For the past few years, hormone replacement therapy has become a well-publicized and highly debated topic, and many women are looking for natural alternatives to “standard” hormone therapy. In the reproductive years, varying cycles of estrogen and progesterone, as well as their effects on neurotransmitters, lead many women to experience mood swings, painful cramps, bloating, and more than 100 other less-than-pleasant symptoms of PMS (premenstrual syndrome). For perimenopausal women, fluctuations in these same hormones can contribute to hot flashes, night sweats, mood changes, and weight gain. These hormonal fluctuations may go on for years before finally dipping down to post-menopausal levels.
With conventional treatment, women with PMS may end up taking a multitude of medicines, one for each symptom, often with incomplete relief. Women going through menopause might also take the symptom management approach or decide to restore their estrogen, progesterone, or testosterone levels through hormone replacement therapy (HRT).
While HRT can be highly effective in treating symptoms such as hot flashes and night sweats, recent research, including a major 2002 study by the Women’s Health Initiative, has led many to conclude that the risks of HRT exceed the benefits for certain groups of women. Read more about the WHI study here. Much of this research was done using a standard FDA-approved hormone therapy called PremPro, a combination of Premarin (conjugated equine estrogen) and Provera (medroxyprogesterone acetate). Since that time, a lot of debate has arisen regarding the use of so-called “natural” or “bio-identical” hormones over these conventional hormone therapies:
What Are Bio-identical Hormones?
Bio-identical hormones are those which are identical in molecular structure to the hormones that women make in their bodies. Other than in a woman’s body, these hormones are not found in nature and therefore must be synthesized in a laboratory, typically from extracts of soy or yams. FDA-approved bio-identical hormones are available; however, these preparations may also be compounded individually.
In contrast, although standard or conventional hormones such as Premarin come from a natural source (the urine of a pregnant mare), they are not bio-identical and are metabolized into various forms of estrogen other than estradiol, the predominant form of estrogen that declines in menopause. So far, scientific studies have not found that using bio-identical HRT offers any health advantages over standard HRT.
An Alternative to Hormone Replacement
While I believe that HRT using bio-identical hormones and other medications may be extremely useful for women whose lives are deeply disrupted by menopausal symptoms or PMS, I have found that taking an Ayurvedic approach aimed at restoring balance in the whole body eliminates, or at least greatly reduces, the need for a pharmaceutical approach. Symptoms of discomfort are our body’s way of communicating to us. Instead of simply masking the symptoms with hormonal treatment or medication, it’s important to listen to what the underlying message may be and address any underlying imbalances. The time of perimenopause and menopause is not only a transition from the physiology of the reproductive years, but also an opening to address the deeper meaning of life and spirit.
Many of my patients have found that certain lifestyle changes and simple techniques such as the ones below have allowed them to balance their hormones and reclaim health.
1. Eat your broccoli. Cruciferous vegetables such as broccoli, cauliflower, bok choy, Brussels sprouts, cabbage, and kohlrabi contain a substance called indole-3-carbinol (I3C), which is metabolized in the body to produce diindolylmethane (DIM). Both of these substances help modulate estrogens and have been shown to have some anti-cancer effects, particularly for breast cancer.
2. Maintain a healthy weight. Excessive adipose (fat) tissue can act as an endocrine organ, producing more estrogen in the body. By maintaining a healthy weight, your body is not stimulated to overproduce certain hormones.
3. Include phytoestrogens in your diet. Found in soy foods, flax seeds, sunflower seeds, bean sprouts, and legumes such as garbanzo beans and peas, phytoestrogens are plant-based substances that can help balance your hormones naturally.
Although there has been some controversy in the media over the consumption of soy, I do not know of any scientific studies showing that eating soy-containing foods is harmful. My view is that consuming small amounts of soy in the diet can be beneficial. However, I would advise against taking phytoestrogens such as soy as supplements as we do not know enough about the effects of taking these compounds in high doses. Also, I caution against eating processed soy products and soy additives in many foods, but instead encourage the use of traditional soy foods such as tofu, edamame, tempeh, miso, and soy sauce. Make sure they are organic and non-GMO.
If you have known thyroid disease, I would also caution against eating foods that contain phytoestrogens raw as goitrogens in these foods may interfere with thyroid function. Cooking does neutralize this effect, but avoid consumption within two hours of taking any thyroid medication.
4. Consider the use of herbal remedies. In my practice, the Ayurvedic herb shatavari has been useful for both menopausal hot flashes and PMS associated with irritability and mood swings. Other herbal remedies have also proven helpful for both physical and psychological symptoms. As each individual is different, always speak with a trained practitioner before using herbal remedies.
5. Breathe deeply. Doing fifteen minutes of deep belly breathing twice daily has been shown in several clinical trials to decrease hot flashes and night sweats as well as improve a woman’s sense of well-being. In addition, I encourage women (and men) to learn a mind-quieting technique such as Primordial Sound Meditation, which helps decrease stress hormones and allows the body to function more efficiently.
Addressing lifestyle including diet, physical activity and stress management as well as gaining support from practitioners and loved ones is an excellent start. In addition to helping with hormonal balance, these mind-body techniques to bring about balance create a greater sense of wellbeing and ultimately optimum health.
About the Author
Dr. Valencia Porter is the Chopra Center's Director of Integrative Medicine. Board-certified in both general preventive medicine and integrative holistic medicine, she has an integrative approach that incorporates many areas of health and healing, including Ayurveda, functional medicine, environmental medicine, nutrition, herbal medicine, and biofield (energy) therapies. As a Vedic Master she is certified to teach Primordial Sound Meditation, Perfect Health Ayurvedic Lifestyle, and Seven Spiritual Laws of Yoga.