Bioidentical hormones and chinese medicine for women's health


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Ein Vortrag in Hongkong Sept. 2012

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Bioidentical hormones and chinese medicine for women's health

  1. 1. Bio-identical Hormones and Chinese Medicine for Womens Health Dr. Helen Wai-Ngan Ng Schreiber Hong Kong 1. Sept. 2012
  2. 2. 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
  3. 3. 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.
  4. 4. Hormone Releasing Glands HypothalamusPituitary Gland ( anterior, posterior) Thyroid Gland Pancreas Adrenal Glands Ovaries Testes
  5. 5. List of Human Hormonese.g.:InsulinThyroid hormones (T4, T3)Sexual hormones (estrogens, progesterone, testosterone )AdrenalinGrowth Hormone (GH)Releasing / Stimulating hormones (from pituitary gland and Hypothalamus) (TRH, TSH, GnRH, FSH, LH)Vitamin D …... etc.
  6. 6. Hormones, chemical structure, class and subclassChemical class: Peptides / SteroidsSubclass: Thyroid hormones/ catacholamines/ androgens ( 19 C)/ estrogens (18 C) / progestins (21 C)Hormones within subclass:Thyroxin T4/ triiodothyronine T3Estradiol E2 / Estriol E3/ Estrone E1Progesterone
  7. 7. CholesterinAus Wikipedia die freieEnzyklopädie©
  8. 8. Release & Feedback MechanismsTRH (Thyrotropin releasing hormone)TSH (Thyroid stimulating hormone)T4 (Thyroxin), T3 (triiodothyronine)*******GnRH (Gonadotropin releasing hormone)FSH (Follicle stimulating hormone)Estradiol (E2)LH (Luteinizing hormone)Progesterone
  9. 9. The Female Cycle„The only constant feature of the female cycle is CHANGE.“ (author unknown) quoted from „Natürliche Hormontherapie“
  10. 10. Eisprung(ab 8., ideal 12. – 15. Tag) 1. 14. 15. 28. day 1 - 14 Estrogendominance Ovulation day 15-28 Progesteronedominance 28 - Day Cycle©23.6.2012 J.Armbruster
  11. 11. Estrogen – the hormone of beauty• Estradiol (E2) – strongly effects growth Estriol (E3) – Effects on mucous membranes and bladder• Estrone (E1) – the storage Estrogen
  12. 12. 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
  13. 13. Progesterone - “Hormone of wisdom”Calls for maturity
  14. 14. 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
  15. 15. CholesterinAus Wikipedia die freieEnzyklopädie©
  16. 16. Commonly used “false hormones”• “false estrogens” ( derivatives)• Ethinyl estradiol• Estradiol valerate• “false progesterone” (a progestine)• Medroxyprogesteron acetate• Dienogest• Levonorgestrel
  17. 17. Künstliches Pseudohormon Natürliches Progestational In der Natur nicht vorkommendes steroidal Ketone des „ Gestagen“ MenschenMedroxyprogesteronacetat Progesteron(pregn-4-ene-3,20-dione,17-(acetyloxy)-6- (pregn-4-ene-3,20-dione)methyl-,(6 Alpha)- natürliches, bio-identisches=synthetisch verändertes nicht bio- Gelbkörperhormon des Menschenidentisches „Progesteron“ ©23.6.2012 J.Armbruster
  18. 18. Artificial C-21/ C 19 Gestagene / Progestine Norgestrel Megestrolacetat Norethindronacetat More Progestines:MedroxyprogesteronacetatLynestrenolNorethynodrelNorethisteron Nach John Lee, M.D. und Wikipedia Human Progesterone
  19. 19. Chemical substances simulating effects of hormones• The „Anti-Baby Pill“ (contraceptive pill)• Valette - Ethinylestradiol 0,03 mg. Dienogest 2 mg• Belara - Ethinylestradiol 0,03 mg Chlormadinon acetat 2 mg• Yasminelle – Ethinylestradiol 0.02 mg Drospirenon 3 mg
  20. 20. Preparations with „false Hormones“• The „Hormonring“• Mirena - Levonorgestrel 0,52 mg ( 0,02 mg/ Tag)• Nuvaring – Ethinyestradiol 2,7 mg (0,015 mg / Tag) Etonogetrel 11,7 mg (0,12 mg / Tag) Visanne 2 mg – Dienogest 2 mg
  21. 21. 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)
  22. 22. 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)
  23. 23. 7 Decades in the life of a Woman Childhood Puberty Young womanhood Middle age Old age Senile
