Addressing Women’s Changing Health Needs - Discovering How Nutritional Ingredients Can Support the Fairer Sex

by Heather Granato
Originally Posted at http://www.naturalproductsmarketplace.com

Throughout the ages, women have been alternately worshiped, feared, honored and ridiculed for the innate physical changes and powers all women face in their lives. However, there is growing interest in gender-specific medicine that addresses women’s particular health needs.

“While regular exercise, a balanced diet and nutritional support are critical for maintaining health, genderspecific nutritional products can address the hormonal, metabolic, biochemical and general physiological needs of men and women,” said Theresa A. Sehi, D.C., president of Herbotanix. “When there is disruption of normal functioning and symptoms occur—as typically occurs in conjunction with periods of hormonal change—gender-specific nutritional products with therapeutic activity can be especially effective.”

The best first view of women’s health may be from the vantage point of hormonal influence. While men enter their teen years on a surge of testosterone—one that often never fully abates—from the time women start menarche, their bodies face constant fluctuations of sexual hormones throughout their lives. Among those critical hormones are estrogen, which is responsible for guiding a woman’s body through pregnancy; progesterone, which works with estrogen on conception and regulates menstruation; luteinizing hormone (LH) and follicle stimulating hormone (FSH), which both impact ovary follicle maturation; and androgen, which stimulates growth at puberty then falls off dramatically at menopause. The circle of sexual fertility starts, on average, in the early teen years and comes to a halt in the early 50s.

And it’s not just your customers’ imagination; those hormonal fluctuations do have a serious impact on physiology and mood on a monthly basis for most women. In fact, it is estimated that at least 85 percent of menstruating women suffer from at least one physical and/or emotional symptom of premenstrual syndrome (PMS).

In the realm of basic nutrition, a case-control study nested within the prospective Nurses’ Health Study II cohort found women with the highest intake of vitamin D had almost half the risk of PMS of those in the lowest quintile; high calcium intake produced a 30-percent risk reduction.1 And a review in Nutrition noted calcium supplementation appears to significantly reduce the physical and emotional symptoms of PMS, and even suggested PMS could be a predictor of osteoporosis induced by low calcium intake.2 And calcium’s partner magnesium may also support menstrual health, as administration of 200 mg/d plus 50 mg/d of vitamin B6 was found in one study to significantly reduce anxiety-related PMS symptoms, including mood swings and irritability.3

Natural treatments may also help women address pain connected with dysmenorrhea (severe pain and blood loss with menstruation) and other uterine complaints. Administration of 30 mg/twice daily of French maritime pine bark extract (as Pycnogenol®, from Natural Health Science) to 47 women with dysmennhorea led to significant relief of abdominal and back pain after three months of treatment.4 Administration of 400 IU/d to 500 IU/d of vitamin E to teenage girls suffering primary dysmenorrhea alleviated pain severity and decreased blood loss.5

Vitex agnus-castus, better known as chaste tree, is a well-known botanical remedy for PMS. It has been shown efficacious in treating a range of gynecological disorders, including menstrual irregularities, hormone imbalances and cyclic mastalgia.6 German researchers examined the impact of Vitex on PMS symptoms including depression, anxiety, craving and edema, and found 93 percent of participants had a reduction in or cessation of symptoms after four months.7 Similar results were reported in a Turkish study, in which Vitex positively impacted breast pain and tenderness along with PMS.8

As menstruation ceases, declining levels of estrogen and progesterone signal the entry into perimenopause. During this two- to four-year time frame, a woman’s periods become less regular and she may experience menopausal symptoms such as hot flashes and night sweats. According to the National Institute on Aging, common symptoms of menopause include a change in periods, hot flashes, problems with the vagina and/or bladder, sexual dysfunction, sleep problems, mood changes, weight gain, joint pain and memory problems.

Tori Hudson, N.D., founder of Vitanica, noted she has patients who ask what symptoms they can expect and when they will subside. “Unfortunately, you can anticipate the course of an illness in other cases, but you can’t here because it’s not an illness,” she said. “That makes options key because you don’t want that one-size-fitsall approach. Some women will need hormones, some need different types, different dosages. The duration is variable, the intensity of symptoms is variable, and there are infinite possibilities for treatments.”

