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Women's Health
Kim Schoenhals
05/26/2003 Women's Health by Kim Schoenhals Once considered fragile, insipid creatures, women have fought long and hard for equal rights in America and over the decades have earned the right to vote, a strong presence in the workforce and an increased enrollment in the U.S. military. In 1984, American women earned another significant gain in terms of equality--that is the year women surpassed men in the number of annual deaths from heart disease. In addition to heart disease, breast cancer and osteoporosis are statistically more of a threat to women than men. Other conditions affecting women specifically have their basis in hormone balance and include premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD) and menopause. Traditional medicine has offered several therapies for heart disease, cancer, osteoporosis and hormone-related conditions. However, a blow to women's faith in traditional medicine was delivered in July 2002 when the National Institutes of Health (NIH) halted an arm of its eight-year hormone replacement therapy (HRT) study after five years due to unacceptable increases in the risk of breast cancer and heart disease.1 Prior to this trial, and continuing today, millions of women have used HRT to combat the side effects of decreased estrogen production. Menopausal women are more likely to suffer heart disease and osteoporosis, as well as to develop symptoms such as insomnia, memory loss and hot flashes. Since NIH halted its trial, women have increasingly turned to alternative medicine in the hopes of reducing the risk of chronic disease, as well as for relief from menopause. The North American Menopause Society (NAMS) recommends several alternative therapies for women who do not want to use HRT. Specifically, they advise women to eat well and get plenty of exercise, but they also mention using soy foods and black cohosh to reduce the occurrence of hot flashes, and vitamin D and calcium to improve bone health. According to the Natural Marketing Institute's (NMI) Health & Wellness Trends Database, women are most likely to use supplements for bone health, with 62.3 percent of women surveyed reporting they would use supplements to self-treat osteoporosis. NMI also noted 50.2 percent of women would use supplements to treat cancer, 47.2 percent for menopausal issues, and 51.3 percent cited a willingness to use supplements for heart disease. Heart Disease Nearly 50 percent of all female deaths are caused by heart disease. According to the Centers for Disease Control and Prevention's (CDC) National Vital Statistics Report, heart disease was the No. 1 killer among both men and women in the year 2000, although women still held the top spot with 365,953 succumbing to heart disease compared to 344,804 men. The category of cardiovascular diseases encompasses coronary heart disease, stroke, congestive heart failure and high blood pressure. About 6.6 million women alive today have a history of heart attack, angina pectoris (chest pain caused by reduced blood supply to the heart) or both, according to the American Heart Association (AHA). AHA also reports heart disease rates are two to three times greater in women who have reached menopause compared to women of the same age before menopause. Probably one of the more common complementary therapies for reducing the risk of heart disease is a regimen of antioxidants. There are several different types of antioxidants, ranging from vitamins and minerals to carotenoids, flavonoids and botanicals. The research on many of these is promising for protecting heart health, although not all results have been positive. A study of antioxidant vitamins in combination with HRT for reducing the risk of coronary atherosclerosis in women was concluded without promising results.2 Researchers at San Francisco General Hospital randomly assigned 423 postmenopausal women with coronary heart disease to receive either HRT or matching placebo, and 400 IU of vitamin E plus 500 mg of vitamin C twice daily or placebo. Results indicated while there was no interaction between the treatments, neither HRT nor antioxidant vitamins provided a cardiovascular benefit. A trial out of the University of Illinois, Chicago, ended similarly, with researchers concluding HRT combined with vitamins C and E does not specifically benefit cardiovascular health in postmenopausal women with coronary heart disease.3 Contrarily, a six-year study of vitamins C and E indicated the combination effectively slowed the progression of atherosclerosis.4 Researchers initially enrolled 520 smoking and nonsmoking men and postmenopausal women--440 of whom completed the study--to take 136 IU of vitamin E plus 250 mg of slow-release vitamin C twice daily for six years. Researchers concluded the combination slowed atherosclerotic