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Bio-identical Hormones and Chinese Medicine for Womens Health Dr. Helen Wai-Ngan Ng Schreiber Hong Kong 1. Sept. 2012
Contents• Introduction: Role and image of women, east & west, in changing times• Biology of Hormones• Physiology of Female Reproductive System• Clinical aspects, Womens health issues• Shanyao and Chinese Medicine for Womens Health• Our clinical study and case examples
Hormones• Chemical messengers (sending signals)• Produced by cells or a “gland”• Transferred to “target cells“ with “receptors“• Binding & activation leads to cell-specific responses (cell metabolism). Thus the biochemical structure is decisive!• Small amounts, big effects on vital functions, also emotional reactions.
Estrogen – the hormone of beauty• Estradiol (E2) – strongly effects growth Estriol (E3) – Effects on mucous membranes and bladder• Estrone (E1) – the storage Estrogen
Estrogen (s)• Sexual hormonse specific for the female, produced mainly in the ovaries• 3 in this subclass are especially important: E1 Estrone, E2 Estradiol, E3 Estriol• Effect the growth & development of the femal body• Responsible for the healthy state of the female reproductive organs and also of the bones, blood vessels, urinary tract…• Loosen connective tissues, effect water retention, und fat accumulation in cells, increase blood clotting
Progesterone - “Hormone of wisdom”Calls for maturity
Progesterone• Sexually neutral. Produced mainly in the “yellow body” (corpus luteum) of women & in the placenta during pregnancy. „pro gestra“ = supporting gestation (pregnancy)• Precursor for Cortisol, Testosteron & the estrogens. Complementary & balancing factor of estrogen and terstosterone• 20% of receptors in the brain, important for emotional balance, improves concentration, memory and sleep• Heart and blood vessels, bones, skin and connective tissues. Supports the thyroid gland• Increases energy metabolism, excretion of connective tissue fluids, regulates blood pressure and blood clotting
Artificial C-21/ C 19 Gestagene / Progestine Norgestrel Megestrolacetat Norethindronacetat More Progestines:MedroxyprogesteronacetatLynestrenolNorethynodrelNorethisteron Nach John Lee, M.D. und Wikipedia Human Progesterone
Substances used in „HRT“- Progestines (e.g. Provera) + CEE (conjugated equine estrogens)- Premarin = pregnant mares urin (CEE) (Presomin)- pills, injections, suppositories, subdermal implants, skin patches, gels- dosages, systemic / lokal effects, side effects, constant/ cyclical level of hormones in blood- oral intake estrogens: increased risk of thrombosis, especially ethinyl estradiol (pill)
Bioidentical Hormones• Biochemical structures are identical with our own hormones in the body• When applied properly – gentle and without side effects• Over 70 years of experience: (Dr. K. Dalton, Dr. John Lee, Dr Michael Platt, Dr. V. Rimkus, Frau Dr. A. Scheuernstuhl), no known side effects• from Diosgenin, extracted from the roots of the mexican wild yams (Dioscorea villosa)
7 Decades in the life of a Woman Childhood Puberty Young womanhood Middle age Old age Senile
Developments and Roles of the Female • 经 jing Menstruation • 孕yun Pregnancy • 产chan Birth • 育 yu Nursing, education
Disturbances of Menstruation• Onset of puberty – early/ late? Amenorrhea• Irregular cycles – too short, too long• Irregular bleeding – too little, too much• Premenstrual Syndrom (PMS) – lower abdomenal pains, tension in the breast, mood changes (Estrogen dominance)• Related problem of puberty: acne
Effects of the contraceptive Pill 2 components: an estrogen derivative (e.g. ethinyl estradiol, estradiol valerate), a progestine The two hormone like chemicals turn off the production of FSH and LH through the feedback mechanism on the pituitary gland – no ovulation! (purpose of contraception) Thus no „Yellow body“ & no production of progesterone. Consequences of Progesterone deficiency They simulate the effects of estradiol and progesterone on the uterus, giving rise to an artificial menstrual bleeding