Hormone replacement therapy (HRT)— a combination of estrogen and progestin, given to women with a uterus, as opposed to estrogen replacement therapy, ERT, for women without a uterus—has served as the main treatment menopausal women have turned to for alleviating such symptoms. However, women are increasingly turning to more complementary or alternative medical (CAM) therapies to treat menopausal symptoms. In fact, the North American Menopause Society (NAMS) suggests women seeking relief from mild vasomotor symptoms first explore lifestyle changes and/or dietary supplements such as dietary isoflavones, black cohosh or vitamin E.9

Possibly the best known of those alternative remedies is black cohosh (Actaea racemosa, syn. Cimicifuga racemosa). Researchers at the University of Illinois Chicago (UIC) NIH Center for Botanical Dietary Supplements Research note black cohosh appears to alleviate menopausal symptoms such as hot flashes, profuse sweating, insomnia and anxiety at a dosage of 40 to 80 mg/d, without estrogenic activity, making it safe for women with estrogen-related cancer concerns.10

“Black cohosh is really the foundational herb for menopause,” Hudson said. “Then you can treat the additional dominant symptoms, such as insomnia or anxiety, appropriately.

”The research on black cohosh is compelling. German researchers found 40 mg/d of black cohosh extract provided symptom relief to more than 300 women with climacteric complaints,11 and an Italian study in 64 menopausal women reported 40 mg/d of black cohosh was as effective as traditional HRT treatment in reducing hot flashes.12 One of the largest trials involved more than 2,000 Hungarian women taking black cohosh extract (as Remifemin®, available from Enzymatic Therapy); after 12 weeks of intervention, favorable decreases were seen in hot flashes, sweating,insomnia and anxiety.13

Mary Jane Minkin, M.D., noted she recommends Remifemin to her patients who are interested in alternative menopausal therapies. “Millions of women have taken Remifemin, and it has an excellent safety profile,” she said. “In addition, it has significant activity against hot flashes and night sweats, and you know exactly what you’re getting as far as the amount of root extract.”

Other menopausal options have some estrogenic activity, which may alleviate the decline in endogenous production. “Phytoestrogens are a key nutrient to support hormonal balance and decrease symptoms during menopause,” said Barbara Levenstein, director of new product development and education at Arkopharma. “Isoflavones found in soy and red clover, and lignans, abundant in flax seed and fiber-rich food, are some of the best sources of phytoestrogens.”

Dutch researchers reported intervention with red clover (Trifolium pratense L.), as Promensil, from Novogen, supplying 80 mg/d isoflavones for 12 weeks produced a 44 percent reduction in hot flashes.14 Similar findings were reported in an intervention with 53 menopausal women, in whom Promensil supplementation decreased the rate of menopausal symptoms and triglyceride levels.15 Another multi-center, double blind study found intervention with Promensil reduced the number of hot flashes more rapidly than placebo, though there was no difference at the end of the study in reduction of mean daily hot flashes.16

“While Promensil was not as good as estrogen at stopping hot flushes, it is better than placebo and works with very few side effects,” said Lila Nachtigall, M.D., director of the Women’s Wellness Program at the New York University Medical Center; Nachtigall has conducted studies using Promensil for menopausal symptoms. “In addition, studies have shown that it doesn’t increase breast density or endometrial lining, suggesting its safety profile. So if a woman is determined not to take estrogen, we can use something like Promensil first.”