progression in subjects with high cholesterol. Another antioxidant that is important in the realm of heart health is coenzyme Q10 (CoQ10), a vitamin-like nutrient known for its role in promoting cellular energy production in the body's mitochondria. Mitochondrial function may be supported by CoQ10 administration and is of particular importance during and after heart surgery, according to researchers at the Alfred Hospital and Baker Institute in Australia.5 CoQ10 may also be useful as an adjuvant treatment for chronic heart failure, according to a review out of the Medical College of Virginia in Richmond.6 Researchers at the Department of Veterans Affairs Medical Center in Boise, Idaho, stated CoQ10 is a safe treatment option for hypertensive patients.7 CoQ10 supplementation is also important for patients taking statin drugs for high cholesterol levels, because the drugs are known to deplete the body of its CoQ10 stores.8 A group of antioxidants known as carotenoids, which are fat-soluble pigments found in plants, may also have something to do with how well heart health is maintained. Two carotenoids, lutein and lycopene, have been studied for their effects on heart health. An animal study conducted at the University of Southern California, Los Angeles, demonstrated increased dietary intake of lutein protected against the development of atherosclerosis.9 As for lycopene, it was shown to decrease the risk of cardiovascular disease specifically in women, as noted in a presentation given by researchers from Boston's Harvard Medical School at the 2002 annual meeting of the American College of Cardiology.10 Like carotenoids, flavonoids are plant pigments with antioxidant properties that may contribute to their ability to improve parameters of heart health. In particular, grapeseed extract promotes cardiovascular health in various ways, according to researchers at Creighton University in Omaha, Neb., who conducted in vitro, animal and human research.11 A research review of grapeseed extract (as MegaNatural Gold, manufactured by Madera, Calif.-based Polyphenolics) indicated oral intake decreased plasma total and LDL cholesterol in subjects with high cholesterol, although HDL cholesterol was also decreased.12 Soy isoflavones have also been proven to benefit heart health--particularly in women. Researchers at the University of Hull and Hull Royal Infirmary in England found that of 32 postmenopausal women with Type II diabetes, those assigned to take phytoestrogens (30 g/d of soy protein, 132 mg/d of isoflavones) exhibited reductions in mean values for total and LDL cholesterol, as well as decreased values for fasting insulin and insulin resistance.13 Another study showed phytoestrogen intake reduced the risk of atherosclerosis and arterial degeneration in menopausal women.14 Red clover isoflavones have also been shown to help maintain heart health in menopausal women. Researchers from the Institute of Gynecology and Reproduction in Lima, Peru, randomly assigned 100 hypercholesterolemic, menopausal women to take either a red clover isoflavone formula (as Promensil, manufactured by Stamford, Conn.-based Novogen Ltd.) or placebo.15 Women in the treatment group maintained cholesterol levels more effectively than women in the placebo group, leading researchers to conclude long-term use of the supplement would help women maintain healthy cholesterol levels. Another plant that impacts cholesterol levels is Commiphora mukul, commonly known as guggul. The heart-healing constituents of guggul are its guggulsterones and guggulsterols, which are believed to contribute to healthy cholesterol levels. Researchers at Baylor College of Medicine in Houston determined the mechanism of action behind guggul's activity is its inhibition of the FXR receptor, which is a hormone receptor activated by bile acids responsible for cholesterol homeostasis.16 Some of the same researchers determined guggulsterone E and guggulsterone Z are responsible for the extract's lipid-lowering activity.17 In the United States, Piscataway, N.J.-based Sabinsa Corp. holds U.S. patent No. 6,436,991 covering its guggul extract (Gugulipid) for the prevention and treatment of cardiovascular disease.
