dose that Dr. Pierpaoli typically advocates.
You might want to start out with 3 mg, then see if you can get just as good a benefit from going to 2 mg, and then possibly to 1 mg. My general opinion is that a 1 mg dose is not likely to cause headache and depression as a side effect.
Dr. Jacob Teitelbaum, who works with patients with chronic fatigue syndrome, fibromyalgia, and thyroid disease, feels that the effectiveness of melatonin may stem from its ability to promote quality sleep. Says Teitelbaum:
What happens is when you don’t have sleep, you’re suppressing the whole system. Getting proper sleep is restoring hypothalamic function. And the melatonin is, at minimum, helping ensure better quality of sleep. In addition, in the entire hormone system, the pineal can be viewed as the leader of the whole orchestra. If it’s sluggish, the rest of the hormonal system can be sluggish.
Dr. Molly Roberts also feels that melatonin is helpful for sleep in perimenopausal and menopausal women. According to Roberts:
I recommend melatonin on a regular basis. The first symptom of perimenopause is often a problem with sleep. You fall asleep but then wake up in the middle of the night, feeling anxious and stressed out. When you wake, you feel tired. The sleep clock gets out of balance. Melatonin can help. It’s not a sleeping pill, but really a way of resetting the sleep clock.
Supplementing with Melatonin
The main side effects from low-dose (5 mg or less) melatonin appears to be some morning grogginess, vivid dreams and nightmares, and a mild headache after use in a small percentage of users. There are rare reports of allergic skin reactions from melatonin supplements.
There really are no published long-term studies evaluating the data regarding use of low-dose melatonin. All the doctors I spoke with, many who use low-dose melatonin themselves and recommend it to patients, felt that, based on the results of shorter-term studies, we are not likely to discover any problems with longer-term use of low-dose melatonin. Melatonin should not be used by women who are pregnant or lactating, however.
If you’re interested in supplementing with melatonin, you should choose the brand carefully. You want to be sure you are getting pure, pharmaceutical-grade melatonin. Experts suggest that you use only synthetic melatonin, which carries no risk of transmitting animal brain diseases.
I personally prefer a formulation that Dr. Pierpaoli himself created. (He wanted to make sure there was a pharmaceutical-grade melatonin available without prescription, and his formulation, known as TI-MElatonin, is a 3 mg tablet that also includes zinc, to help potentiate the melatonin, and selenium, for the immune system.) The Life Extension Foundation has also created a good-quality time-released melatonin in 300 mcg (0.3 mg) capsules. These might be helpful for those who find half a 3 mg tablet too high a dose.
You’ll sometimes hear that melatonin is not recommended for people with autoimmune disease. For those women who have thyroid problems due to autoimmune Hashimoto’s or Graves’ disease, this may seem problematic. But it’s important to note that the concern was reportedly based on an isolated case where melatonin was linked to autoimmune hepatitis. Dr. Pierpaoli believes that melatonin is helpful for autoimmune diseases and explained why in an interview he gave to International Anti-aging Systems, a U.K.-based pharmacy:
As for autoimmunity, melatonin must be used in autoimmune diseases simply because it will restore a normal immune reaction and the capacity of the immune system to recognize “self” antigens. We have observed complete recovery! The etiology of all autoimmune diseases affecting the skin, the glands, the blood and any other tissue is based on congenital or acquired inability to recognize our own body tissues and thus to mount an autoimmune reaction. Aging itself is largely a hidden, latent and insidious autoimmune process leading to vasculitis (sclerosis of vessels), autoantibodies and cancer. Our work of 40 years has led to the demonstration that immunity is totally under hormonal control. Melatonin will not increase the synthesis of aggressive autoantibodies; on the contrary it will progressively lead to healing of the basic hormonal derangements underlying and initiating the autoimmune process.
PHYTOESTROGENS
One of the biggest controversies for women in perimenopause/menopause—and for women with thyroid problems—is the use of phytoestrogens, whether in food, herbal, or supplement form, as natural treatment for symptoms like hot flashes.
In order to understand the controversy, let’s take a look at the phytoestrogens, what they are, and the risks and potential benefits for women.
A phytoestrogen, which is sometimes called a dietary estrogen or plant estrogen, is a compound found in plants that has some biochemical similarity to estradiol, so that, when consumed, it can have an estrogenic effect. Basically, isoflavones bind to estrogen receptors, and it’s thought that by mimicking the effects of estrogen, they may be able to block some of estrogen’s negative effects and risks and reduce the risk of hormone-associated cancer.
