Optimizing Menopausal Health. Lee Carroll B.Sc. Berris Burgoyne ND, B.HSc

Transcription

1 1 Optimizing Menopausal Health Lee Carroll B.Sc. Berris Burgoyne ND, B.HSc

2 Standard Process sponsors these webinars to provide healthcare information to practitioners and to provide them the opportunity to hear about the views, recommendations and experiences of other practitioners. Standard Process has not evaluated the legal status of any products (except for Standard Process and MediHerb products), services or recommendations with respect to State or Federal laws, including scope of practice. Standard Process does not and cannot accept responsibility for errors or omissions or for any consequences from applications of the information provided and makes no warranty, expressed or implied, with respect to the information provided. Lee and Berris recommendations for Standard Process product dosages are sometimes different than the doses that appear on the product labels. Please refer to the product labels or to the product descriptions found in the product catalog or on the website for Standard Process dosage recommendations. 2

3 The Menopausal Change Insert photo 3

4 Menopausal Health and Vitality The aim of herbal menopausal support is to: assist the body to adjust to this important change provide support for the discomfort associated with menopausal change support ovarian health and function support adrenal function Herbal support may be required for several years 4

5 Key Products Wild Yam Complex Adrenal Complex Tribulus Bone Complex 5

6 The Menopausal Change During the transitional years, hormone levels can naturally fluctuate causing normal changes to the menstrual cycle and menstruation Common menopausal challenges may include: mood changes vaginal dryness bladder discomfort hot flashes with or without sweats sleep challenges with or without night sweats 6

7 Herbal Strategy Phytoestrogens are plant compounds with a natural ability to interact with estrogen receptors Phytoestrogens compete strongly for estrogen receptors, however their action at these receptors is very weak, eg much weaker than estradiol Phytoestrogens are selective Can function as estrogen agonists OR antagonists depending on the hormonal environment Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingston, Edinburgh, 2000, pp

8 Estrogen Receptor Complexities Estrogen receptors are present in almost all organs and tissues of the body There are two main classes of estrogen receptors (ER and ER ) which are distributed unevenly in body tissues ER predominates in the uterus, pituitary, kidney and breast and is the classical estrogen receptor ER are found in bone, prostate, brain (hypothalamus) and reproductive organs A third (membrane bound) estrogen receptor has recently been discovered GPER 8

9 SERM Selective estrogen receptor modulator (SERM) Estradiol, naturally produced in the body, is a pure estrogen agonist In contrast to pure estrogen agonists or antagonists, SERMs have a mixed or selective pattern of estrogen agonist/antagonist activity, which depends on the tissue targeted and the type of receptor stimulated 9

10 Wild Yam Complex Wild Yam root and rhizome 4:1 extract 100 mg from Dioscorea villosa root and rhizome 400 mg Shatavari root 4:1 extract from Asparagus racemosus root 400 mg 100 mg St John s Wort herb flowering top 6:1 extract 100 mg from Hypericum perforatum herb fl top 600 mg Containing hypericins 300 mcg 10

11 Wild Yam Complex Sage herb 5:1 extract from Salvia fructicosa herb 290 mg Black Cohosh root 5:1 extract from Cimicifuga racemosa root 100 mg Korean Ginseng root 5:1 extract from Panax ginseng root 75 mg Containing ginsenosides 1.3 mg, Rb 2 to Rb 1 is NLT 0.4 by HPLC 58 mg 20 mg 15 mg Dosage: 3-4 tablets per day. 6 per day can be used in the first few weeks of treatment to accelerate the effect. 11

12 Wild Yam Complex - Indications Provide relief from discomfort associated with menopause Promote a natural, healthy balance within the mature female endocrine system Help maintain feelings of well-being Balance and support normal female physiology and function Calm the nerves and restore balance in temporary mood challenges 12

13 13

14 Wild Yam Wild Yam contains phytochemicals called steroidal saponins Newly identified - Dioscin + glucose molecule Dioscorea villosa roots Diosgenin Dioscin 14

