Alternatives for Hormone Replacement:

What’s Out There?

The use of alternative therapies is on the rise, and with the recent news that hormone replacement therapy may cause dementia, among other conditions, that number could skyrocket.

“Surveys show that the group that tries alternative products the most is cancer patients (90 percent), next is menopausal women (75-80 percent) and then the general public
(50 percent),” says Dr. Joan C. Engebretson, associate professor at The University of Texas Health Science Center at Houston School of Nursing and director of the Division of Target Populations.

“Not only is the public spending about $27 billion out-of-pocket annually for these alternatives, they are not telling their physicians. Some of these substances can react negatively with prescription drugs or certain medical conditions,” Engebretson says.

Soy and Black Cohosh head the list of botanicals used for menopausal symptoms. These two plants are currently being studied through grants from the Center for Complementary and Alternative Medicine (NCCAM), which was established by the National Institutes of Health (NIH). Also being studied at this center are red clover, hops, dong quai, and flax seed.

Topping the list

Some of the more frequently used herbs by women are:

Black cohash - Used to reduce menopausal symptoms, such as hot flashes. Avoid in pregnancy.
Cayenne pepper - taken externally for muscle spasms and internally as an anti-spasmodic.
Chasteberry (Vitex) - Balancing effect on hormones, used for PMS and menopausal symptoms.
Cranberry – antibacterial, may prevent urinary tract infections if taken early. It seems to help the urinary tract slough off bacteria that sticks to the walls of the bladder and urethra.
Dong quai - Used for menopausal symptoms. Recent research has not demonstrated effectiveness.
Echinacea– immune stimulant as well as antiviral, antibacterial and anti-inflammatory. For colds, arthritis and herpes. To be taken orally and not used as a vaginal suppository, which causes irritation. Avoid in immune disorders. Reports of effectiveness conflict.
Evening primrose oil – an Omega 6 oil used for PMS and psoriasis. Research is promising in lowering cholesterol.
Feverfew – anti-inflammatory, used to prevent migraines. May cause rebound migraines. Avoid if allergic to daisies.
Garlic capsule – to lower cholesterol and blood pressure. May interact with anti-coagulants; it, too, has blood-thinning properties.
Ginkgo Biloba – anti-oxidant, memory enhancer. May have some efficacy in Alzheimer’s and dementia, but must be used 6-8 weeks before it begins to work. Because it is a blood thinner, it interacts with anti-coagulants.
Ginseng (Asian) - General tonic for depression and/or fatigue and is used as an antioxidant. Use with caution if hypersensitive. It may interact with several types of medications. It has blood-thinning properties and may also cause reactions in heart patients.
Soy/Isoflavone Isolates - May control hot flashes. Treatment for prevention of coronary heart disease and osteoporosis.
St. John’s Wort – herbal medication that interacts with certain brain chemicals like serotonin-- used for treating anxiety and mild depression. Avoid in pregnancy or if taking psychotropic medications. Consult your doctor if you are taking certain anti-cancer drugs, anti-virals or will be going under anesthesia.
Valerian – a sedative used for insomnia. Avoid use with alcohol, as it is a depressant.
Wild Yam extracts – used for uterine cramps, menstrual disorders during peri-menopause and menopause.

People take herbal medications in the form of tablets, capsules, inhalants and teas. Labeling of those supplements packaged in the U.S. is regulated by the Dietary Supplement Health and Education Act of 1994. Claims may not be made to cure any disease. It must state on the bottle that the Federal Drug Administration (FDA) has not evaluated the substance.

“People often believe that natural substances cannot hurt them and subsequently take more of them than they should. Any substance that can help, can also hurt, and dosage is a concern to health care providers because there is no standardization,” explains Engebretson. Supplements from other countries can contain contaminants. Interactions with medical conditions can be serious.

If you have a suppressed immune system, avoid herbs because of the possibility of contaminants. Except for ginger (preferably prepared as tea), used for nausea and morning sickness, avoid using herbs during pregnancy. Some of them cause uterine contractions. Avoid herbs if you are on dialysis and have severe kidney disease except for milk thistle, which is sometimes used as a liver tonic.

If you have hypertension or cardiac arrhythmias, avoid dong quai and mahaung, which contain ephedra, a stimulant. Be careful of weight-loss products. Read the ingredient list, as the active ingredient in many is mahaung or ephedra or other products related to ephedra, which can cause health problems.

Most important, patients should tell their health care providers what herbs they are using, especially prior to surgery or any other medical procedure, as several herbs alter bleeding factors and others are CNS depressants.

For more information, Engebretson recommends several web sites:

www.herbalgram.org. this site is published by the American Botanical Council;
www.menopause.org/ site of the North American Menopause Society;
www.mdanderson.org/departments/cimer/ site of the UT M.D. Anderson Cancer Center’s Complementary Integrative Medicine Education Resources (CIMER);
www.nccam.nih.gov site of the NIH’s National Center for Complementary and Alternative Medicine.

» Back to main story...

UPDATED: 6-30-2003

About Dr. Engebretson:

Dr. Joan Engebretson is a professor at the UT School of Nursing.

See Dr. Engebretson also at:

Intimate Enemy

Health Tip:

Special Instructions for Children Being Vaccinated Against Flu for the First Time:

Children 6 months up to 9 years of age getting a flu vaccine for the first time will need two doses of vaccine the first year they are vaccinated. If possible, the first dose should be given in September or as soon as vaccine becomes available. The second dose should be given 28 or more days after the first dose. The first dose "primes" the immune system; the second dose provides immune protection. Children who only get one dose but who need two doses can have reduced or no protection from a single dose of flu vaccine. Two doses are necessary to protect these children. If your child needs two doses, begin the process early, so that children are protected before influenza starts circulating in your community. Be sure to follow up to get your child a second dose if they need one. It usually takes about two weeks after the second dose for protection to begin.

Because flu viruses change every year, the vaccine is updated annually. So even if you or your children got a flu vaccine last year, you both still need to get a flu vaccine this season to remain protected. If October and November slip by, and you haven’t gotten your children or yourself vaccinated, get vaccinated in December or later.