| Moderator:
Welcome to today's chat! Our topic is "Alternative Therapies for Menopause and Other Women's Health Concerns" and our guests are Ethan Basch, M.D. and Kate Ulbricht, Pharm.D. Ethan Basch, M.D., is chief editor of the Natural Standard Research Collaboration, which provides unbiased, evidence-based complementary and alternative medicine information on www.naturalstandard.com. He is a graduate of Harvard Medical School, and has been a faculty member at Harvard Medical School, Massachusetts General Hospital, University of Rhode Island, and Northeastern University among other institutions. He is currently practicing oncology at Memorial Sloan Kettering Cancer Center. He serves on the editorial boards of the Journal of Herbal Pharmacotherapy, the Journal of the American Nutraceutical Association, and Harvard Health Publications, to name a few. Catherine (Kate) Ulbricht, Pharm.D., is a senior attending pharmacist at Massachusetts General Hospital, and an assistant professor at Massachusetts College of Pharmacy, Northeastern University, and the University of Rhode Island, plus multiple other colleges. She is a co-founder of Natural Standard Research Collaboration, which provides high-level complementary and alternative medicine information to educate professionals and consumers. She is also editor of the Journal of Herbal Pharmacotherapy, the Journal of Integrative Cancer Medicine, and many more. You may submit your questions at any time. Please be patient; this is a live event. When the chat starts, the questions will be read to the expert one at a time. There may be a slight delay as the answers are dictated to the transcriptionist, who then types the responses into the chat room. Please remember that it is not possible to diagnose or give specific recommendations for an individual situation. All questions will be considered with the understanding that the answers will address general issues. You should seek professional help for your personal circumstances. As soon as possible, a transcript of this chat will be available. For those interested in more information on this topic, the transcript will include links to additional resources, including www.naturalstandard.com. Question:
Are there any alternative therapies that help with sex drive or sexual dysfunction? I have heard about herbal versions of Viagra for men. Are there equivalents for women? Do they work? Dr. Basch:
There are many herbs and supplements advertised on the Internet for libido and sexual dysfunction. For men, yohimbine hydrochloride, which is present in small amounts in bark extracts of the yohimbe tree, is effective to some extent for erectile dysfunction. However, yohimbe bark extract probably does not have enough of the active ingredient to be effective. Similarly, yohimbe bark extract has been promoted for women to increase libido; although there is no clear scientific evidence to support this claim. Many other herbs and supplements have been promoted or tested for female sexual dysfunction, including ephedra, ginkgo, black cohosh, burdock, garlic, ginger, ginseng, gotu kola, kava, lavender, marshmallow (not the kind you roast over the fire — it is a herb), saw palmetto and sweet almond. Many alternative modalities have also been tried, including acupuncture, acupressure, aromatherapy, guided imagery, hypnosis, Reiki and yoga. Wild yams (they are different from those you buy at the supermarket) have also been popular for this use, primarily because wild yams have historically been used in the manufacturing process of some hormones. However, the wild yam itself does not appear to have any hormonal properties in the human body. Therefore, in conclusion, there are no scientifically proven sexual enhancement herbs or supplements at this time. There is risk of side effects and drug interactions. Dr. Ulbricht:
You should discuss these issues with your doctor and pharmacist because there are conventional therapies with more research that may be able to help. Some prescription drugs cause a side effect of sexual dysfunction; adjusting the dose or switching to a different drug may solve the problem. A lot of people have these issues but do not discuss them with their doctors. It is a medical issue, and you should be open with your health care provider. That is what we are here for, and happy to help. There is no need to feel uncomfortable. To find out more about the modalities that were discussed, go to the Complementary And Alternative Medicine area of InteliHealth and www.naturalstandard.com. Question:
What suggestions do you have to help menopausal insomnia? Dr. Basch:
There are many symptoms that can accompany menopause. This has been a major area of controversy recently, from a treatment perspective, due to emerging data about prescription Hormone Replacement Therapy (HRT). There are many herbs and supplements that have been used for menopausal symptoms, as well as herbs and supplements that are used for insomnia due to any cause. Dr. Ulbricht:
For insomnia, a lot of study has been done on melatonin, which is a naturally occurring substance in the body. Hundreds of studies have been done using melatonin for jet lag and numerous other types of sleep disorders. It seems to be fairly well tolerated. One word of advice: there appears to be a window of opportunity for taking it. You need to be in bed ready to fall asleep and should feel the effects in about 20 minutes if it is going to work for you. Dr. Basch:
Valerian has also been studied for insomnia, and appears to improve quality of sleep and number of hours of sleep. It is not clear if it is as effective as prescription drugs used as sleep aids such as diazepam (Valium), lorazepam (Ativan), or Zolpidem (Ambien). Many other herbs and supplements — for example, astragalus, black cohosh, co-enzyme Q10, ginkgo, ginseng, hawthorn, niacin, passionflower, St. John's wort and thyme — have been promoted for sleep disorders; however none have been scientifically proven to help. Aromatherapy (such as lavender oil) is also popular for helping to induce sleep. Dr. Ulbricht:
Many liquid preparations may contain large volumes of alcohol, so if you are purchasing an extract or a tincture be sure to check the label. Alcohol will increase the drowsiness effect, and may interact with some medications such as metronidazole (Flagyl) or disulfiram (Antabuse). Pregnant women or breastfeeding mothers should not take these liquid preparations. Dr. Basch:
We will address menopausal symptoms in a later question. Comment:
I found that a small dose of copper as you would get in a multivitamin helped my insomnia. Dr. Basch:
We are not aware of any scientific evidence for this, but thank you for your comment. Question:
Do hot flashes EVER stop? I am 71, and was on HRT for 28 years after a hysterectomy. In October I stopped HRT and began using soy, and this month I am using black cohosh. Dr. Basch:
In many women, hot flashes do resolve, although now that HRT is less commonly used, there are more women reporting long-term menopausal symptoms. This is a growing concern among many physicians. However, the risks associated with long-term use of prescription HRT still appear to outweigh the benefits for most women, even women with persistent menopausal symptoms. For women who have stopped using hormones, herbal preparations may seem like an effective alternative. There is evidence favoring the use of soy and black cohosh for the relief of menopausal symptoms. However, these herbs may have similar effects in the body to estrogen, and therefore may carry some of the same risks as HRT. This is an area of controversy, because some studies suggest that soy or black cohosh may actually block some of the effects of estrogen. Thus, the risk remains unclear at this time. There is early evidence that SSRI antidepressant drugs such as sertraline (Zoloft) or fluoxetine (Prozac) may be helpful for menopausal symptoms without estrogenic effects. Similarly, vitamin E has gained popularity, although there is no good research in this area. Question:
Are there any herbal contraceptive pills? Dr. Ulbricht:
We are not aware of evidence supporting an herbal supplement for birth control. However, there are numerous herbs and supplements that interact with prescription oral contraceptives and alter their effectiveness. Unplanned pregnancies have been reported. People taking St. John's wort with birth control pills, for example, have become pregnant. As an aside, pregnant women should approach the use of herbs and supplements cautiously, as many have not been tested for safety during pregnancy or breastfeeding. Speak with your obstetrician and pharmacist before using any new therapies. Question:
Are there any herbals that can be used as a morning-after pill? Dr. Basch:
There are no herbs that have been well evaluated scientifically for this purpose. Women who have concerns in this area should speak with a qualified health care professional about their concerns and should not self-treat. Some herbs have been used traditionally to cause abortions, although there is no scientific evidence for any of them, and there may be serious safety concerns for both fetus and mother. These are not recommended. Question:
What can you do to prevent osteoporosis? What about coral calcium? Dr. Ulbricht:
Calcium supplementation is recommended in all women, both premenopausal and postmenopausal, for osteoporosis prevention. I am often asked which calcium is the best. Some advertisements suggest that oyster calcium or coral calcium is superior, but the truth is that your body doesn't know the difference. It doesn't matter where the calcium comes from. You do need an adequate supply of vitamin D for absorption of calcium. People can take the cheapest formulation. Tums and other calcium products are available. Talk with your health care professional and pharmacist to determine the most appropriate dose for you. There are some prescription medications that you should not take at the same time as calcium. Women with low bone mineral density may also need to take a prescription drug to strengthen bones, and postmenopausal women or women at risk of fractures should speak with their doctor about bone mineral density testing. Dr. Basch:
A number of other herbs — such as black tea and horsetail, as well as some of the "phytoestrogenic" herbs such as red clover, soy, black cohosh and dong quai — have been used for osteoporosis or osteoporosis prevention, but none have been proven effective. Women at risk for low bone density should speak with their physician about having a bone mineral density test because there are treatments for osteoporosis that are beneficial. Dr. Ulbricht:
Shark cartilage and bovine cartilage are also promoted for this use because they contain high levels of calcium. Again, your standard generic calcium, which is much less expensive, is equally effective. Some shark cartilage preparations can run $700 to $1,000 per month. You can buy a bottle of calcium at the pharmacy for $3. Also, please remember that herbs and supplements aren't regulated by the FDA, so you cannot be sure of what you are getting. Question:
Perimenopause seems to be a hot topic lately. Even Dr. Phil had a show devoted to the topic. Dr. Phil's wife, Robin, has been following a natural treatment and talked about having her saliva and hair follicles tested. Can you please comment on these tests? Dr, Basch:
Testing of hair follicles in laboratories has become popular with some types of complementary practitioners for a number of conditions, including menopausal symptoms and cancer. Unfortunately, at this time there is no reliable scientific evidence to support the use of this sort of testing. Question:
Is there anything natural that I can use for PMS? Dr. Ulbricht:
There are many preparations touted for PMS. Evening primrose oil is popular for this use, although two well-designed studies have failed to show any benefit. A number of other herbs have been used, such as belladonna, ginkgo St. John's wort, pennyroyal and goldenseal, but there is no known scientific evidence to support their use. People have also tried reflexology, relaxation therapy, aromatherapy and yoga for relief of symptoms. However, as Dr. Ulbricht noted, none have been scientifically proven to help symptoms. Question:
Can you comment on the use of flaxseed oil and progesterone cream as viable options for hormone replacement? Dr. Basch:
First, we will discuss flaxseed oil. Flaxseed oil has been scientifically evaluated for a number of medical conditions, but it has not been well tested for menopausal symptoms. Flaxseed oil contains alpha-linoleic acid as well as unsaturated fatty acids. However, it is not clear if these are beneficial in menopausal women. Dr. Ulbricht:
Flaxseed has multiple potential interactions. There is good scientific evidence that flaxseed is effective in the management of constipation, but it should not be taken with other laxatives. It has potential interactions with anticoagulants ("blood thinners"), lithium, and drugs used for diabetes. It may add to the effects of drugs used for high cholesterol and it may interact with birth control pills and hormone replacement therapy (HRT). Dr. Basch:
This brings up a very good point that we always try to stress, which is that many herbs and supplements are active substances in the body, and although they may have beneficial effects, our knowledge of the potential allergy, adverse effects and interactions is growing. Therefore, using one of these agents should be approached in the same way as you approach starting a new prescription drug, under supervision of a qualified health care professional and your pharmacist. Dr. Ulbricht:
Regarding the use of progesterone cream for symptom relief, there is a concern of having side effects. Be cautious because agents that are applied topically (on the skin) may be absorbed by the body. This is especially a concern if you have any hormone-sensitive conditions such as breast cancer, endometriosis or uterine cancer. The potential benefits of this therapy should be discussed with your doctor and pharmacist. Chasteberry, bloodroot, oregano (in high doses), damiana and yucca have been purported to have progesterone-like properties. Some herbs with proposed estrogen-like effects include alfalfa, hops, kudzu, licorice, pomegranate (in high doses) and white horehound. These are in addition to the others we discussed earlier today — black cohosh, red clover, burdock, soy, thyme and dong quai. Moderator:
Well, our time is up. We had a lot of great questions, and I wish we had time to get to them all! I'd like to thank both of our guests for taking time out of their busy schedules to join us this afternoon. For those who joined us late, a transcript of the entire chat will be available soon. If you are interested in more information on alternative therapies, the transcript will include links to additional resources. | 