Like guggul, flaxseed is known for lowering cholesterol levels. Research out of Oklahoma State University in Stillwater demonstrated this effect in postmenopausal women, with those taking ground flaxseed (40 g/d) for three months exhibiting a 4.7-percent reduction in both LDL and HDL cholesterol, and a 12.8-percent reduction in triglycerides.18 Contrarily, a study out of Universite Laval in Quebec indicated 40 g/d of flaxseed did not improve cholesterol profiles in 25 menopausal women with high cholesterol compared to HRT.19 A botanical extract of French maritime pine bark also has been shown to contribute to heart health. Researchers at the University of California, Davis, found that of 25 healthy subjects assigned to receive the extract (150 mg/d of Pycnogenol, available from Hillside, N.J.-based Natural Health Science) or placebo for six weeks, those in the treatment group exhibited increased plasma antioxidant activity and HDL cholesterol levels, as well as reduced LDL cholesterol levels.20 Research out of the University of Arizona, Tucson, indicated pine bark extract (200 mg/d of Pycnogenol) decreased systolic blood pressure in 11 hypertensive patients after eight weeks of supplementation.21 Another study of pine bark extract, which has been accepted for publication in Life Sciences, demonstrated that of 58 hypertensive patients, those taking 100 mg/d of the extract (as Pycnogenol) for 12 weeks required smaller doses of nifedipine to attain reductions in blood pressure.22 A mineral that may improve heart health in older women is calcium. Researchers in New Zealand enrolled 223 postmenopausal women (average age of 72) in a randomized, placebo-controlled trial of calcium citrate (1 g/d) and found that after one year, women taking the mineral exhibited an average 7-percent increase in HDL cholesterol.23 Popularly believed to reduce the risk of heart disease, B vitamins have been reviewed numerous times for their potential role in heart health. Researchers analyzing the Nurses' Health Study, a cohort of 75,521 women, found that while B vitamin intake did not fully explain the reduction in heart disease risk, B vitamin fortified whole grain intake reduced the women's risk of heart disease.24 A review of 1,419 men and 1,531 women, however, failed to show folic acid or vitamin B12 specifically reduced the risk of fatal cardiovascular disease.25 Another vitamin, vitamin D, may protect women against coronary heart disease, according to researchers at the University of California, San Francisco, who reviewed data for 9,704 ambulatory women above the age of 65 who participated in the Study of Osteoporotic Fractures.26 The researchers concluded vitamin D supplements in particular decreased the risk of heart disease mortality. Essential fatty acids (EFAs) are also well-known for their benefits in heart health. The omega-3s in particular, from both marine and plant sources, are protective for individuals at risk of heart disease, according to researchers from the AHA Nutrition Committee.27 Specifically in women, fish and omega-3 intake has proven protective, according to a review of the Nurses' Health Study.28 The review demonstrated that of 84,688 women ages 34 to 59 years old, those who ate fish five or more times per week were less likely to die of heart disease than women who rarely ate fish. In addition, women with the highest intakes of omega-3 fatty acids were less likely to die of coronary heart disease than women with lower intakes, and they had a decreased risk of non-fatal myocardial infarction, as well. Cancer Cancer is the No. 2 killer in America, although it is more deadly to men than women, according to CDC, which noted 286,082 men and 267,009 women died of cancer in 2000. While cancer generally affects men more often than women, breast cancer is much more prevalent among the fairer sex, and ovarian, cervical and uterine cancers are specific to women. Breast cancer does affect men, although it is much more common in women. An estimated 211,300 new cases of invasive breast cancer will be diagnosed in 2003, according to the Susan G. Komen Breast Cancer Foundation, and the disease will take the lives of approximately 39,800 women and 400 men. The female-specific cancers are less prevalent than breast cancer, but no less worrisome. Among U.S. women, ovarian cancer is the sixth most common cancer and the fifth most likely to result in death, according to the American Cancer Society (ACS). ACS estimates 25,400 new cases of ovarian cancer will be diagnosed in the United States in 2003, and about 14,300 women will die of it. Cervical cancer is much less deadly now than it was, according to ACS, and mortality rates for this type of cancer went down by 74 percent between 1955 and 1992. The reason is mainly due to an increase in the practice of Pap tests, which can detect pre-cancerous changes on the cervix. These abnormal cells, if treated, will usually not develop into cancer, although according to ACS estimates, about 12,200 new cases of invasive cervical cancer will be diagnosed in the United States in 2003, with approximately 4,100 women dying from it. Uterine cancer can be grouped into three categories, depending from which type of cell it develops. Approximately 40,100 American women will be diagnosed with some form of uterine cancer in 2003, according to ACS, and an estimated 6,800 women will die of it. There are countless traditional methods for dealing with cancer, including radiation, chemotherapy and surgery, although supplements may