In the newest of the St. John’s wort studies in perimenopausal/menopausal women, a total of 100 Iranian women with an average age of 50 participated in a randomized, double-blind, placebo-controlled clinical trial comparing St. John’s wort with placebo in the treatment of hot flashes.[1] 50 women received 20 drops three times daily of St. John’s wort extract (Hypericin) that contained hypericin 0.2 mg/mL and 50 women received a placebo of distilled water. The study duration was two months. Clinical exams and interviews were performed at baseline, 4 weeks and 8 weeks. Treatment effectiveness was measured evaluating frequency, duration and severity of hot flashes as the main objective of the study.

In women taking St. John’s wort, the frequency began to decline during the 1^st and 2^nd months, but showed more improvement during the 2^nd month. There was no statistical change in hot flash frequency during the first month of placebo but did improve during the second month. Women who used St. John’s wort showed more improvement in hot flash frequency than placebo. The decline in duration of hot flashes was statistically significant at week 8 and the decline was much more evident in the St. John’s wort group. The severity of hot flashes was relieved in the St. John’s wort group during the 2 months of treatment and was more significant in the second month. Women in the placebo group did not show any significant decrease in severity of hot flashes during the 1^st month, but they did have some improvement during the 2^nd month, but not as great as those women in the St. John’s wort group.

Comments

St. John’s wort has emerged as an important clinical tool in treating perimenopausal/menopausal women—for hot flashes and/or depression and/or mood swings, and/or sleep problems either as an encapsulated standardized extract from 300 mg twice per day to three times per day, or a tincture/liquid extract ½ tsp 2-3 times per day, or in combination with other menopause therapies such as black cohosh, maca extract, kava or others.

Reference

[1] Abdali K, Khajehei M, Tabatabaee R. Effect of St. John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause 2010;17(2): 326-331.

The evidence for the use of chaste tree berry in the treatment of mastalgia has been reported in both randomized and non-randomized studies. A large open study without a control group of 1634 women with cyclic mastalgia as part of their premenstrual syndrome demonstrated that after 3 months of treatment, 80% of patients rated their response as a good and 81% rates it as a very good treatment for their mastalgia. [1] In a prospective, multi-center trial using chaste tree in 50 patients with premenstrual cyclic mastalgia, 43 women were treated daily with chaste tree for three consecutive menstrual cycles.[2] By the end of the study period, cyclical mastalgia decreased significantly along with a smaller degree of improvement even 3 months after stopping the plant. Thirty-eight women rated the effectiveness as moderate to excellent, with 5 reporting no effect. In a randomized controlled trial, 97 women with cyclical mastalgia had twice the decrease in intensity of pain after one or two treatment cycles as compared to placebo.[3] The duration of pain also improved in the chaste tree group. In the chaste tree group, half the women did not have severe pain at all during any time of the menstrual cycle and only 25% had severe pain for 4% of the days compared with severe mastalgia one fifth of the time before their use of chaste tree began. In a randomized trial of premenstrual dysphoric disorder, comparing chaste tree with an SSRI, 58% of patients being treated with chaste tree had an improvement in their cyclical mastalgia and 68% of patients had improvements in their psychological symptoms.[4] In a randomized controlled placebo controlled trial, 170 women were given chaste tree or placebo for three consecutive cycles. The improvement in breast pain was greater in the chaste tree group (52%) compared with the placebo group (24%). [5]

Consider a standardized extract of chaste tree berry—usually one capsule per day all month long for a minimum of two but preferably three consecutive months.

References

[1] Loch E, Selle H, Boblitz N. Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus castus. J Womens Health Gend Based Med 2000;9:315-320.)

[2] (Berger D, Schaffner W, Schrader E, Meier B, Brattstrom A. Efficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome. Arch Gynecol Obstet 2000;264:150-153.)

[3] ( Halaska M, Beles P, Gorkow C, Sieder C. Treatment of cyclical mastalgia with a solution containing a Vitex agnus castus extract: results of a placebo-controlled double-blind study. Breast 1000; 8:175-181. )

[4] (Atmaca M, Kumru S, Tezcan E. Fluoxetine versus Vitex agnus castus extract in the treatment of premenstrual dysphoric disorder. Hum Psychopharmacol 2003;18:191-195.)

