Premarin (conjugated estrogen) is one of the most frequently prescribed medications in the United States.1 Considering that only half of the population can be prescribed this medication (females), and that only elderly patients need this medication, it is an astounding number. I am often asked by practitioners about patients of theirs who are prescribed estrogen but wish to take herbal alternatives, or patients who are prescribed herbs but wonder if the estrogenic effects of the herbs will conflict with their current therapy. I will try to address these issues in three separate parts. Part one will discuss herbs that have estrogenic effects, along with possible side-effects; part two will cover herbs that may be used to treat menopausal signs and symptoms; and part three will focus on herbs that may be used to treat osteoporosis.
Estrogen is commonly prescribed for numerous purposes, including (but not limited to) menopausal signs and symptoms, osteoporosis, and atrophic vaginitis. More recently, the beneficial effects of estrogen have been observed in patients with Alzheimer's disease (with improvement up to 16 weeks) and dyslipidemia.
In addition to drugs, there are many other alternatives for natural sources of estrogen. In traditional Chinese medicine, many herbs have estrogenic effects. Although Chinese herbs are not prescribed individually for such purposes, the addition of herbs with estrogen-like effects will definitely supplement a formula and enhance its overall therapeutic value. According to studies in mice, it has been discovered that fructus cnidii monnieri (she chuang zi), semen cassiae (jue ming zi) and radicis angelicae sinensis (dang gui) increase estradiol levels; flos carthami tinctorii (hong hua) increases FHS levels; and semen astragali complanati (sha yuan zi) increases the weight of the uterus.2
The use of estrogen replacement therapy, despite numerous benefits, still has many potential conflicts and controversies. One of the biggest disadvantages associated with the use of estrogen is the staggering number of side-effects, including, but not limited to, increased risk of breast and uterine cancer; endometrial carcinoma; malignant neoplasm; gallbladder disease; thromboembolitic disease; and photosensitivity.3 Due to these adverse effects, many people opt not to take estrogen supplements; many others cannot take estrogen supplements.
In addition to side-effects, one contraindication of estrogen supplementation is for patients who have cancer of the breast, uterus or endometrium. Use of drugs, supplements or foods with hormonal activity may stimulate the growth of cancer cells, and must be avoided. Specifically with Chinese herbs, those that increase the secretion of female hormones or increase the weight of the sex organs should be avoided. Examples include she chuang zi, jue ming zi, dang gui, hong hua, and sha yuan zi. Furthermore, patients should be careful eating meat or animal products, as many of these have been treated with hormones to hasten growth.4
In summary, though traditional Chinese medicine and Western medicine have vastly different diagnostic criteria and treatment approaches, the medicines used by the two systems are in fact similar in many ways. Both have similar therapeutic effects and potential conflicts. Protocols concerning how to incorporate these herbs into formulas for the treatment of menopause and osteoporosis will be discussed in parts two and three of this series.
References
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In the past five years of my clinical practice, I have seen an astonishing upsurge in the chronic use of proton-pump inhibitor (PPI) medications for the gastrointestinal issue diagnosed by allopathic medicine as GERD. It is not uncommon to encounter patients taking these prescriptions for five-plus years.
Working with chronically ill patients entails acknowledging the reality that not all patients will survive their diagnosis. Chinese medicine and acupuncture play a crucial role in palliative and end-of-life care, addressing medication and disease side effects, alleviating pain associated with death, reducing anxiety and stress, and helping patients find peace during the dying process.