There are several different phytoestrogens, but the best known are the isoflavone phytoestrogens, including soy and red clover, and the lignans, including flaxseed.
The highest concentrations of phytoestrogens are found in flaxseed, soy products, soy protein concentrate, tofu, and tempeh, followed by
Phytoestrogens have gotten a great deal of attention because they may have antioxidant benefits, as well as cancer- and heart disease–fighting capabilities. In addition, they have a reputation as being a natural option to help with menopausal symptoms such as hot flashes. Studies so far, however, have not supported any of the anticancer claims for phytoestrogens.
Phytoestrogens: Are They Effective?
Soy and red clover, which both contain isoflavone phytoestrogens, are popular for treating menopause. Soy is often recommended to women in its food form—tofu, tempeh, miso, soy milk, edamame, soy burgers, and so on—but also in pills and protein powders that contain high concentrations of the phytoestrogens found in soy, known as isoflavones.
The fact that women in Asian countries, who regularly have soy in their diet, have fewer hot flashes and menopausal symptoms has frequently been used to justify the belief that soy can treat menopausal symptoms.
Despite the myths that prevail, Asians actually do not eat large quantities of soy. Rather, the typical Asian diet may include 5 to 10 grams of soy protein per day. This is in contrast to some American diets that may include as much as 60 grams of soy protein a day, from various processed forms of soy, soy supplements, soy milk, and so on.
So far, the proven benefit that soy proponents can offer is that substituting soy protein for animal protein can slightly reduce cholesterol levels. But can soy foods help hot flashes? The evidence is mixed. In fact, in eight different randomized controlled trials of soy foods, only one of the studies found a significant reduction in the frequency of hot flashes, but several showed a slight reduction in frequency. Generally, there’s little published evidence to support the idea that increasing soy isoflavone intake from food or supplements substantially improves hot flashes. At the same time, we know that Asian women, who traditionally have a higher amount of soy in the diet, have much lower rates of hot flashes than American women. And doctors and women themselves continue to report that soy helps somewhat with hot flashes and menopausal symptoms.
Studies regarding red clover have also been mixed. Most of them have focused on a popular over-the-counter menopause supplement, Promensil, that includes 40 grams of isoflavones per capsule. One study found that, at the daily dosage of one 40 mg tablet, Promensil (a preparation of red clover) had no effect on symptoms, but there was a slight reduction in moderate to severe symptoms at 80 mg per day. Numerous other studies on Promensil and other red clover formulations have shown no effect on menopausal symptoms.
Flaxseeds contain high levels of omega-3 fatty acids, as well as lignan phytoestrogens. Apart from the phytoestrogen properties, flax is thought to stabilize blood sugar and function as a laxative (due to its high fiber content). Some studies have shown a slight reduction in menopausal symptoms in women using flaxseed compared with a placebo, but it’s not considered enough to be statistically significant.
The reality is that with some natural approaches, we simply don’t have widespread, long-term research studies that give definitive information. When we do have studies that show benefits to natural approaches, the results are sometimes reported to be “not statistically significant.”
What this means is that there isn’t statistical evidence to back up observations of an impact. It doesn’t discount entirely the possibility of a cause-effect connection.
Keep in mind that failing to find statistical evidence of a relationship doesn’t prove there isn’t one.
Some experts suggest, for example, that factors that are not obvious to researchers may make some women more predisposed than others to respond well to natural treatments. Regarding phytoestrogens, for example, a 2005 study on menopause from the journal Human Reproduction Update said:
Recent data suggest that only individuals capable of metabolizing isoflavone daidzein into equol may receive significant health benefits, and thus populations must be analyzed separately by microflora and metabolic characteristics. Significant results are likely to be obscured when subpopulations are analyzed together, particularly in those studies carried out among Western populations in which only approximately 30% are equol producers compared to Japanese populations where 50–60% of menopausal women are equol producers.
Nationally known nutritionist Ann Louise Gittleman, PhD, author of the popular Fat Flush Plan, has found that for many women, soy is problematic because it’s a hidden food allergen. Also, Dr. Gittleman finds that soy isoflavones work with people who are copper deficient or copper balanced but not in people who have excess copper. Dr. Gittleman talks at great length about the effects of excess copper, a problem that she has found is especially common in perimenopause/menopause, and in thyroid patients, in her terrific book, Why Am I Always So Tired?