[5] (Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. Br Med J 2001;322:134-137.)

More information and registration online at www.americanherbalist.com

You can also register by phone (203) 272-6731

Symptoms were rated using the Daily Symptom Report, The State Anxiety Inventory, the Beck Depression Inventory and the Aggression Questionnaire and Barratt Impulsiveness Scale. Numerous hormones and physiological markers were also measured in the follicular and luteal phases: follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, prolactin, testosterone, cytokine interleukins= IL-1B, IL-6, IL-8, interferon and tumor necrosis factor alpha.

St. John’s wort was statistically more beneficial than placebo in food cravings, swelling, poor coordination, insomnia, confusion, headaches, crying and fatigue. There were no significant effects of St. John’s wort compared with placebo in any of the biochemical blood measurements. St. John’s wort was not statistically more beneficial in anxiety, irritability, depression, nervous tension, mood swings, feeling out of control and pain-related symptoms during two cycles of treatment. However, these pain-related symptoms appeared to improve more than placebo towards the end of each treatment period

Commentary: The results of this PMS study demonstrate once again, the benefit of St. John’s Wort for the treatment of PMS. In this study, it was determined their PMS was mild. The benefit received by women taking St. John’s Wort was achieved during the first menstrual cycle in which it was taken. While St. John’s Wort did not prove to be statistically better than placebo for mood and pain-related PMS symptoms, the pain symptoms did appear to improve more than placebo towards the end of each treatment period, implying that there may be more pain benefits with St. John’s wort after a longer duration of treatment. Several other studies have shown benefit with St. John’s wort.

Reference: Canning S, Waterman M, Orsi N, et al. The efficacy of Hypericum perforatum (ST John’s Wort) for the treatment of premenstrual syndrome. CNS Drugs 2010; 24(3):207-225.

Results: The botanical combination reduced the number of vasomotor symptoms by 46% from baseline compared with 26% in the placebo group. Forty-three percent of women taking the botanical had at least a 50% reduction in the number of symptoms compared with only 6% in the placebo group.

Commentary: New options in botanical interventions for menopause related hot flashes are always welcomed. Mung beans are familiar to many, as a dietary source of nutrients-whether in sprouted form or other use. It is typically consumed for its protein and essential fatty acid content. E. ulmoides is rich in polyphenolic compounds such as lignans and flavonoids. I look forward to continued research on botanical therapies for menopause symptoms and the ability to expand our treatment options.

References:

Garcia J, Gonzaga F, Tan D, et al. Use of a multi-botanical (Nutrafem) for the relief of menopausal vasomotor symptoms: a double-blind, placebo-controlled study. Menopause 2010; 17(2):303-308.

This study was a double blind clinical trial in 150 women in Iran. Two groups of 75 women each were evaluated for severity and duration of breast pain which was measured according to a breast pain chart and something called a Visual Analog Scale.

Chewable tablets of either vitamin E 200 mg tablets or a placebo were given twice a day for 4 months, and again, the severity and duration of breast pain was evaluated at the end of the second and fourth month. The results at two months for vitamin E were dramatically better than placebo in severity and duration, and appear to be achievable in about 70% of the women. The improvement was seen as soon as two months, and no continued improvement after 4 months.

Commentary: Other studies have been conducted in vitamin E and breast pain. In 1997, Khanna et al compared vitamin E with a drug called Danazol. Vitamin E reduced pain in 41% of the women in the studies and Danazol had similar pain reduction in 72% of the women. Clearly the drug helped more women, but the side effects of that drug are significant and one third of the women developed other side effects. Meyer et al did a study in 1990 but did not show any benefit from Vitamin E. Ernester in 1985 studied 201 women with mastalgia as it relates to fibrocystic breast disease. He concluded that vitamin E was not effective, but he was not evaluating breast pain as a distinct issue. In 2004, Bespalov et al studied 66 women with a combination of beta-carotene, vitamin E, vitamin C and garlic powder. There was a reduction in the severity of mastalgia, premenstrual syndrome, infrequent menses and menstrual cramping as well as a reduction in symptoms of fibromatosis in 75% of the women compared with 45% of women on placebo.

If vitamin E alone is not sufficiently helpful in reducing mastalgia, evening primrose or borage oil should be considered, as well as carotenoids, iodine, eliminating caffeine, lowering saturated fats in the diet and increasing fiber.