be an effective adjuvant treatment. "[M]any cancer patients combine some form of complementary and alternative medicine therapies with their conventional therapies," according to researchers at the University of Kansas Medical Center in Kansas City. "The most common choice of these therapies is the use of antioxidants."29 The same researchers published a case study of two patients with ovarian cancer and noted antioxidants appeared to be safe and effective when combined with traditional therapy.30 In addition to the increased need for antioxidants because of heightened free radical production from chemotherapy, antioxidants may also be needed to correct deficiencies that can occur in response to the body's internal fight against cancer cells. Increased lipid peroxidation and decreased antioxidant levels are common in patients with breast cancer31 and cervical cancer.32 Specifically, vitamin C and vitamin E are found in low levels in cervical cancer patients, perhaps because they deplete themselves by scavenging lipid peroxides, according to researchers in India.33 Vitamin E, which is made up of eight isomers including four tocopherols and four tocotrienols, may also be protective in breast cancer. Tocotrienols (as Tocomin palm tocotrienol complex supplied by Edison, N.J.-based Carotech Inc.) have been shown to inhibit the growth of human breast cancer cells in vitro, according to researchers from the University of Western Ontario, Canada.34 They also showed that the palm tocotrienol complex worked synergistically with tamoxifen to inhibit breast cancer cells, and the effect was 45-times higher with the combination than with either compound used alone. Additional in vitro research out of the University of Reading in England demonstrated individual tocotrienol isomers inhibited human breast cancer cell growth irrespective of estrogen receptor status.35 In ovarian cancer, vitamins C and E were found to be protective, according to a study out of the University of North Carolina, Chapel Hill.36 Researchers in Italy found an inverse relationship between vitamins C and E, as well as beta-carotene, and the incidence of breast cancer, leading them to conclude consumption of nutrient-rich fruits and vegetables had a protective effect.37 A team at Harvard Medical School, however, did not find a significantly protective effect against ovarian cancer from the consumption of antioxidants from supplements or food.38 A team of Italian researchers found an inverse association between intake of selected micronutrients--prevalent in fruits and vegetables--and ovarian cancer.39 Their study indicated vitamin E, as well as the carotenoids beta-carotene, lutein and zeaxanthin, and the mineral calcium, were protective against ovarian cancer. While some research on carotenoids and cancer has failed to demonstrate a protective effect--such as a case-cohort analysis of 56,837 women that did not indicate carotenoid intake led to a reduced risk of breast cancer40--much of the research has been positive. In vitro research with human breast cancer cells showed an anti-proliferation effect with beta-carotene and lycopene, as well as zeaxanthin and astaxanthin.41 Human research has also shown a protective effect against breast cancer with carotenoid intake, according to a case-control study out of the Johns Hopkins University in Baltimore, Md., involving 590 women.42 Researchers noted median concentrations of beta-carotene, lycopene, total carotene and lutein were significantly lower in cases than controls. Lycopene has been specifically indicated in reducing the risk of breast cancer. Researchers from Ben-Gurion University in Be'er Sheva, Israel, found lycopene is more effective at preventing breast cancer when it is combined with other tomato phytonutrients. Their unpublished in vitro research demonstrated a complex of tomato phytonutrients (as Lyc-O-Mato, manufactured by New York-based Lycored/Biodar) dramatically decreased cell proliferation in a line of breast cancer cells. Beta-carotene intake may also be linked to reduced breast cancer risk, as serum levels of beta-carotene are inversely associated with risk for the disease.43 In addition, high intakes of beta-carotene were associated with a 16-percent decrease in the risk of ovarian cancer, according to a meta-analysis out of the Marshfield Clinic Cancer Center in Wisconsin.44 However, beta-carotene may not protect against cervical cancer because it was ineffective for reducing the risk of cervical abnormalities, according to researchers at the University of California, Irvine.45 Conversely, alpha-carotene, beta-cryptoxanthin and lutein/zeaxanthin may protect against cervical cancer by reducing the risk of cervical lesions, according to researchers at the University of Washington, Seattle.46 Indole-3-carbinol (I3C), a constituent of cruciferous vegetables, is also