Holistic physician Tieraona Low Dog, MD, says that soy appears to work only for a subsection of her patients.
Some women do well with soy, some don’t. Some can convert it into active compounds, others can’t. I’ve found that vegetarians may be better able to convert soy. But in general, I haven’t found soy overly helpful for the majority of women.
Taking Phytoestrogens
In general, if you are interested in trying phytoestrogens for menopause symptoms, most of the experts I interviewed agreed that you should bypass supplement forms and focus on incorporating them into your diet. That means you probably can give a pass to red clover supplements like Promensil and any isoflavones or phytoestrogen supplements that come in a bottle.
Holistic nutritionists Dr. Annemarie Colbin and Dr. Ann Louise Gittleman both recommend that perimenopausal/menopausal women who want to incorporate flax in their diet grind flaxseeds and add them to foods like cereals, oatmeal, soups, and salads. Keep in mind that flax is high in fiber, so you may want to introduce it gradually.
Also, remember that you will want to have your thyroid rechecked six to twelve weeks after starting or stopping any dietary changes that include fiber (including flaxseeds).
If you are going to eat soy, most of the experts I spoke with agreed: stay away from processed forms of soy, and stick to soy in its natural, fermented forms, such as tempeh and miso. Dr. Ann Louise Gittleman has some thoughts:
Make sure the soy is not genetically modified, and that it’s served in its original form, the Asian way, and fermented—like tofu or tempeh or miso.
Dr. Annemarie Colbin thinks soy may be oversold. Says Colbin:
I find it interesting that there’s such a push for soy as a health food ever since soybeans became genetically engineered. These big companies have a huge marketing machine. I would not use any of the imitation meat soy foods, or any soy that is extruded, extracted, or genetically engineered. Just miso, a little tofu, tempeh occasionally. I have heard of women finding soy milk helpful for hot flashes, so you can occasionally try a glass of soy milk or a little tofu. But two times a week at most.
Dr. Jacob Teitelbaum feels that for women suffering hot flashes, they can try soy—in moderation—and see if it helps.
I’d suggest a woman consider trying a small bit of soy every day—like a handful of edamame, or some soy milk or soy cheese.
I think that holistic physician Molly Roberts summed it up well. According to Dr. Roberts, “Soy is one of those things where it’s important to remember: everything in moderation—a little goes a long way.”
Safety
In the short term, the various phytoestrogens appear to be safe, with few adverse effects. There are no studies, however, demonstrating the safety of longer-term use of high-dose phytoestrogens.
With any of the phytoestrogens, there is a question of the impact on hormone-sensitive tissue and the potential to cause or aggravate hormone-sensitive cancers. So far, we do not have information that shows that long-term use of phytoestrogens is safe in this respect.
In fact, there are some concerns, especially regarding the risk of endometrial hyperplasia (a buildup of the uterine lining, which may precede cancer) in women using high levels of soy extract. Many practitioners caution against use of soy and other phytoestrogens—except as an occasional food—for certain groups of women, especially
Gynecologist and North American Menopause Society spokesperson Dr. Risa Kagan explains why women should be cautious about soy as a menopause treatment:
I think there is confusion about soy. To take excessive amounts of soy is controversial; what are the proven benefits? There may be some benefits for heart-healthy diet, but to indulge in high levels of phytoestrogens, thinking it’s healthy, is questionable. We’re telling breast cancer patients to be careful about how much soy to consume, because we don’t know the effects. It’s one thing for women to grow up in Asia, eating a particular diet, but for older Western patients with a breast cancer risk, we really don’t know the impact of a diet heavy in soy protein.
The isoflavones in soy are considered endocrine disrupters and have the ability to disturb proper thyroid function. Much like they do with estrogen, isoflavones can fit into the body’s thyroid receptor sites, where they contribute to functional hypothyroidism at the cellular level, due to their receptor-blocking capabilities.
There are concerns about the impact on the thyroid of overconsumption of phytoestrogens, soy in particular. One study involving premenopausal women gave them 60 grams of soy protein per day for one month. This amount was enough to disrupt the menstrual cycle, and the effects continued for three months after the soy was eliminated from the diet.
Another study found that intake of soy over a long period causes enlargement of the thyroid and suppresses thyroid function. Other studies have shown that high soy intake in premenopausal women could suppress ovarian production of estradiol and progesterone by as much as 20 to 50 percent.
