Note: If you have menopausal symptoms, you should consult with your physician. The following blog is not intended to replace proper diagnosis and treatment by a skilled physician.
I have seen hundreds of female patients with the chief complaint of menopausal symptoms (i.e. hot flashes, night sweats, depression, etc.), and have never had a single patient fail to improve significantly (and in most cases completely) unless the patient was not patient (no pun intended) and stopped the suggested therapeutic protocol too early. Women can experience menopausal symptoms to varying degrees, mild to severe, and for varying lengths of time, months to years, and even decades in some rare cases. If the menopausal symptoms are mild, they can improve within weeks. If severe, on the other hand, it can take a few months for the symptoms to be satisfactorily alleviated. The results are clearly dependent on the compliance level of the patient. The single most important therapy missing in most menopausal womens prescription (regardless of whether they are seen by conventional doctors or natural medicine doctors) is liver cleansing and sufficient water consumption. (Refer to sections below on these subjects.) In this blog, I have outlined the most common methods of addressing menopausal symptoms, from the most aggressive (i.e. drugs) to the least aggressive (i.e. dietary and lifestyle suggestions). Notice that the more aggressive the therapy, the higher the likelihood of side effects.
1) Medical HRT or Hormone Replacement Therapy (examples: Premarin, Provera, and Prempro)
Medical HRT is almost exclusively prescribed by conventional practitioners (medical doctors, osteopathic doctors, nurse practitioners, etc.). Some of these products are actually horse female hormones (derived from female horses urine) which are much more powerful than human hormones, and can cause serious side effects in humans such as cancer. (Refer to section below.)
Premarin contains conjugated estrogens (i.e. synthetic estrogen) alone. It does not contain any progesterone.
Provera contains medroxyprogesterone acetate (i.e. synthetic progesterone) alone. It does not contain any estrogens.
Prempro contains conjugated estrogens (i.e. synthetic estrogen) AND medroxyprogesterone acetate (i.e. synthetic progesterone) both. Medroxyprogesterone acetate is known as a progestin. (Progestin is a term used for synthetic derivatives which differ structurally from the natural progesterone that is found in humans.)
I have only had one patient who had to stay on synthetic HRT for a number of months before being able to switch to natural HRT. We had to cleanse her liver during this period in order to allow the transition. Most patients are able to make this transition successfully without any preparation. It is noteworthy that this one patient did not have any ovaries at all. Note that ovaries and adrenal glands make female hormones. If you are missing the ovaries, you will have to rely very heavily on your adrenal glands to do this job. And since your adrenal glands are already busy enough helping you deal with all the stress in your life, they can burn out, and you will be lacking sufficient amount of female hormones in your body. Therefore, it makes sense that a woman who is missing one or both of her ovaries would be much more in need of female hormone replacement therapy as well as adrenal support, which is a whole new topic by itself. You can google adrenal fatigue and adrenal support to learn more about these subjects.
2) Natural HRT or Human Bio-identical Hormone Replacement Therapy:
Natural HRT can be any combination of the three types of natural estrogens (i.e. Estrone, Estradiol, or Estriol) and/or natural progesterone (i.e. Prometrium) . Estrone is also known as E1, Estradiol as E2, Estriol as E3. The prescription name of natural progesterone is Prometrium. Note that Estradiol or E2 is by far the most potent and popular form of natural estrogen prescribed by doctors. More and more conventional doctors are prescribing E2, as opposed medical HRT (refer to section above), for their patients.
Biest is a premade combination of E2 and E3, while Triest is a premade combination of all the above three estrogens.
Natural HRT is what most naturopathic doctors prescribe for their menopausal patients, as opposed to medical HRT which is what conventional practitioners prescribe. A minority of conventional practitioners are starting to prescribe natural HRT, including Estradiol and even Prometrium.
The most common potencies of Estradiol are 0.5 and 1 mg per pill. The typical dose is one pill daily. The most common potencies of Prometrium are 100 and 200 mg per pill. The typical dose is one pill daily. If the patient is taking both, I recommend that they take one in AM and the other one in PM.
Natural HRT can be prescribed in cream form as well. These are compounded items and can only be obtained from compounding pharmacies.
It only makes sense that a chemical that is bio-identical to what we innately have in our own body is going to be healthier for us than a chemical that is foreign to our body. Natural HRT simply makes more sense for women that horse-derived synthetic HRT. And, of course, you have all heard of the long-term side effects due to the use of synthetic HRT. Some potential side effects include various female cancers such as breast and uterine cancers.
Then, why dont more conventional doctors prescribe natural HRT over the synthetic, horse-derived ones? I believe the reason is simply that a substance that is either natural or identical to a natural substance in nature cannot be copy righted, and thus not profitable. And, the conventional medical world is heavily influenced by financial incentives promoted by pharmaceutical companies.
Many doctors (even some wholistic MDs) advocate the benefits of natural HRT, not just for management of menopausal symptoms, but for a variety of other health promoting reasons. I believe the patient should make an informed and educated decision on this subject. Therefore, I try to share what I know with the patient during the interview process, and let the patient make the final determination as to whether they should take natural HRT or not, and if so, for how long. If the menopausal symptoms are severe, I do prescribe natural HRT at least on a temporary basis until we are able to address the underlying reasons behind the menopausal symptoms, such as poor diet and suboptimal liver function. (Refer to sections below.) Once the persons diet and liver function are sufficiently improved (and this process may take many months in some cases), they should not have to take any form of HRT for management of their menopausal symptoms, including hot flashes and night sweats. You must be thinking, Every woman I know who has gone through menopause has suffered some symptoms so are you saying that they all had a poor diet and/or suboptimal liver function? The answer is yes. Menopause is supposed to be smooth sailing. If it is not, then either the persons diet is unhealthy or they are!
