Within the past 2 months, I saw three women for relief of menopausal symptoms. Two had a history of breast cancer and the third one was just diagnosed with an early stage disease. Their histories revealed one thing in common - long-term use of bio-identical female hormones prior to diagnosis.
As a medical oncologist I have some concern about the safety of Hormone Replacement Therapy (HRT). For around a quarter of century, gynecologists handed out prescriptions of synthetic estrogens to women in menopause without any evidence of safety concerns. It was thought that estrogen would provide a fountain of youth and it might even protect the heart. Then in 2002, a large government-sponsored study called Women's Health Initiative (WHI) was discontinued prematurely after researchers discovered an increased risk of breast cancer, heart attack and stroke in post-menopausal women taking HRT. Since that time, the use of bio-identical hormones has taken off. Many believe it is natural and safe.
But, is it really safe?
It cost taxpayers more than 500 million dollars for the WHI study, about 10,000 women were followed for a median of 9 years before reaching the conclusion. It is highly unlikely for the government to sponsor another study with similar design. Let's look at what we do know about this topic:
Acupuncture and Chinese herbal therapy - an alternative to HRT
- Drug safety is related not only to the chemical formula of the molecule but the duration of usage. We really don't know the long-term safety of many prescription drugs.
- Let's look at the drug Tamoxifen, a weak estrogen, indicated for treating metastatic breast cancer and breast cancer prevention. It works because it competes with endogenous estrogen for estrogen receptor, the binding protein on cell membrane, and the net result is a much weaker estrogenic effect on whole body if one takes Tamoxifen. However, there is laboratory evidence of stimulation of cancer growth if a higher concentration of Tamoxifen is mixed with breast cancer cell lines.
- At least two folds increased risk of uterine cancer has been reported in those using Tamoxifen as the uterine lining is sensitive to estrogen simulation.
- Phytoestrogen, estrogen from plant source such as soy, is generally regarded as safe, but high dose of soy isoflavone is not recommended for hot flashes for safety concern.
The crucial question is whether there is any alternative to estrogen in managing menopausal symptoms. Several studies over the last decade showed that acupuncture is effective, even for those women with history of breast cancer on endogenous estrogen lowering drugs such as Tamoxifen or Aromatose inhibitors. My personal practice experience surely echoes these study outcome. A recent publication in Journal of Clinical Oncology called the "Ac Climat" study in which 190 women with a mean age of 49 years with diagnosis of breast cancer were treated with 10 acupuncture treatments. In addition to a significantly lowered hot flash score, there was improvement in health-related quality of life outcomes in the vasomotor, physical, or psychosocial dimensions at the end of treatments.
I have also compounded Chinese herbs for each individual in order to treat menopause. By mixing cooling herbs, blood invigorators, kidney energy boosters, calming herbs, etc., tailored to each individual, most patients feel better.
THIS TOO SHALL PASS
. Menopausal symptoms do gradually get better with time. What physicians should, but do not emphasize enough, is life style medicine. For instance, regular exercises, a healthy diet containing cooling foods and avoiding hot and spicy foods, meditation, all help to certain extent.