In a February 18, 1999, official letter of protest to the Food and Drug Administration (FDA), Doerge and Daniel Sheehan, who at that time were the FDA’s two key experts on soy, protested the health claims approved by the adminstration on soy products, saying:
There is abundant evidence that some of the isoflavones found in soy, including genistein and equol, a metabolize of daidzen, demonstrate toxicity in estrogen sensitive tissues and in the thyroid. This is true for a number of species, including humans. Additionally, isoflavones are inhibitors of the thyroid peroxidase, which makes T3 and T4. Inhibition can be expected to generate thyroid abnormalities, including goiter and autoimmune thyroiditis. There exists a significant body of animal data that demonstrates goitrogenic and even carcinogenic effects of soy products. Moreover, there are significant reports of goitrogenic effects from soy consumption in human infants and adults.
The argument about soy’s dangers to the thyroid continues, with spokespeople from the soy industry arguing that it is safe and has no effect on the thyroid, and other researchers periodically releasing studies that show that phytoestrogens have endocrine-disrupting, thyroid-slowing capabilities. For thyroid patients, however, it appears that the isoflavone-intensive forms of soy (for example, supplements and powders) may be more problematic, while occasional use of a fermented soy food may not pose a danger. But overconsumption of phytoestrogens may in fact be a trigger for thyroid disease in some women and may worsen thyroid problems in women who already have a thyroid condition.
To sum up, then, when used in moderation as foods (that is, fermented forms of soy and flaxseeds) and not overconsumed, phytoestrogens appear to be safe.
Will they help your menopause symptoms? Possibly. You have to try them to find out.
Is it safe to use phytoestrogens regularly and over a longer period of time, to help resolve your menopausal symptoms? There, you need to be careful. When overconsumed or taken in high-concentration dietary supplements over longer periods of time, phytoestrogens may be associated with thyroid dysfunction, thickening of the uterus, and other hormonal effects. The risk that phytoestrogens will stimulate certain forms of estrogen receptor-positive cancers, including breast and uterine cancer, is still a question that has not been resolved.
Other Supplements
BLACK COHOSH
Black cohosh (Actaea racemosa) is one of the best-known herbs used as a perimenopause/menopause treatment. It’s a perennial plant, native to North America. It was used by Native American healers and doctors for centuries to help relieve perimenopausal symptoms.
Black cohosh is perhaps the best studied of the herbs for menopause, but the studies are contradictory.
On the positive end, there are studies that have shown that black cohosh
One randomized, double-blind, placebo-controlled trial (considered to be optimal in research) found that women who took two 2 mg tablets of the popular Remifemin brand of black cohosh twice daily had a fairly dramatic reduction in hot flashes as compared with placebo and conjugated estrogens. The women using black cohosh also had reduced anxiety.
At the same time, there are studies that show no measurable benefit to black cohosh. The highly publicized HALT (Herbal Alternatives for Menopause Trial) study, for example, found that black cohosh used alone or as part of a multiherb treatment did not improve hot flashes and night sweats, and that over a year of evaluation, only prescription hormone therapy resulted in a “clinically important decrease in vasomotor symptoms frequency.”
The National Institutes of Health put it, “Although preliminary evidence is encouraging, the currently available data are not sufficient to support a recommendation on the use of black cohosh for menopausal symptoms.”
At the same time, because there is some supporting evidence, the World Health Organization has recognized the use of black cohosh for “treatment of climacteric symptoms such as hot flashes, profuse sweating, sleeping disorders and nervous irritability.” The North American Menopause Society recommends black cohosh, in conjunction with lifestyle approaches, as a first-line treatment option for women with mild hot flashes and night sweats.
Dr. Tieraona Low Dog believes that black cohosh can be useful, not typically for hot flashes, but for other menopausal symptoms. Says Low Dog:
Black cohosh has traditionally been used for three things: rheumatic pain, melancholy, and sluggish childbirth. So for menopausal women, I’ve found it more beneficial for joint pain, which is a menopausal symptom for some women, rather than hot flashes. Some of the recent research is suggesting that it is working through the central nervous system and neurotransmitters, which is actually more consistent with its historical use than believing it has “estrogenic properties,” which does not appear to be the case. So I often recommend black cohosh for menopausal women who have low-lying depression and body aches, for whom hot flashes are not the main concern.
Occasionally, side effects of black cohosh can include stomach upset, vomiting, dizziness, headaches, visual disturbances, slowed heartbeat, and heaviness in the legs. Some studies have raised significant concerns about the possibility of liver damage with black cohosh. The long-term safety of black cohosh, especially as it affects uterine and breast safety, as well as cancer risk, is not known.
