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Re: Hot flashes/phytoestrogensFrom: Bryan Jick (drbryan@earthlink.net)Fri Jan 24 19:11:18 1997
I recently gave a talk on menopause, natural estrogen therapy, and did some research on the subject, which may be of interest. First, I refer you to the book, "Smart Medicine for Menopause," by an Australian physician, Sandra Cabot, M.D., with many chapters on the "natural approach" to HRT. Basically, there are plant phytoestrogens found in some herbs, such as Dong Quai, Black Cohosh, Damiana, and Licorice. Extracts of these sold in health food stores help alleviate hot flashes in some women. They are thought to be about 1/200 the potency of pharmacologic estrogen. Also, there are some food products which contain estradiol itself. In fact Estrace (pure 17-beta estradiol) is extracted from soybeans. Therefore TOFU can provide some degree of pure estradiol. Yams contain pure natural estrogen and progesterone, and yam extract is available in health-food stores as well (as creams or capsules). I would expect that if patients see reduction in H.F. from plant-derived estrogen sources, then reduction in total Chol, reduction in LDL, and improved HDL (all known properties of estrogen) would also occur. I agree that standardization would be helpful, since there is the risk that patients could self-medicate themselves into endometrial hyperplasia/carcinoma if they try hard enough! Part of the problem is the definition of a "natural" estrogen. Medically, natural should be an estrogen naturally found in nature (e.g. in plants, animals or people), and synthetic means made up in a laboratory. To patients, natural is anything not sold by a drug company. In reality, Premarin is natural, but many patients are turned off by the "horse urine" aspect. Estrace, although from a drug company, is natural estrogen. Natural progesterone, micronized, is a valid drug to prescribe (and has had favorable press, e.g. PEPI trial). I now have patients who want "natural" HRT post-menopausal, and I give it to them. I carefully explain the basis for deciding whether or not a hormone is natural. I use Estrace 0.5 mg. bid, and natural micronized progesterone 100 mg. po bid. We start off with blood levels of estrogen, progesterone, and testosterone. If T is low, and patient has low libido, we discuss the pros and cons of androgen replacement as well. The side effects tend to be less with natural, and since patients self-select this route, they are usually VERY HAPPY when a doctor is willing to go along with them, rather than try to talk them out of it. As you can tell, I am not an academician. However, as long this approach is relatively safe, scientifically reasonable and definitely in demand by patients, I am willing to offer it.
-- Bryan S. Jick, M.D., F.A.C.O.G. Pasadena, CA
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