suspected to promote the regression of cervical lesions, thereby reducing the risk of cervical cancer. Researchers at Louisiana State University in Shreveport randomly assigned 30 patients with cervical lesions to take either placebo or 200 mg/d or 400 mg/d of I3C (provided by Orem, Utah-based Designed Nutritional Products, which holds a patent for I3C in alleviating symptoms of fibromyalgia and received in May patents for applications with PMS and menopause).47 After 12 weeks, none of the patients in the placebo group had complete regression, while four of eight patients in the 200 mg/d group and four of nine patients in the 400 mg/d group had complete regression. The lignan-containing flaxseed may reduce the risk of breast cancer by increasing hormone metabolism, according to researchers at the University of Minnesota, St. Paul.48 For three seven-week periods, 28 postmenopausal women received 0 g/d, 5 g/d and 10 g/d of ground flaxseed in addition to their habitual diets. Analysis of serum samples indicated the flaxseed diets significantly reduced serum concentrations of 17 beta-estradiol and estrone sulfate, indicating an influence in endogenous hormone metabolism. Like flaxseed, soy and its isoflavones may reduce the risk of breast cancer through altering hormone metabolism. A higher intake of soyfoods can reduce levels of estrone--a particular estrogen that is known to increase the risk of breast cancer among postmenopausal women--according to researchers at the Keck School of Medicine at the University of Southern California, Los Angeles.49 The same researchers found a high intake of soy during adolescence also reduces the risk of breast cancer, and additional soy intake during adulthood may also lower this risk.50 A similar study conducted at the Vanderbilt University School of Medicine in Nashville, Tenn., demonstrated a reduced risk of breast cancer with adolescent soyfood intake.51 Soy intake may also reduce the occurrence of high-risk mammographic parenchymal patterns, predictors in breast cancer development.52 Animal research of soy supplementation has also shown a risk reduction with intake. Researchers at Creighton University School of Medicine in Omaha, Neb., studied the effect of supplementation with isolated soy protein on breast cancer risk.53 They found that with soy supplementation, mice had a significant reduction in the number of detectable tumors compared to the control group. Black cohosh, an herb studied widely for its role in reducing menopause symptoms, may be useful for reducing breast cancer risk. Research out of the University of Illinois in Chicago indicated black cohosh has free radical scavenging ability and protected against cellular DNA damage in a line of breast cancer cells.54 An unpublished, company-sponsored, in vitro study indicated a proprietary blend of black cohosh (as Menophase, available from Wayne, N.J.-based Triarco Industries) had no effect on either alpha or beta estrogen receptors, perhaps lending it to the prevention of breast cancer. The research also indicated the ingredient may be useful for inhibiting the activity of aromatase, an enzyme that plays a role in the conversion of estrogen to estradiol, thereby reducing estrogen circulation in both normal and malignant breast tissue. Osteoporosis Osteoporosis, like breast cancer and heart disease, affects both men and women, but is more prevalent among women. According to the National Osteoporosis Foundation (NOF), of the 10 million Americans estimated to have osteoporosis, 80 percent are women. Porous bones are the manifestation of osteoporosis, which is characterized by low bone mass and structural deterioration of bone tissue that leads to fragility and a susceptibility to fractures. One of the more commonly recognized complementary therapies for osteoporosis is the use of calcium and vitamin D supplements. Research has shown calcium and vitamin D are important for bone maintenance and supplementation can both reduce the risk of osteoporosis and improve bone health in those with the condition.55,56 Calcium and vitamin D are also specifically noted to reduce the rate of menopause-related bone loss, as well as decrease the risk of fractures in postmenopausal women.57 An 18-year prospective analysis of 72,337 postmenopausal women indicated vitamin D intake specifically lowered the risk of osteoporotic hip fractures.58 Calcium and vitamin D are also known for their excellent safety profile, according to researchers from the University of Michigan, Ann Arbor.59 The two nutrients improved musculoskeletal function and decreased falls in 122 elderly women who were randomly assigned to take 1,200 mg/d of calcium plus 800 IU/d of vitamin D (as cholecalciferol) or calcium alone for 12 weeks.60 The intervention with vitamin D plus calcium reduced the risk of falls by 49 percent compared to calcium