The commercial formulation of black cohosh known as Remifemin has been used in Europe for nearly 50 years, and it appears to be safe according to studies. Remifemin, which contains black cohosh extract equivalent to 20 mg of plant root per tablet, has been studied extensively, and some practitioners suggest that if you are going to use black cohosh, you use this brand specifically. Dr. Jacob Teitelbaum suggests that those who want to try Remifemin start with two tablets twice a day for two months, then drop to one tablet twice a day.
Dr. Risa Kagan advises that patients who want to use black cohosh take certain precautions:
There is mixed evidence for black cohosh, but if you are taking it, you want to make sure you’re getting a good quality, so I’d recommend Remifemin, because it’s tested and you know what you’re getting. But there is some evidence of liver disease, so we recommend that liver function be checked before and during use of black cohosh.
Other practitioners suggest you avoid staying on black cohosh for extended periods beyond six months to a year. Some experts suggest that women with breast cancer should consider avoiding black cohosh until the effects on breast health have been more thoroughly studied.
DAMIANA
Damiana (Turnera diffusa or Turnera aphrodisiaca) is an herbal remedy that has mainly been used in the southwestern United States and Mexico. Dr. Tieraona Low Dog highly recommends damiana for menopausal symptoms:
Damiana is the herb I have used most successfully for menopausal symptoms. Many Latina women would come into my herb shop, asking for damiana. I would ask, “What do you use it for?” and they would tell me that it was helpful for hot flashes and for low sex drive, and generally say, “It makes me feel better.”
Dr. Low Dog recommends using damiana in a tea or tincture form. If using the tincture, thirty drops (2 to 3 mL) two or three times a day can work well. For those who take capsules, Dr. Low Dog recommends 500 mg three times a day.
DONG QUAI
Dong quai (Angelica sinensis) is a Chinese medicine herb that has been used to treat various gynecological conditions. There are few large-sized trials to establish dong quai’s value and effectiveness, but there is some research and evidence suggesting that dong quai root may have some properties to help women in perimenopause/menopause. In particular, as part of combination treatments, it may reduce hot flashes, boost immune function, and improve bone health.
One study looked at a traditional Chinese remedy combining dong quai and chamomile and found that, within a month, there was a significant difference in relief of hot flashes, insomnia, and fatigue in the women taking the remedy, compared with placebo. Other studies have shown that it may be as effective as antianxiety drugs like Valium in helping to relieve stress. There is a suggestion that dong quai stimulates the proliferation of bone cells, which may help protect against osteoporosis.
Note, however, that these studies are all based on customized use of dong quai by Chinese medicine practitioners, and not over-the-counter dong quai supplements. In traditional Chinese medicine, dong quai is never used alone. It is always used in combination with other herbs, and studies of dong quai alone have not shown it to be effective in addressing menopausal symptoms.
Because it does not have an estrogenic effect, it’s considered fairly safe. However, there is a possible herb–drug interaction between donq quai and warfarin (the blood-thinning drug Coumadin), so women taking anticoagulants and blood thinners should avoid dong quai.
HERBS FOR SLEEP
For women experiencing sleep problems, there are several herbs that have traditionally been used, including valerian and hops. Valerian (Valeriana officinalis) acts as a sedative and may help with insomnia and overall sleep quality. Hops (Humulus lupulus) is thought to maintain sleep. Some experts believe that the combination of valerian and hops is optimal in that valerian helps you fall asleep, and hops helps you stay asleep.
A tip: Dr. Jacob Teitelbaum has formulated an herbal sleep remedy for his patients with chronic fatigue and fibromyalgia to help them sleep well without the need for prescription medications. This remedy, End Fatigue Revitalizing Sleep Formula, from PhytoPharmica/Enzymatic Therapies, is now available widely, and it’s the one I use and find very helpful. Dr. Teitelbaum combines valerian and hops, along with other ingredients that aid in relaxtion, reducing anxiety, and promoting sleep, including passion flower (Passiflora incarnata), L-theanine (an amino acid commonly found in tea), wild lettuce (Lactuca virosa), and Jamaica dogwood (Piscidia pis-cipula).
SAGE
Dr. Tieraona Low Dog recommends that women consider a very underused herb, sage, during perimenopause/menopause. Sage’s traditional use has been to reduce excessive sweating and relieve night sweats.
