Sometime ago, a 51-year-old housewife whom we’ve been treating for several years for high blood pressure, complained of an increasing frequency of bothersome symptoms which we attributed to her menopausal condition. We explained to her that at the onset of menopause, a woman’s estrogen production is greatly reduced, and practically the whole body is affected, challenging not only one’s physical health but mental health as well. It generally occurs shortly after a woman celebrates her 50th birthday, but for some, it may occur much earlier, particularly if they underwent surgery removing their ovaries. This is called surgical menopause.
Symptoms can range from hot flashes to mood swings, easy fatigability, brain fog, increased sensitivity and irritability and vaginal dryness—such that some authors describe it as if one’s body is a battlefield. All these symptoms are due to the huge hormonal change that occurs in the body as the ovaries stop producing hormones, mainly estrogen. This impacts the entire woman’s body, physically and mentally.
Not only a sex hormone
Contrary to what others think, estrogen is not only a sex hormone that is responsible for developing a woman’s secondary physical traits and regulating her menstrual cycle. It also affects the other organs of the body such as the urinary tract, cardiovascular system, bones, skin, hair, mucous membranes, brain and musculoskeletal system. That’s why some women may feel that their whole body is in shambles and feel distraught about it.
Going back to our patient, we conferred with her gynecologist and discussed if we should give her hormonal replacement therapy (HRT), but considering her hypertension and previous history of breast cysts and one episode of swelling of the leg veins (deep vein phlebitis), we agreed that HRT might do more harm than good. In predisposed women, HRT may also enhance the development of blood clots in the blood vessels.
We thought of trying plant-based phytoestrogen dietary supplements, and when she came back after around two months, she happily reported a significant reduction in the frequency of her hot flashes and other symptoms, including vaginal dryness. The symptoms didn’t totally disappear, but they were a lot more tolerable.
In 2016, a meta-analysis integrating findings from 62 published studies looking at 6,653 women who participated in clinical trials evaluating the effectiveness and safety of plant-based therapies supported the beneficial effects of these herbal remedies on menopausal symptoms of hot flashes, night sweats and vaginal dryness. The study was thoroughly peer-reviewed and published in the prestigious Journal of the American Medical Association (JAMA). (Franco OH, et al. Jama. 2016; 315[23]:2554-2563)
The authors reported the following findings: Use of phytoestrogens in general was associated with a decrease in the number of daily hot flashes and vaginal dryness between the treatment groups and placebo, but not in the number of night sweats; individual phytoestrogen interventions such as dietary and supplemental soy isoflavones were associated with improvement in daily hot flashes and vaginal dryness; and, several herb remedies, but not Chinese medicinal herbs, were associated with an overall decrease in the frequency of symptoms.
In a separate commentary by Dr. Neil Skolnik in the Cleveland Journal of Medicine, he noted that the findings in this study is significant in that five to eight out of 10 menopausal women experience hot flashes or night sweats which may be bothersome for many. Although HRT has been shown to be effective in relieving symptoms, there is still that major concern for its use because of the potential risk of increasing the incidence of breast cancer and cardiovascular disease with estrogen replacement.
Alternative treatment
Around half of women and their physicians therefore decide to try alternative symptomatic treatment for perimenopausal symptoms; and this fairly robust meta-analysis validates the recommendation that plant-based phytoestrogens, which has a molecular similarity to estrogen, can help alleviate menopausal symptoms.
“This study gives us guidance with regard to efficacy, showing that phytoestrogens do provide benefit in decreasing menopausal symptoms,” writes Dr. Skolnik. He cautions however that we also don’t know if there’s any similar risk observed with synthetic HRT. This area of risk with plant-based phytoestrogens “is still undetermined as the size and length of the studies assessed would not adequately examine risk,” explains Dr. Skolnik.
Another problem experienced by many women after menopause is an increase in frequency of urinary tract infection (UTI). Another published study reports that UTI episodes in women were lowered with the consumption of cranberry juice beverage.
The study was scientifically designed—a double-blind, placebo-controlled clinical trial enrolling 373 women with a history of recent UTI, who were divided into two groups. One group consumed a 240 milliliter serving of cranberry beverage/day (n=185) or a placebo (the beverage tasted like cranberry but was not really cranberry juice) (n=188). The respective beverages were given for 24 weekends or close to six months. (Maki KC et al. Am J Clin Nutr. 2016; 103:1434-42)
Preventive strategies
The researchers reported the following: There were 39 diagnosed episodes of clinical UTI in the cranberry group compared to 67 episodes in the placebo group. After adjusting for antibiotic use, the reduction with cranberry juice was 39 percent; clinical UTI with pyuria or pus cells in the urine was also significantly reduced by 37 percent; and, time to UTI with urine culture tests positively did not differ significantly between groups.
Dr. Skolnik also reviewed this study and he noted that recurrent UTIs is a common clinical problem encountered by physicians and that one out of four women who have a first episode of UTI will experience a recurrence in six months. He explained that this is due to risk factors like sexual intercourse, use of spermicide and diaphragm for contraception, and previous history of UTIs. Various studies recommended preventive strategies like voiding immediately after sexual intercourse, use of probiotics, and even taking antibiotic or urinary antiseptics prophylactically after intercourse.
Dr. Skolnik noted that the findings in this study are consistent with other studies on cranberry juice, showing approximately a 40-percent reduction in recurrent UTIs. “This study lends further evidence to support using daily cranberry juice for prophylaxis of UTIs in women with multiple UTI recurrences,” he wrote. This can significantly minimize the intake of antibiotics for UTI, so antibiotic resistance can be avoided with its frequent or prophylactic use.
Modern medicine makes doctors think of sophisticated and sometimes complicated treatments, with their accompanying side effects. Sometimes, we just need to go back to basics, and see if mother nature has something in store for whatever ailments we have.