Natural Health and Herbal Remedies Blog – information on herbal medicine

The Maine Women’s Health Study, one of the largest studies to date that has followed women through treatment for problems like heavy bleeding and chronic pelvic pain, presents a unique opportunity to compare hysterectomy with non-surgical therapies. In one part of the study over 350 women from the State of Maine, in the north-eastern United States, who had a hysterectomy were interviewed at the time of surgery and then three, six and twelve months later. Most had been diagnosed as having fibroids, abnormal bleeding, chronic pelvic pain, endometriosis, a cancer, or prolapse. The peak age for hysterectomy in this group of mainly White women was the early forties. Another study was conducted at the same time for comparative purposes; it involved nearly 400 Maine women who had non-surgical treatment for fibroids, chronic pelvic pain and abnormal bleeding.3 In general, the women who had hysterectomies had more severe symptoms than the non-surgical treatment group and their activities were more limited as a result.

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In older homes water supplies may contain high levels of lead from lead pipes leading into the house, especially if the water is soft. Even if your pipes are copper (which can carry its own problems), then the pipes may be joined by lead solder, or the pipes to the street may be lead. Lead can leach into the water just by standing in lead pipes overnight so allow the tap to run for a minute first thing in the morning. Always use water from the cold tap, not the hot one, for cooking, making hot drinks, etc, because lead dissolves more easily into hot water.

It is now well-known that lead, especially from petrol fumes, can have a disastrous effect on the behavioural and intellectual development of children.

Leaded petrol has been gradually phased out, with more and more cars running on lead-free petrol. Since January 2000 it has not be available at all.

What You Can Do

•     Since the 1960s all paint has been lead-free, but if you are renovating an old house then you must be careful when scraping or burning off old paint. Take extra precautions, such as wearing a mask; and have good ventilation, or get a professional to do the job. Also make sure that enough time is left for the renovations to be completed before the four-month preconception period.

•     If at all possible, try to live away from very busy roads where lead levels could be high. Otherwise ruse net curtains to try to lessen your exposure.

•     Use a water filter for all your water, including cooking, hot drinks, etc. Either get a simple jug water filter or a filter that is fitted under the sink that runs into the cold water supply. The choice of a filter is not easy because a jug filter is made of plastic (raising concerns about xenoestrogens) and bottled water often comes in plastic. The experts are now asking to know what the plastics are made from, as not all plastics leach chemicals and then we could make an informed choice.

•     If you are unsure about your water supply, or if you have lead pipes or a lead tank, then you can ask your local environmental health department or water supplier to test the water for you. Your public library should have a copy of the Drinking Water Inspectorate’s Annual Report which details the monitoring of the water supply and when the water has exceeded ‘maximum permitted levels’. (A few years ago there was a problem with my local water and the public were told that it was safe to drink but not to use it to fill up fish tanks, as it could kill the fish. That gave everybody confidence!)

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The decision whether or not to have hormone replacement therapy if your ovaries are removed is difficult and complex because there is considerable controversy about the role of hormone replacement therapy following a radical hysterectomy for endometriosis.

Hormone replacement therapy is the administration of synthetic hormones to replace those which were previously produced by the ovaries in order to prevent or minimize the effects of menopause. It usually involves the use of both synthetic oestrogen and progesterone but sometimes only synthetic oestrogen is used.

The two main forms of administration are tablets and implants and there are a variety of strengths which can be used depending on the severity of your menopausal symptoms.

The most common side effects of hormone replacement therapy are nausea and sore breasts, although in the long-term it is possibly associated with a slightly increased risk of developing breast cancer. Hormone replacement therapy will prevent or reduce the effects of surgical menopause but it may also slightly increase the likelihood that you will have a persistence or recurrence of your endometriosis.

Hormone replacement therapy will prevent or reduce most of the symptoms of menopause, including hot flushes, night sweats and a dry vagina. More importantly, it will significantly reduce the likelihood that you will develop heart disease or osteoporosis later in life.