According to Dr. Low Dog:
Sage is an old folk remedy for night sweats and hot flashes, and it can be a useful herb for women in perimenopause/menopause. Many don’t like the taste of the tea and prefer capsules. I usually recommend women take 1,000 mg of sage around 4:00 to 6:00 p.m. As an added benefit, it can be good for digestion and the stomach, and may even have some benefits for the brain and memory.
EVENING PRIMROSE OIL
Our bodies need—but cannot make—good fats known as essential fatty acids, so we must get them from the foods we eat or supplements. One essential fatty acid in particular, gamma-linolenic acid (GLA), which is found in evening primrose oil (EPO, Oenothera bi-ennis L.), may help reduce inflammation, lessen cramps and PMS symptoms, help with water retention and bloating, and reduce breast pain. It is also known to be helpful in maintaining better moisture balance in skin, hair, and mucous membranes, such as vaginal tissues, eyes, and mouth.
Many practitioners suggest approximately 2,000 mg a day as a level at which benefits might be felt. Studies are inconclusive, but the safety of EPO makes it a supplement that women can consider trying, as results will be felt within several weeks if it is going to work.
EPO typically has few side effects; occasionally, patients complain of mild nausea, diarrhea, gas, and bloating. It should not, however, be used in patients diagnosed with schizophrenia who are taking antipsychotic medication or with anyone taking anticoagulants.
ST. JOHN’S WORT
St. John’s wort (Hypericum perforatum) has been used for centuries to treat mental disorders, depression, anxiety, sleep disorders, and nerve pain. There is some scientific evidence that it is useful for treating mild to moderate—but not major—depression and mild anxiety.
St. John’s wort can have some side effects, including sensitivity to sunlight, dry mouth, dizziness, stomach problems, fatigue, headache, and sexual dysfunction. It can also interact with a number of drugs, including antidepressants, birth control pills, warfarin, and coagulants, as well as with a variety of other heart and immune system medications.
PYCNOGENOL
Pycnogenol (Pinus pinaster spp. atlantica), a pine bark extract, is a potent antioxidant. For menopausal women, one Scandinavian study found that pycnogenol could help with hot flashes, depression, anxiety, sleep problems, vaginal dryness, fatigue, headache, and lack of sex drive. It is thought to work primarily by improving blood flow. There are no known adverse side effects of pycnogenol, and it’s thought that 100 mg, twice a day, is a level that may result in improvement in menopausal symptoms.
VITAMIN E
Vitamin E is widely used for treating hot flashes, but there is limited and mixed research supporting the use. Some studies have shown that use of vitamin E at 800 IU may result in one less hot flash per day. More studies are needed to evaluate the use of vitamin E. But at this level, it’s considered safe and may be worth trying.
VITAMIN D
We don’t typically think of vitamin D as relating to menopause, except for its role in helping with calcium absorption. But Dr. Jacob Teitelbaum believes that getting some natural vitamin D—“A daily walk in the sunshine!” as he says—is one of the best things we can do to ensure sufficient vitamin D levels. Says Teitelbaum:
Vitamin D is a critical hormone, not just a vitamin, and it helps support hypothalamic and autonomic function. The hypothalamus helps regulate follicle-stimulating hormone, luteinizing hormone, and estrogen production. So supporting the hypothalamic function, with exercise, sleep—and sunshine (vitamin D)—is critical.
If you are taking vitamin D supplements, many experts recommend approximately 600 IU daily. If you have autoimmune disease or suffer winter seasonal affective disorder or depression, some experts recommend that you supplement with as much as 2,000 IU a day.
CHASTEBERRY/VITEX
Chasteberry (Vitex agnus-castus), which is also referred to as vitex, is the berry of a shrub that has been used for centuries to treat various conditions affecting women, including premenstrual problems, breast tenderness, and menstrual irregularities. Some studies suggest that chasteberry works by affecting brain levels of the neurotransmitter dopamine, which then has an impact on the body’s prolactin levels. (Prolactin can be a factor in breast tenderness and PMS.) Chasteberry may also help with progesterone balancing.
A number of clinical trials of chasteberry suggest that it can help with the following symptoms:
Dr. Tieraona Low Dog uses chasteberry for perimenopausal women with irregular cycles, to enhance fertility. In women who are menopausal, Dr. Low Dog uses it primarily for sleep issues and for women who work night shifts who have excessive fatigue.
GINSENG
Panax ginseng has been recommended for menopause complaints. Dr. Tieraona Low Dog has evaluated studies of ginseng and found that, while there is little evidence for any effect on hot flashes, it can help with depression, mood swings, energy, sleep disturbances, and general well-being.