Can HRT (hormone replacement therapy) cause you to gain weight?
Yes. The majority of women with menopausal symptoms have estrogen dominance (i.e. a higher ratio of estrogen to progesterone). Taking medical or even natural HRT is often not needed for estrogen dominance if some of the other recommendations are maintained. Adding hormones for estrogen dominance may suppress symptoms by artificially balancing estrogen/progesterone ratio, but can elevate both to excessively high levels. This increases the workload on the liver which often leads to weight gain from storing the by-products away in new fat cells. Therefore, if you are taking HRT and are unable to lose weight, you should get your hormone levels checked by doing a salivary hormone panel.
3) Phytoestrogen formulations of various kinds. Phyto means plant, and phytoestrogens are herbs that have the ability to cause estrogenic and/or antiestrogenic effects. Phytoestrogens include herbs such as vitex, black cohosh, dong quai, red clover, etc.
One phytoestrogen formulation that we offer through our dispensary is called Estroflash which comes in pill form. (A famous over-the-counter phytoestrogen formulation is called Estroven.) I also put together various herbal formulations in liquid/tincture form that are made to match each patients unique physiological needs.
Another supplement that we carry in our dispensary thats high in demand is PhytoB. PhytoB contains bio-identical female hormones (estradiol and progesterone) as well as phytoestrogens. It does not contain as much bio-identical hormones as prescription drugs. (This is not an over-the-counter supplement.) So, if I ever want my patients to take some natural HRT along with phytoestrogens, I prescribe PhytoB.
4) Constitutional homeopathy (Research this subject on our website for more information):
In some cases, one single constitutional homeopathic remedy once a month or so is sufficient in addressing menopausal symptoms of hot flashes and/or night sweats. In the majority of the cases that I see in my practice, constitutional homeopathy is not by itself sufficient, although it is very helpful.
A persons constitutional remedy is based on their temperament and/or personality profile, and is likely going to be the MOST EFFECTIVE WAY OF ADDRESSING A PERSONS EMOTOINAL CHALLENGES, including depression and/or anxiety. I find that it is often NOT as effective in treating the hot flashes and/or night sweats as it is in treating the depression or mood changes that accompany menopause. Although I have in some cases very successfully treated all the menopausal symptoms (including hot flashes and night sweats) using only their constitutional homeopathic remedy and no other therapies.
5) Liver cleansing- THIS IS A KEY STEP AND IS ALWAYS IGNORED IN CONVENTIOAL MEDICINE, AND OFTEN NOT ADDRESSED THOROUGHLY ENOUGH EVEN BY NATURAL MEDICINE PRACTITIONERS.
I suggest cleansing or detoxifying the liver using a variety of methods, including diet, herbs, homeopathic remedies, castor oil application over the abdomen/liver, and specific nutrients such as selenium and molybdenum. These specific therapies are not discussed in this blog, but will be in a future one.
Note, however, that in the majority of cases, by the time the woman is demonstrating menopausal symptoms, their digestive system is, at least in part, compromised. Therefore, I rarely focus on cleansing the liver using nutrients since they need to be absorbed first before they can be helpful, and the process of absorption itself is under question. I find homeopathic remedies (such as UNDA compounds) much more helpful in detoxifying the liver in cases where the liver is very toxic. The reason homeopathic remedies are more efficacious in cases of severe liver toxicity is that homeopathics work energetically and completely bypass the process of digestion and absorption. In other words, once taken orally, they affect the liver instantaneously without having to pass through the blood stream via the gut. To my knowledge, the mechanism of action of homeopathic remedies is not 100% understood, but research is underway. It is clear, however, that their primary action has an energetic effect on the body which ends up bringing about pharmacological reactions as a result.
Note: If CONSTIPATED, you MUST get this condition 100% successfully treated (i.e. have at least 1-2 BMs daily) before your menopausal symptoms are satisfactorily addressed. Why? The reason is that constipation is a sure sign that your liver is toxic! As long as you have a toxic liver, you are going to suffer from menopausal symptoms. Therefore, it only makes sense that constipation must be at least treated, if not cured, in order to bring about complete relief from menopausal symptoms.
6) Diet:
a. Drink a sufficient amount of water on a daily basis. Id recommend drinking half of your bodys weight in ounces of water per day. Ideally, drink filtered water as opposed to tap water. (Refer to our recommendations page on this website for a company that will come install a high quality water filter on your kitchen faucet.)
b. Avoid eating sweets as much as possible.
c. Simply eat healthy.
Note: Drinking enough water and avoiding sweets is so important in treating menopausal symptoms, that Id go as far as to say that if the patient is willing to follow through with these recommendations, their menopausal symptoms of hot flashes and night sweats will be at least 50% improved in the majority of cases.
7) Lifestyle suggestions: Try to exercise regularly and keep the stress level in your life down. Note that stress is a significant factor in causing menopausal symptoms. A simplistic summary of how this comes about is as follows: Stress contributes to elevation of cortisol which is the hormone of fight or flight. Cortisol will cause elevation of estrogen in the body, and you end up with estrogen dominance which can cause menopausal symptoms (Most salivary female hormone tests show estrogen dominance or a higher estrogen to progesterone ratio).
Again, if you follow the above protocol (natural HRT, phytoestrogens, liver cleansing, constitutional homeopathy, proper diet and lifestyle), you will gradually find relief from menopausal symptoms, and should ultimately be able to stop the natural HRT and phytoestrogens and continue to feel well. In other words, simply eating healthy and doing regular liver cleansing should be sufficient at some point in addressing menopausal symptoms on your journey towards health.
In health,
Dr. Sharif