15 Wild Yam The oral application of Wild Yam (Dioscorea villosa) must be clearly differentiated from its use in progesterone creams The use of these progesterone creams appears to have arisen from the confusion between the phytochemicals in the herb and the hormone progesterone This in turn follows from the fact that yams (Dioscorea spp.) are industrially used as a source of progesterone precursors Wild Yam only works when taken orally 15

16 A steroidal saponin from Wild Yam Progesterone 16

17 Steroidal Saponins In the normally low estrogen environment of peri- and postmenopause, many herbs may provide support through the binding of their steroidal compounds to estrogen receptors in the hypothalamus Because some menopausal challenges are thought to be initiated via the hypothalamus (especially hot flashes), this selective binding could be sufficient to support menopausal symptoms 17

18 Shatavari Support for menopausal symptoms Promote general well being by increasing cellular vitality and resistance to stress Support healthy functioning of ovaries, fallopian tubes and uterus To improve sexual health and vitality As a tonic for general tiredness, fatigue, and immune support 18

19 Is Black Cohosh Estrogenic? There are two schools of thought: Black Cohosh acts like a SERM And/or Black Cohosh acts on menopausal symptoms by mechanisms unrelated to any estrogenic effect 19

20 Black Cohosh Clinical Trials Improved menopausal symptoms 1,2,3 and bone metabolism equal to conventional therapy 1 1. Wuttke W et al. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas 2003; 44 Suppl 1: S Pockaj BA et al. Pilot evaluation of black cohosh for the treatment of hot flashes in women. Cancer Invest 2004; 22(4): Osmers R, Friede M et al. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol 2005;105(5 Pt 1):

21 Black Cohosh Clinical Trials Reduction in menopausal symptoms without changes to vaginal tissue and hormone levels 1 Improved symptoms equal to conventional therapy with no unwanted changes to the endometrium 2 Reduction in hot flashes, sweating, sleep and mood challenges 3 1. Liske E. Physiological investigation of a unique extract of black cohosh: a 6- month clinic study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med 2002; 11(2): Nappi RE, Malavasi B et al. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transermal estradiol. Gynecol Endocrinol 2005; 20(1): Rostock M et al. Black cohosh in tamoxifen-treated breast cancer patients with climacteric complaints - a prospective observational study. Gynecol Endocrinol 2011; 27(10):

22 22

23 St John s Wort & Black Cohosh Four clinical studies using a combination of St John's Wort and Black Cohosh The placebo-controlled trials - effective in reducing menopausal symptoms, including the mood component Boblitz N et al. Focus Altern Complement Ther 2000; 5: 85 2 Uebelhack R et al. Black cohosh and St John s wort for climacteric complaints: a randomized trial. Obstet Gynecol 2006; 107 (2 Pt 1): Chung DJ et al. Black cohosh and St John s wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J 2007; 48(2):

24 St John s Wort & Black Cohosh The observational study found the combination was superior to Black Cohosh alone in alleviating menopausal mood challenges 4 1 Briese V et al. Black cohosh with or without St John s wort for symptomspecific climacteric treatment-results of a large-scale, controlled, observational study. Maturitas 2007; 57(4):

25 St John s Wort Reduced hot flashes, improved quality of life and improvement in sleep quality 12 week trial using a standardized SJW extract providing 2.7mg hypericin per day Equivalent to 3 x MediHerb St John s Wort 1.8g tablets Or 4 x Wild Yam Complex and 2 x St John s Wort 1.8g Al-Akoum M et al. Effects of Hypericum perforatum (St. John's wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause 2009; 16(2):

26 St John s Wort and Mood Cochrane Reviews - St John s Wort was better than placebo and had similar effect to conventional therapy in adults with mood challenges 1,2 Refer to doses on previous slide 1. Jou H J et al. Extracts of St John s wort for mild to moderate depression: a meta-analysis of randomized, double-blinded, placebo- controlled trials. Nutritional Sciences Journal 2005; 30(4); Linde K et al. St John s wort for treating depression. Cochrane Database Syst Rev 2008; (4): CD

27 Korean Ginseng TCM uses include tonification of the vital energy and spleen, calming the nerves, organ support, low vitality with mood and sleep challenges In Western herbal medicine, Korean Ginseng is used as an adaptogenic tonic indicated for physical or mental exhaustion and to improve mood and sexual health 27