alone, according to researchers from the University of Basel, Switzerland. Aside from calcium and vitamin D, several other vitamins and minerals are needed for maintaining and improving bone health. A study of 136 healthy postmenopausal women out of the University of Connecticut, Storrs, demonstrated magnesium, zinc and vitamin C were significantly related to bone mineral density.61 Magnesium is required for several facets of bone health, including strength, preservation and remodeling.62 An animal study conducted at the University of Southern California, Los Angeles, demonstrated the necessity of magnesium in bone formation, with magnesium-depleted mice exhibiting a significant decrease in skeletal magnesium concentrations.63 Vitamin C, an antioxidant, is known for its contribution to collagen formation, and has also been shown to affect bone mineral density, according to researchers from the University of Perugia in Italy.64 They evaluated blood and plasma samples from 75 osteoporotic and 75 healthy women and found mean plasma levels of vitamin C, vitamin E and vitamin A were consistently lower in osteoporotic women compared to controls. Vitamin A has been a slightly controversial nutrient in the realm of bone health research. In reviewing the Nurses' Health Study, a cohort of 72,337 postmenopausal women aged 34 to 77 years old, investigators from Brigham and Women's Hospital and Harvard Medical School determined long-term intake of a diet high in retinol may promote the development of osteoporotic hip fractures in women.65 Researchers identified 603 incident hip fractures resulting from low or moderate trauma between 1980 and 1998, with women in the highest quintile of vitamin A intake (3,000 mcg/d of retinol equivalents) at a significantly higher risk compared to women in the lowest quintile of intake. Researchers attributed increased risk primarily to retinol intake, as beta-carotene did not contribute to serum retinol concentrations and was not associated with an increased risk of fracture. Vitamin K is necessary for bone health in general, though it may have particular application for women. A review of the Framingham Heart Study conducted out of Tufts University in Boston indicated that of 1,479 women, those with the lowest intakes of vitamin K had significantly lower mean bone mineral density at the femoral neck and spine than women with the highest intakes.66 Researchers concluded this finding supported previous research indicating low vitamin K intake is associated with an increased risk of hip fracture. One of the B vitamins, vitamin B12, may have a link to bone mineral content status in women, according to researchers at Wageningen University in The Netherlands.67 They investigated vitamin B12 levels in 143 elderly women and noted osteoporosis occurred more often among the women with deficient vitamin B12 levels than among women with normal status. This same occurrence was not noted in the 51 men who participated in the study. Soy and its isoflavones have been widely studied in regard to improving women's bone health. A randomized, double blind, placebo-controlled study conducted at the University of Messina in Italy indicated the soy isoflavone genistein had positive effects on bone loss and increased bone formation in postmenopausal women.68 Soy protein with isoflavones has also been shown to attenuate bone loss in perimenopausal women, as noted by researchers at Iowa State University, Ames.69 They randomly assigned 69 perimenopausal women to receive either soy protein rich in isoflavones or depleted of them, or whey protein (control) for 24 weeks. At the end of the study period, the percentage change in lumbar spine bone mineral density and bone mineral content did not change in either soy group, although there was a loss in the control group. Researchers also noted the isoflavone-rich diet had a positive effect on bone mineral density. (The soy protein for this study was provided by the St. Louis-based Solae Co.) Researchers at Baylor College of Medicine in Houston are currently conducting the Osteoporosis Prevention Using Soy (OPUS) study, a randomized, double blind, placebo-controlled trial that will determine the bone-protective effects of soy isoflavones (as SoyLife, provided by Minneapolis-based Acatris Inc.) in a group of 400 postmenopausal women. The women will be divided into one of three study groups--80 mg/d of isoflavones, 120 mg/d of isoflavones or placebo--and all women will also be given 600 mg/d of calcium and 400 IU/d of vitamin D. The $4.5 million study is scheduled for completion before the end of 2004. Ipriflavone, the synthetic form of soy isoflavones, has also been studied in regard to women's health after menopause. A recent report out of the Center for Clinical and Basic Research in Bellerup, Denmark, indicated 200 mg of ipriflavone three times daily did