There is a risk that the oestrogen component of hormone replacement therapy will lead to a persistence or recurrence of the implants remaining in your body. Many gynecologists believe that because the concentrations of hormones used are much lower than those produced by the ovary the risk of recurrence is small – probably only about 3% to 5%.

Nevertheless, some gynecologists recommend waiting a minimum of three to six months after a radical hysterectomy before starting hormone replacement therapy. This delay should allow any remaining endometrial implants to degenerate and waste away, reducing the chances that it will cause a persistence or recurrence of your endometriosis.

Some gynecologists suggest that using only a synthetic progesterone such as Provera, rather than both oestrogen and progesterone, as an interim measure for the first few months after surgery will reduce the likelihood of recurrence while still providing some relief from the early symptoms of surgical menopause.

If you are unlucky enough to have a recurrence of your symptoms of endometriosis while on hormone replacement therapy it may be possible to treat the recurrence by stopping or adjusting the dosage. It may also be possible to treat it by having a course of one of the standard hormonal treatments such as Provera or Danazol.

If you do not take hormone replacement therapy you will have a reduced likelihood of having a persistence or recurrence of your endometriosis but you will probably experience the effects of surgical menopause and you will have an increased likelihood of developing heart disease and osteoporosis later in life.

A few women continue to produce enough oestrogen in their bodies to prevent or minimize the effects of surgical menopause. Many women will experience marked symptoms and, although they are often disruptive and unpleasant, some women find that they are easier to cope with than their endometriosis symptoms.

Some women have found that they have been able to prevent or minimize the symptoms of surgical menopause by having a good diet, particularly one high in foods which contain natural oestrogens such as grains, as well as vitamin and mineral supplements, regular vigorous exercise and regular sexual activity.

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Through the ages people have sworn by many different things. Today flushes can be prevented in 100 per cent of cases with oestrogen therapy, that is by replacing the body’s depleted oestrogen with artificial hormones. Oestrogen therapy produces its effect in a matter of days.

Alternative treatment There are some women who cannot or will not take oestrogen.

Progestogens (synthetic progesterone) is a most effective alternative. Progesterone is the hormone that is produced in the second half of the menstrual cycle before the menopause.

Clonidine (Dixarit) prevents flushes in some patients, but it has poor results with resistant flushes which have gone on for many years. It is certainly not as effective as oestrogen. Side-effects from clonidine are dry mouth on maximum doses, and dreaming which can sometimes be intolerable.

Tranquillisers and sedatives, of course, can dampen down an uncomfortable flush and have been given by those who disapprove of oestrogen or are unaccustomed to its use. To me they have unnecessary, addictive properties.

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At the menopause, the levels of oestrogen (the female hormone) and testosterone (the male hormone) both fall. If the ovaries are removed, testosterone levels will fall still further. This can lead to an altered libido, and the variation between the two hormones perhaps explains the variation in libido from one woman to another.

Some women experience a sudden loss of libido with the hormonal changes, but this settles provided that no other factors are involved. It can also be helped of course by oestrogen replacement. However, libido depends on so many things general good health, rest and interest in one’s partner. It is no good expecting books or hormone replacement to repair libido of a couple who are sick of each other after twenty-five years of living together. Certainly oestrogens can help, just as they can help to eliminate dyspareunia, or uncomfortable intercourse, and my advice is that whenever any aspect of your physical, mental or emotional health is declining, you must put more effort into it. In addition, whatever turned you on once may be used to help to improve your libido at this time.

Implants What can be done if oestrogen replacement alone fails to improve a declining libido?

It has long been felt that testosterone was the hormonal ingredient responsible for libido. This hormone is better given by a pellet or injection than by mouth. We have conducted two studies in which we introduced pellets of oestrogen and testosterone under the skin with great success. This is a simple procedure taking a few minutes under local anaesthetic. We also compared the use of the oestrogen and testosterone mixture with oestrogen used alone.