Another phytoestrogenic compound is soy isoflavones, which have been studied for their ability to relieve climacteric complaints because of the low reported frequency of hot flushes in Asian cultures, where soy consumption is more prevalent.17 Soy isoflavone treatment reduced hot flushes by 44 percent in a six-month Brazilian study,18 and had similar effects in an Italian study when soy isoflavones were given orally (50 mg/d or 75 mg/d) or transdermally (12 mg/d).19 Specialty formulas of isoflavones have also proven beneficial. For example, an Italian study involving 177 postmenopausal women experiencing five or more hot flushes per day found 50 mg/d of genistin and daidzin (as SoySelect®, from Indena) reduced severity and incidence of hot flushes in only two weeks, and to a greater degree than placebo after six weeks.20 Further research found SoySelect had synergistic effects in reducing hot flushes when combined with HRT.21

Red clover and soy are not the only source of phytoestrogens studied for their impact on menopausal symptoms. Another source of phytoestrogens is Polygonum cuspidatum, an herb used in traditional Chinese medicine; its estrogenic effects are attributed to its resveratrol content. In a study of a standardized extract of transresveratrol from Polygonum cuspidatum (as Protykin®, from InterHealth Nutraceuticals), researchers found the extract improved menopausal symptoms such as hot flushes, mood swings and bone strength.22

Specialty formulas may also positively impact menopausal symptoms. Researchers from Samsung Cheil Hospital, Korea, performed a double blind study on a phytochemical formula that includes Shanzhiside methyl ester, Cynanchum wilfordii and Phlomis umbrosa (as EstroG- 100™, from JLM Marketing); a total of 47 postmenopausal women were included in the study. After three months, there was a significant improvement in hot flashes and vaginal dryness in the EstroG-100 group.

Another study using a combination of Salvia officinalis (sage) and Medicago sativa (alfalfa) in 30 menopausal women with hot flushes found the combination therapy completely alleviated hot flushes and night sweating in 20 women and reduced symptoms in the remainder; the researchers attributed the results to a slight anti-dopaminergic action, positively affecting neurotransmitters.23 “Lower levels of estrogen in the blood trigger the release of a regulating factor from the hypothalamus to encourage more hormone production from the ovaries,” explained Eileen Sheets, managing director at Bioforce. “Because the hypothalamus acts as the control center for temperature regulation, you can attribute many of the physical symptoms that occur during menopause to the imbalance in that control mechanism as it struggles with its different tasks.”

The use of adaptogens may also assist in menopausal support, as studies on the proprietary formula Femenessence™ from Natural Health International have shown the ability of its active compounds (Lepidium peruvianum Chacon, as Maca-GO™) to help balance levels of LH, FSH, estrogen and progesterone. “Maca-GO primarily works through adaptogenic properties that stimulate the hypothalamus to induce the body to create a healthy, balanced hormonal state for optimal health,” said James Frame, director of operations with Natural Health. “Therefore, it works differently on each woman depending on what stage of life she is at, her own personal biological make-up and individual health.”

Two studies presented at the NAMS 2006 Annual Congress examined Femenessence’s impact on peri- and postmenopausal women. In the first trial, which included 21 peri-menopausal women aged 42 to 52, researchers provided active treatment (2,000 mg/d of Maca-GO) for two months and assessed hormonal changes and menopausal symptoms.24 Intervention alleviated symptoms including hot flashes, night sweats, mood swings and decreased libido, and significantly increased FSH, LH, estrogen and progesterone levels. The second trial included 100 postmenopausal women who received placebo or 2,000 mg/d of Maca- GO for two months; a parallel study was conducted on ovariectomized rats to assess antidepressive and anxiolytic effects.25 In the women, active intervention significantly increased estrogen and reduced FSH levels, and alleviated menopausal symptoms. The animal arm showed Maca-GO had an anti-depressantlike and sedative effect in the ovariectomized rats, with no anxiolytic activity in control animals.

“Femenessence is different because it actually improves levels of all the key hormones,” Frame said. “Unlike estrogen, progesterone and LH, which all decrease production during menopause, a woman’s production of FSH dramatically increases. This increase in FSH is related to many of the adverse symptoms experienced during this stage of life. Femenessence induces physiological harmony through an increase in estrogen, progesterone and LH, while reducing FSH in postmenopausal women as well as contributing to lower cholesterol, increased bone density and helping to substantially alleviate menopausal symptoms including depression and stress.”

 

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