Side effects include headache, upset stomach, and, less commonly, increased blood pressure and raised blood sugar levels.
Complementary Medicine
Several complementary medicine approaches may enhance your overall approach to resolving hormone imbalances: traditional Chinese medicine, osteopathy, adrenal assessment and treatment, and tissue mineral analysis.
TRADITIONAL CHINESE MEDICINE
Physician and Chinese medicine practitioner/acupuncturist Adrienne Clamp, MD, was drawn to the practice of Chinese herbal medicine and acupuncture after an education in conventional medicine.
Things that aren’t useful don’t last, and while I can share off the top of my head some 50 or 60 drugs that are no longer used just since I’ve been practicing medicine, many of the Chinese formulas I use have been around for 2,000 years, and are being continuously tweaked. There is longevity and wisdom in Chinese medicine, and I respect the view of looking at people in this holistic way.
Dr. Clamp says, to understand a traditional Chinese medicine view of menopause and thyroid imbalance, you need to consider the concept of “kidney energy.” Says Dr. Clamp:
In Chinese medicine, picture a cauldron of water with fire beneath it. The fire below the cauldron is your kidney energy, or yang energy. The water in the cauldron is your yin energy. At menopause, it’s as if there is no more water in your cauldron, but the fire continues to burn beneath it. This “false fire”—which is felt by some women as hot flashes—has burned up the water—the “yin energy.” Yin is moon—the quiet, nutritive, meditative, soft, more feminine energy. Since we’re a yang society—on the go and action-oriented—it’s not easy for menopausal women to replenish that “burned up” yin.
During perimenopause, many women are so overtaxed that they don’t have enough yin. We are natural multitaskers, raising children, working, cooking dinner, and without hormonal balance, we can become tired or worn out, and get that frazzled feeling like we can’t deal. Excitement, stress, and sleep problems all burn away the yin and leave many women yin deficient during perimenopause.
Acupuncture can help to build energy, and herbs can be used to help sustain it.
Dr. Jocelyne Eberstein, a licensed acupuncturist and Chinese medicine practitioner, agrees:
In women in this age group, one of the first areas of decline is with the thyroid and adrenals. What I try to do with Chinese medicine and acupuncture is to help jump-start the hormonal cascade, stimulating it at the level of the pituitary. Then, what you’re getting is a downstream cascade of hormonal balance.
Acupuncture requires a trained and licensed practitioner, and Chinese herbal medicine is not a do-it-yourself process, so don’t just pick a Chinese herbal formula off the shelf of your health food store. You need a proper Chinese medicine diagnosis and appropriate treatment with acupuncture and herbal remedies, and that can only come from a trained practitioner.
Your health care providers may be a resource for referral to Chinese medicine practitioners and acupuncturists, and some conventional medical practitioners practice acupuncture. In addition, the American Association of Acupuncture and Oriental Medicine (AAAOM) maintains a referral service for licensed practitioners.
TRADITIONAL OSTEOPATHY
An osteopath is a physician trained in the field of osteopathic medicine. Like an MD (medical doctor), a DO (doctor of osteopathic medicine) is a fully trained and licensed physician, and both are considered equal in terms of their authority to diagnose and treat various health conditions, prescribe medications, and perform surgery.
The difference between an MD and a DO is that their educational approach is different. Osteopathic medicine emphasizes the whole person, emphasizing the connection between the musculoskeletal system and disease and symptoms. Both DOs and MDs need an undergraduate degree and four years of medical school. Osteopaths cover the same curriculum as MDs at osteopathic medical schools, plus, an additional 300 to 500 hours of specialized training on the musculoskeletal system. DOs and MDs then typically do two to six years of internship and residency programs, pass state licensing exams, and obtain continuing education to remain certified. Like MDs, DOs can specialize in particular areas of medicine.
Some osteopaths take a hands-on osteopathic approach, using cranial and musculoskeletal systems to help restore balance and relieve neurologic, respiratory, digestive, and other symptoms. Osteopaths who practice using only the hands-on treatments tend to refer to themselves as “traditional” osteopaths.
Scott Kwiatkowski, DO, a traditional osteopath practicing in Silver Spring, Maryland, believes that osteopathy can be an excellent part of an integrative approach to hormonal imbalance. Says Kwiatkowski:
I like to view the body as a house, with frame, plumbing, and electricity. The bones are the frame. The circulatory and lymph systems are the plumbing. And the brain, spinal column, and nerves are the electrical system. Osteopaths work with the frame—the structure—to improve the circulatory and electrical systems—meaning we work with the bones, to help improve the health of the circulatory, lymph, nervous system, and hormones.