  24. 24. Developments and Roles of the Female • 经 jing Menstruation • 孕yun Pregnancy • 产chan Birth • 育 yu Nursing, education
  25. 25. 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
  26. 26. 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
  27. 27. Amenorrhea, Infertility• Delayed maturity• Consequence of the pill. Psychic and emotional Stress• Thyroid function deficiency• Other chronic illnesses• TCM: Kidney deficiency, cold
  28. 28. Disturbances of Pregnancy Pregnancy sickness (Progesterone Habitual Abortion Deficiency) Water retention Excessive weight gain Increased blood pressure Gestational diabetes Postnatal depression
  29. 29. Other gynaecological problems Ovarian Cysts (PCOS) (Estrogen- Uterine Myoma dominance) Prolapse (Stress incontinence) Tumor (* breast cancer, ovarian Ca)
  30. 30. 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
  31. 31. 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
  32. 32. 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
  33. 33. 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
  34. 34. 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)
  35. 35. 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)
  36. 36. Bioidentical Hormone Replacement Therapy (BHRT) Examples: Progesterone cream 3%, 5%, 10% Progesterone capsules 50 mg. ( 1 – 2 / day) Estradiol capsules 0.1 mg., 0.2 mg. (1 – 2 /day) DHEA capsules 5 mg., 6 mg. (1 / day) Testosteron cream 1%, 5 %, 10 %
  37. 37. Yang YinMan Woman
  38. 38. Physiological Characteristics以 血 为 本 Xue (Blood ) is the basis以 血 为 用 Xue is consumed阴 常 不 足 Yin is often not enough阳 常 有 余 Yang is often in (relative) excess
  39. 39. TCM Diagnosis 中医辨症八钢 Yin 阴 / Yang 阳 internal 里 / external 表 cold 寒 / warm 热deficiency虚 / fullness 实
  40. 40. 中医辨症• 脏腑: 脾 (三阴交, 血海, 阴陵泉)• 肾 (太溪, 照海)• 肝 (太冲)• 卫,气,营,血: 气 血• 经络: 任脉 (关元, 气海)• 冲脉
  41. 41. women’s health problems, TCM coldness ! 寒 younger women:• Qi deficiency (spleen, kidney) 气虚• Qi Stagnation ( Liver Qi) (PMS) 肝气郁• elderly women:• Xue (Blood) deficiency血虚• Xue Stagnation 血滞• Yin deficiency ( Liver, kidney) 阴虚
  42. 42. 辨症论治• 驱寒 温阳 (艾灸, 付子, 肉桂)• 健脾 滋阴 (淮山药, 熟地, 杞子)• 补血 活血 (当归, 川芎)• 疏肝 解郁 (白芍药, 玟瑰花)
  43. 43. Treatment with TCM四 物汤 (Si Wu Tang, Dekot der 4 Bestandteile)1) Dang gui (Angelika sinensis) 当归2) Chuan xiong (Ligustici chuanxiong) 川芎3) Shu di huang (Rehmanniae prep.) 熟地黄4) Bai shao (Paeonia alba) 白芍药
  44. 44. Angelicae sinensis radix Xue erhaltend und ergänzend. Warm. Emporhebend. Leber Milz Herz Unterer Erwärmer18.08.12 Dres. Helen Wai-Ngan und 71
  45. 45. • Chuanxiong (Xue bewegendes Mittel)
  46. 46. • Shudihuang (Yin stützendes Mittel)
  47. 47. Paeoniae lactiflorae radix Xue erhaltend und ergänzend. Neutral / Kalt, absenkend. Leber (Qi Stagnation lösend), Milz18.08.12 Dres. Helen Wai-Ngan und Tiefe, Unterer Erwärmer Die 74
  48. 48. TCM Treatment principles Effects of the 4 components of Si Wu Tang:1) Nourish Xue 补血(also nourish Qi , Ma36 足三里, Ma30气冲, Le3太冲,MP6 三阴交, Bl17, Bl18….)2) Activate Xue (Xue Stase lösen) 活血MP10 血海, MP1 隐白3) Nourish (kidney & liver)Yin 滋(肾肝)阴 KG3关气, KG4气海, (Moxa), Ni7 复留4) remove Liver Qi Stagnation解(肝气)郁Gb足临 泣41, Gb34阳陵泉, KS6内关, Xi Punkte
  49. 49. Rosae flos besänftigt die Leber, löst Stagnation18.08.12 Dres. Helen Wai-Ngan und 78
  50. 50. • Dioscoreae Rhizoma (Shanyao) (Yamswurzel)Yin und Qi stützendes Mittel
  51. 51. BHRT / TCM comparison• Bioidentical Hormontherapy = Replacement therapy (passive) 填补性治疗 Chinese Medicine (herbal teas, Acupuncture,• Dietetics) = Regulatory therapy (active) 调理性治疗
  52. 52. 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
  53. 53. 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.
  54. 54. 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.
  55. 55. Thank youFor your Attention!