From our results we now believe that testosterone is necessary. We eliminated the side-effects of the testosterone in the group we studied by adjusting the balance of the two hormones. Oestrogen implants alone are indicated when patients are nauseated by oestrogen taken orally or when hot flushes are not eliminated by oestrogens taken by other methods. A mixture of oestrogen plus testosterone is indicated for loss of libido and depression unrelieved by other methods. Implants are a boon to many women with these symptoms, particularly to young women who have lost their ovaries. These women in some instances feel mentally flat and feel nothing sexually.

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Cancer of the endometrium, the lining of the uterus, affects only one in 9000 women per year; it is not very common. In comparison, one in 1600 women dies of breast cancer. Cancer of the uterus is easily detected because of irregular bleeding and, unless it is neglected few women should die of it. If it spreads, it spreads slowly. It occurs most commonly in overweight women and also tends to run in families, so that women with mothers or sisters who have developed cancer of the uterus should be more aware of it.

Confusion surrounding the American articles

Immediately the American articles linking endometrial cancer with oestrogens were published, a meeting of senior clinicians* was called to consider them and to set up definite guidelines for our clinic. The meeting found that:

• the articles were based on retrospective studies, that is after the women had developed cancer of the uterus and it had been diagnosed, then their histories were looked back upon. In cases like this the wrong conclusions are often reached. The women were asked, for instance, if they had at any time taken oestrogen, and as many women at that time in the United States were on oestrogens, the common reply was ‘yes’.

• women were not screened before they had the oestrogen to see whether the cancer was already there.

• many women put on oestrogen therapy, are put on it to control irregular periods at the menopause. These irregular periods, if not investigated, may indicate that cancer is there already. There was no indication of the dose given (very high doses are often used in the United States) and no regime of treatment was outlined – that is, were progestogens also given, and were oestrogens given continuously or with a break of one week in four?

• endometrial hyperplasia is common, often being confused with endometrial cancer.

With all this discussion no wonder there is confusion, compounded by exaggerated press reports which are, in some cases, inaccurate. Women are worried, and, if not, their husbands and families are. They take themselves off oestrogens, and, if symptoms are present, suffer unnecessarily.

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(THINNING OF THE BONES)

Thousands of people in Australia today are affected by osteoporosis – or thinning of the bones, and of these, four in five are postmenopausal women. Affected people break their bones more easily, and there are some whose bones simply collapse under their own weight. Three common fractures occur in postmenopausal women: compression fracture of the spine; fracture of the forearm, especially the wrists; and fracture of the neck of the femur (hips). A compression fracture of the spine, due to the collapse of the vertebral column, causes the dowager’s hump commonly seen in postmenopausal women. These fractures are markedly more common in women than men of a similar age group. Changes in bone are responsible for some backaches in women of this age group.

Loss of bone is associated with an altered calcium metabolism which gives rise to a negative calcium balance, that is the body is losing more calcium than it is retaining. The bones lose density and become porous, as you can see from the X-ray in figure 5.1. They also become brittle, and fractures can occur with very little trauma. Bones in the spine compress with the weight of the body, resulting in height loss in women.

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There is no proven evidence for this at this time. The facts are that the women of America have been taking oestrogen since the 1930′s and figures on breast cancer have been carefully watched by stringent authorities in that country. Two papers have suggested that oestrogens may cause breast cancer, but a large number have suggested that they do not. Another large recent survey has indicated that oestrogen plus progestogen is protective for breast cancer and for this reason we believe that if women are to take oestrogen long term, even if they have had a hysterectomy, should be offered progestogen as well to protect their breasts with the above evidence made clear to them. It is felt that if there is a risk it must be a small one.

Can oestrogens make cancer of the breast grow if it is already present?

It is possible, if you already have cancer of the breast, that oestrogens will speed the cancer’s growth, and all doctors would include examination of your breasts in a ation when giving oestrogen therapy. However, examination by your doctor is not all that is necessary. Self-examination should be practised once a month. If periods are still * ^ be done after the period when breasts are less lumpy and tense. It is up to you to care for yourself.

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