not prevent bone loss or affect biochemical markers of bone metabolism.70 In opposition to this finding, researchers from the University of Michigan, Ann Arbor, noted in a research review that ipriflavone does have some effect on decreasing bone turnover and maintaining bone mineral density.71 Hormone-Related Issues Premenstrual syndrome (PMS) and its more severe cousin, premenstrual dysphoric disorder (PMDD), as well as menopause are all rooted in a woman's hormone levels. All three conditions are known for the bothersome symptoms they cause, both physical and emotional. While PMS, PMDD and menopause are not diseases to be cured, the symptoms that accompany them can be eased with traditional and alternative medicine. As many as 75 percent of menstruating women suffer from PMS, according to MayoClinic.com, and exhibit symptoms such as weight gain and bloating, breast tenderness, and mood swings caused partially by cyclic changes in hormones. Approximately 30 percent to 40 percent of women have symptoms that are severe enough to affect their daily lives, and about 7 percent have the psychologically disabling form of PMS known as PMDD. The troubles associated with PMS and PMDD may end with menopause, although this phase of a woman's life brings with it a new set of symptoms. Menopause is defined by the North American Menopause Society (NAMS) as the point after 12 months of amenorrhea (absence of menstruation) when there is a near complete diminution of ovarian hormone secretion. Approximately 1.35 million American women reached natural menopause in the year 2000, bringing the estimated total number of postmenopausal women in the United States to nearly 40 million. Several minerals and vitamins are thought to contribute to female health and ease hormone-related symptoms. Calcium, for example, has been featured in the realm of easing the symptoms of PMS and possibly even PMDD. Research out of St. Luke's-Roosevelt Hospital Center in New York indicated PMS may represent a clinical manifestation of calcium deficiency,72 and two research reviews indicated calcium has shown promise in clinical settings as a treatment for PMS.73,74 A review conducted at Dalhousie University in Halifax, Canada, suggested calcium carbonate be recommended as a first-line therapy to women with mild to moderate PMS.75 MayoClinic.com has recommended PMS sufferers consider using calcium, as well as magnesium and vitamin E, to improve symptoms of PMS. Researchers at New Orleans' LSU School of Medicine noted clinical evidence supports the use of all three nutrients in alleviating symptoms of PMS.76 Independently, magnesium (200 mg/d) was shown in a double blind, placebo-controlled trial at England's University of Reading to reduce fluid retention caused by PMS.77 In addition to relieving PMS symptoms, vitamin E may reduce the incidence of hot flashes in postmenopausal women, according to researchers at the Mayo Clinic in Rochester, Minn.78 They suggested for mild menopausal hot flashes that do not interfere with sleep or daily function, vitamin E is a reasonable initial treatment option. Contrarily, a research review conducted at Columbia University College of Physicians and Surgeons in Washington, D.C., concluded vitamin E does not affect hot flashes.79 Researchers at the LSU School of Medicine also conducted a double blind trial with magnesium and vitamin B6, learning that 200 mg/d of magnesium combined with 50 mg/d of vitamin B6 reduced anxiety-related PMS symptoms such as nervous tension, mood swings and irritability.80 However, MayoClinic.com warns women against using vitamin B6, saying, "Studies of daily supplementation with vitamin B6 failed to show its effectiveness. High daily doses may cause nerve damage and are considered dangerous." Aside from vitamins and minerals, several botanical and plant-derived ingredients are thought to offer assistance in alleviating the symptoms that occur as a result of a woman's hormone fluctuations. An antioxidant extract of French maritime pine bark is thought to reduce pain associated with menstruation, and a U.S. patent was awarded for this use to Pycnogenol. In research out of Kanazawa University in Japan, the extract (as Pycnogenol) induced a 77-percent reduction in menstrual pain caused by dysmenorrhea (lower abdominal and pelvic pain that occurs during menstruation) when it occurred as a symptom of endometriosis (a chronic overgrowth of misplaced tissue that responds to a woman's menstrual cycle, causing pain and inflammation).81 Several other herbal remedies may alleviate PMS symptoms, as noted by MayoClinic.com. Among those listed were black cohosh, ginger, red raspberry leaf, dandelion tea, chaste tree berry and evening primrose oil. An analysis of 33 trials for PMS conducted at Columbia University in New York indicated chaste tree berry extract shows promise for treating the