28 Sage Traditionally Sage has been used to address excessive sweating and for support of the nervous system 1,2 A recent study showed sage extract improved memory and attention 3 1. British Herbal Pharmacopoeia. Bournemouth: BHMA, Felter HW et al. King s American Dispensatory, 18th Edn, 3rd revision, 1905, reprinted Portland: Eclectic Medical Publications, Scholey AB, etal, Psychopharmacology (Berl) May;198(1):

29 Menopausal Health and Vitality The aim of herbal menopausal support is to: assist the body to adjust to this important change provide support for the discomfort associated with menopausal change support ovarian health and function support adrenal function 29

30 Adrenal Complex Licorice root 7:1 extract From Glycyrrhiza glabra root 1.75 g Containing glycyrrhizin 25 mg 250 mg Rehmannia rhizome 5:1 extract 150 mg from Rehmannia glutinosa rhizome 750 mg Dose: 1 tablet, 2 to 3 times daily, or as directed 30

31 Adrenal Complex Support adrenal function to reduce the effects of occasional stress on the body Support adrenal gland health and energy production to help combat fatigue Help the body adapt to the challenges of everyday life Promote the body s normal resistance function Support a healthy immune system when experiencing occasional stress 31

32 Tribulus Tribulus herb (aerial parts) 55:1 extract from Tribulus terrestris herb (aerial parts) 13.5 g Containing furostanol saponins as protodioscin 100 mg 245 mg Dose: 1 tablet, 2 to 3 times daily, or as directed 32

33 Tribulus - Indications Support normal reproductive function Support normal hormone production Promote vitality and stamina Support physical endurance Promote an overall feeling of well-being 33

34 Tribulus Tribulus (Tribulus terrestris) is one of the best researched examples of the use of a steroidalsaponin containing herb in menopause Like Wild Yam and Shatavari, Tribulus leaf is rich in steroidal saponins Tribulus leaf is a popular herb in Eastern Europe for the management of menopausal symptoms Stuthe J, et al. Poster presentation: 50th Conference Society of Medicinal Plant Research (GA) in Spain,

35 Tribulus Improvement in 98% of women experiencing menopausal symptoms Predominate symptoms included hot flashes (100%), sweating (78%) and sleep challenges (82%) Zarkova S. Tribestan: Experimental and Clinical Investigations. Chemical Pharmaceutical Research Institute, Sofia, Bulgaria. 35

36 Bone Complex Epimedium herb top 12:1 extract from Epimedium sagittatum herb top 2.4 g Containing icariin 20 mg 200 mg Red Clover herb flowering top 5:1 extract 100 mg from Trifolium pratense herb flowering top 500 mg Containing isoflavones 8 mg Kudzu root 10:1 extract from Pueraria lobata root 700 mg Containing pueraria isoflavones calculated as diadzin, puerarin, daidzein 28 mg Black Cohosh root 4:1 extract from Cimicifuga racemosa root 80 mg 70 mg 20 mg Dose: 3 tablets daily, or as directed 36

37 Bone Complex -Indications Support healthy bone tissue, particularly in mature women, in conjunction with weightbearing exercise and a healthy diet containing food sources of calcium and vitamin D Support and maintain healthy normal bone density Beneficially influence normal bone modeling 37

38 Menopausal Support Core Support Wild Yam Complex, 3 to 4 tablets per day. Increasing up to 6 tablets with severe symptoms for short periods of time Adrenal Complex, 2 to 3 tablets per day if stress aggravates the hot flashes Symplex F, 3 tablets 2 times per day 38

39 Additional Support (as required) Tribulus, 3 to 4 tablets per day if challenges persist Bone Complex, 1 tablet 3 times daily where bone support is required Chaste Tree, 1 to 3 tablets per day for erratic periods and PMS in the perimenopause phase Thyroid Complex, 3 to 4 tablets per day Drenamin, 3 tablets 2 times per day Prolamine Iodine, 1 tablet per day 39

40 40

41 41

42 Questions The Menopausal Change Insert photo 42