Amenorrhea, Infertility• Delayed maturity• Consequence of the pill. Psychic and emotional Stress• Thyroid function deficiency• Other chronic illnesses• TCM: Kidney deficiency, cold
Other gynaecological problems Ovarian Cysts (PCOS) (Estrogen- Uterine Myoma dominance) Prolapse (Stress incontinence) Tumor (* breast cancer, ovarian Ca)
Climacterium / Menopause• A natural stage of life• Decrease of important hormones of the body• Symptomes, perception, feelings, attitudes• „ Women in middle age should not be sad – also in history there came after the Middle Ages the New Age !“• Indications for treatment
Symptoms of hormonal imbalance Mood changes, depressive, irritable, loss of interest and joy General feelings of unwell, undue tiredness, not coping with life Sleep disturbances, insomnia Hot flushes, excessive sweating, night sweats Oedema, generalised swelling Headaches, generalised muscle and join pains Nervous anxiety, panic attacks, heart complaints
Hormone Replacement Therapy (HRT)- Treatment of surgically, peri- and post- menopausal women, for discomfort caused by diminished circulating estrogen and progesterone hormones- Mixtures of conjugated equine estrogens (CEE) and progestins vs. “unopposed estrogen therapy”- Via patches, tablets, creams, troches, IUDs, vaginal rings, gels or injections- “sequentially” vs. “continuous” combined HRT- Side effects: Headache, weight changes, fluid retention, changes in menstrual flow
Womens Health Initiative (WHI)- Initiated by the US NIH in 1991- Study effects of HRT: CEE + Progestin, CEE only (women after hysterectomy)- Findings: subjects had a greater incidence of coronary heart disease, breast cancer, stroke, pulm. Embolism- Trial was ended in 2002
Bioidentical Hormones• Biochemical structures are identical with our own hormones in the body• When applied properly – gentle and without side effects• Over 70 years of experience: (UK: Dr. K. Dalton, USA: Dr. John Lee, Dr Michael Platt, Germany: Dr. V. Rimkus, Dr. A. Scheuernstuhl), no known side effects• from Diosgenin, extracted from the roots of the mexican wild yams (Dioscorea villosa)
Bioidentical Hormones Extraction from Mexican Yams roots: Diosgenin Further process in lab to give Progesterone Further process in lab from Progesterone to other hormones e.g. estradiol Dispensed according to individual prescription by „compound pharmacies“ Available as cremes, gels, capsules, troches (sublingual, oral, transdermal application)
Our clinical Study 2012 About 90 patients, 70 + women, 10 men, 8 children Hormone profile of 3 groups: thyroid hormones, sexual hormones (estrogens, progesterone, testosterone), Insulin, DHEA, cortisol, Andrenalin (blood sample on 21. day of cycle) Most common problems: Overweight, gynaecological symptoms, depressive moods, exhaustion, palpitations, insomnia Findings: low Progesterone levels, Estrogen dominance, Insulin resistance Treatment: BHRT, Progesterone good for moods, PMS, estrogen good for hot flushes, sweating, balance is important, Thyroid function also
Case example 1 (A.G.) 23 f, Student (Sport) Aug. 11: Mood changes, depressive, irritable; hot flusches, excessive sweating, since about 2 months has the „Nova Ring“ recently, the pill since few years, saliva test: low progesterone, high testosterone No more such symptoms after removal of the ring But, amenorrhea still after 1 year Recent blood test: low T4 Treatment: Thyroxin 50 mcg.
Case Example 2 (D.R.)- 50 f., owner of Fitness Studio- Hysterectomie 12 years ago because of heavy menstrual bleeding, Myoma- 2 y. later, hot flushes, sleep disturbance, depressive to aggressive mood changes, hair loss, weight gain (in spite of sport)- prescribed different estrogen preparations and pill, T4 75mcg., still severe depression 2005, weight gain ++- 2011: discovered the literature about bioidentical hormones, importance of progesterone- started treating herself with progesterone creme, stopped estradiol, T4 + T3, Testosterone cream for stress incontinence. Weight loss.