symptoms of PMS.82 A research review out of Cedars-Sinai Integrative Medicine Medical Group in Los Angeles suggested chaste tree berry, dong quai and evening primrose oil may be reasonable alternative therapies for PMS symptoms.83 The Cedars-Sinai researchers also noted dong quai and black cohosh are safe for treating menopausal symptoms, although they stated only black cohosh has proven effective. Researchers at Schaper & Brummer GmbH & Co. KG in Salzgitter, Germany, found black cohosh eased menopausal symptoms without the side effects that can occur with HRT.84 They randomly assigned women to either the standard dose (39 mg/d) or a high dose (127.3 mg/d) of black cohosh (as Remifemin, marketed in the United States by GlaxoSmithKline Consumer Healthcare) for 24 weeks in a parallel group study of about 150 peri- and postmenopausal women. Results did not demonstrate additional benefit with the higher dose, leading researchers to conclude a standard dose is effective for reducing the physical and emotional symptoms of menopause. Another herb, Polygonum cuspidatum (P. cuspidatum), is known to have estrogenic effects, which is one reason it is considered potentially effective for postmenopausal health. P. cuspidatum, the active constituent being trans-resveratrol, was studied by researchers at Creighton University School of Pharmacy in Omaha, Neb. While their animal research focused on the cardioprotective properties of P. cuspidatum (as Protykin, manufactured by Benicia, Calif.-based InterHealth Nutraceuticals Inc.), they concluded the herb improves postmenopausal symptoms such as hot flashes, mood swings, vaginal itching and dryness, skin wrinkling, and bone strength.85 Red clover is another herb with phytoestrogen properties and has been suggested to reduce menopausal symptoms. Research out of The Netherlands indicated red clover isoflavones may reduce the severity and occurrence of hot flashes in postmenopausal women.86 After receiving placebo for four weeks, 30 postmenopausal women were randomly assigned to receive either 80 mg/d of red clover isoflavones (as Promensil, marketed by Stamford, Conn.-based Novogen Ltd.) or placebo for another 12 weeks. Researchers noted a 16-percent decrease in the frequency of hot flashes during the initial four-week placebo period. However, during the double blind phase of the study, the isoflavone group exhibited a 44-percent decrease in the occurrence of hot flashes, while no further reduction was noted in the placebo group. Red clover may also reduce symptoms associated with PMS, such as breast pain that occurs as a result of the menstrual cycle. In a double blind study, the majority of women receiving 50 mg/d or 80 mg/d of a red clover isoflavone supplement (as Promensil) showed greater than a 25-percent decline in self-reported breast pain.87 Like red clover, soy and its isoflavones are thought to have numerous benefits in reducing the symptoms of hormone fluctuations in menopause--specifically for hot flashes. A study of 75 menopausal women conducted at Hospital Edouard Herriot in Lyon, France, indicated women taking a soy isoflavone extract (containing a total of 70 mg/d of genistein and daidzein) had a 38-percent reduction in the mean number of hot flashes after four weeks, a 51-percent reduction after eight weeks, and a 61-percent reduction after 16 weeks, compared to a 21-percent reduction in the placebo group after 16 weeks.88 Researchers at the University of Ferrara in Italy found similar results.89 They randomly assigned 104 postmenopausal women to receive either 60 g/d of an isolated soy protein or placebo for 12 weeks, after which time the women in the soy group had a 45-percent reduction in hot flashes compared to a 30-percent reduction in the placebo group. An unpublished study of a soy germ ingredient (as Acatris' SoyLife, containing 10-percent soy isoflavones and .6-percent tocopherols) indicated that of 80 women, those who received soy showed a greater reduction in hot flashes compared to those taking the casein placebo. The research surrounding natural remedies for women's health is seemingly as plentiful as the conditions that affect women today. Female consumers are used to dealing with the monthly irritations of menstruation, as well as the constant threat of heart disease, breast cancer or osteoporosis. While women continue to turn to traditional medicine, they are also frequenting the aisles of health food stores for adjuvant natural remedies. Regardless of the negative media hype that is ubiquitous in this industry, statistics have shown that a large number of women remain faithful to the natural products industry. For this reason, it is important to keep the research coming and to continue supplying well-studied, safe ingredients for the supplements that line retailers' shelves.
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