In dealing with a woman who is going through perimenopause, osteopathically, I look at her as a whole person. Using the tenets of osteopathy, people have all they need contained within them, and the body knows how to regulate itself. It’s a self-healing machine. So I look at structure—how is the body looking, hormonally, with evaluation of sex hormones, adrenals, and the thyroid—and work to rebalance.
In my own case, I have regularly turned to osteopathic treatment, and it’s an important part of my own integrative approach to hormone balance and wellness.
While many osteopaths work as general practitioners and incorporate some hands-on work into their regular practice, you might find that the approach of a “traditional” osteopath to be a wonderful additional to your wellness approach. Appendix A has several referral sources for osteopathic physicians.
Assess the Adrenals
When there is evidence of thyroid dysfunction, it’s important to also consider evaluating adrenal function. The adrenal glands, part of the endocrine system and located on top of the kidneys, coordinate the body’s response to stress, both long-term regular stress and the short-term, “fight or flight” stressors. To deal with more chronic stress, the adrenal glands release cortisol, the body’s “steroid” hormone. To cope with urgent stress, the body releases adrenaline.
Both releases have metabolic effects on the body.
In many women, by our forties, we are dealing with suboptimal adrenal function and adrenal imbalances. Women may have low adrenals in the morning, with levels that become too high later in the day, which is not a normal pattern. Or, in some cases, levels are consistently too low—evidence of underactive adrenal function.
Dr. Adrienne Clamp incorporates adrenal analysis into her overall hormone-balancing approach. According to Clamp:
The role of suboptimal adrenal function is not very well addressed or recognized. It can wreak havoc and undermine health and wellness if not addressed. When thyroid function appears to be normal and still someone suffers with all the symptoms of hypothyroidism, often adrenal hypofunction is to blame. Diagnosis can be suggested by the history of recent or prolonged stress, or recurrent bouts of serious illness. It is best confirmed by measurement of saliva cortisol levels throughout the day and evening. Measurement of the other hormones made by the adrenal gland such as DHEA [dehydroepiandrosterone] sulfate and aldosterone is also helpful.
Treatment of the adrenal gland dysfunction depends on the pattern. I usually turn to herbal adaptogens first, as well as recommending work on stress reduction by means such as meditation, relaxation, learning different coping mechanisms, and psychological counseling, among others. Sometimes hormone replacement is needed and in extreme cases of hypofunction, even low doses of cortisol, though this is typically only after trying the other approaches.
Assess Mineral Imbalances
Holistic nutritionist Dr. Ann Louise Gittleman believes that one of the most important things women with hormonal imbalances can do is to have their minerals evaluated for deficiencies, excesses, or imbalances. According to Gittleman:
The adrenal glands act as a backup system for the ovaries, and when the adrenals weaken and the metabolism slows, copper tends to accumulate. When we’re under stress, we can also develop a zinc deficiency, which can then lead to adrenal insufficiency, which then leads to copper excess or a copper/zinc imbalance. In perimenopause, progesterone deficiency or an estrogen-dominance estrogen/progesterone balance can also cause copper to accumulate. And when we see that imbalance, we also frequently see an underactive thyroid.
Dr. Gittleman recommends that women facing thyroid or reproductive hormone imbalances have what’s known as a tissue mineral analysis, to evaluate the levels of minerals and pinpoint deficiencies, excesses, or imbalances. The tissue mineral analysis, which is done with a hair sample, evaluates the levels of exposure to a host of minerals and toxins. According to Dr. Gittleman:
My feeling is that it’s a key to how women can better go through menopause. Copper imbalance is the most prevalent imbalance I find. Copper overload also causes a sluggish liver, and you can’t metabolize toxins or hormones, so you can become bloated and hormone deficient.
I had my tissue mineral analysis done, and we found some interesting imbalances, as well as some toxic exposures, including slightly high mercury exposure, which is often associated with hypothyroidism. I’m now working to balance these issues nutritionally. But this test found a number of issues, and the test results included a great deal of information about what I can do to help address the imbalances and problems.
If you’re interested in a tissue mineral analysis, some holistic doctors can do this and interpret the results. Appendix A includes information on how you can order your own tissue mineral analysis testing and where to get results interpreted.