References

Parsay S, Olfati F, Nahidi S. Therapeutic effects of vitamin E on cyclic mastalgia. The Breast Journal 2009;15(5):510-514.

In each of the studies, women who consumed the highest dietary intake of soy had a lower risk for endometrial and ovarian cancers compared with the women who had the lowest intake.

Commentary: It is not surprising to see this report as we have seen previous observational studies with similar results, showing lack of endometrial proliferation, endometrial safety and/or reduced risk of endometrial cancer. Only one previous study that I’m aware of, did demonstrate that after 5 years, but not after one year or 3 years, who were given 150 mg per day of soy isoflavone tablets had an increased occurrence of endometrial hyperplasia (but no cases of atypical hyperplasia or endometrial cancer).[ii]

The mechanisms whereby soy appears to have an influence on lowering the risk of hormonal cancers, including breast, appear to be multiple. These include: through its ability to bind to certain estrogen receptors and actually have an estrogen blocking effect, raising sex hormone-binding globulin which decreases circulating estrogens, affecting selected enzyme pathways which result in anti-carcinogenic effects, direct tumor growth inhibition, and having antioxidant effects.

My advice: for most women, and for those who are not allergic to soy or have indigestion with soy products, I recommend 1-2 servings per day of the following soy foods: cooked soy beans, roasted soy nuts, soy milk, tofu, tempeh, edamame, tofu pate (my favorite).

[i] Myung S- K et al. Soy intake and risk of endocrine-related gynaecological cancer: A meta-analysis. BJOG 2009 Dec; 116:1697

[ii] Unfer V, et al. Endometrial effects of long-term treatment with phytoestrogens: a randomized, double-blind, placebo-controlled study. Fertility and Sterility 2004;82:145-148). 150 mg of soy isoflavones per day is above the average intake in an Asian diet (ranging from about 40-90 mg per day

Dear all,
I’m taking another group trip to the sacred holy land of the Navajo-Canyon de Chelly. 
Our base camp is in the valley of the canyon, surrounded by beautiful canyon walls, moon and sun rises and sets.   We do group cooking and eating in an outdoor kitchen.  We camp in our tents with an outhouse and primitive outdoor shower.  Our Navajo guides are Lupita and Jon McClanahan, who are local canyon residents, and very special people.  We will be camping on their ancestral land, in the remote regions of the canyon.

Our daily activities include incredible hikes.  Not too strenuous although for some people the heights can be a problem occasionally.  We hike up and down the canyon walls, hike to Anasazi ruins, and visit a traditional birthing Hogan.  One of my favorite parts is that we will hear incredibly wonderful stories-Navajo and Anasazi history, cultural insights, ceremonial healing ceremonies and some of the healing traditions of the Navajo.  We hear of the birthing traditions, Navajo spirituality, and "the beauty way".    At night, we sit around the fire and talk; Jon or Lupita also tell some stories= grandfather fire, stories from Lupita’s childhood living in the canyon in the traditional ways, and more. 

I have been to the canyon many times in the last 6 years.  Jon and Lupita have become close friends and deeply meaningful teachers.  They are beautiful in their ways and speaking and living.  Their spirituality and their commitment to living their lives in keeping with their traditional spirituality is evident in all that they do.  My life has changed in extraordinary and powerful ways as a result of knowing them. 

If you are interested in this fantastic trip, write Tori Hudson, N.D. at womanstime@aol.com or call, 503-222-2322. You can also learn a bit more about the canyon and Jon and Lupita, from their website, www.footpathjourneys.com

The cost of the trip is affected by the number of people on the trip but I anticipate it to be between 750.00 and 950.00. Your transportation costs to and from Chinle, Arizona are extra. I can work with you to arrange car pools from Phoenix, Arizona.

                                                                                    Tori Hudson, N.D.

Guidelines for screening cervical cancer and abnormal cells of the cervix are regularly evaluated and updated, based on statistics and health data. Both  liquid-based and the conventional pap smear slide methods of screening are acceptable, but the majority of current screening uses the liquid-based process. The liquid-based technology will filter out most of the blood and inflammatory cells and debris, and in addition, can be used for HPV testing as well as gonorrhea and chlamydia infections.

As of December 2009, the American College of Obstetricians and Gynecologists (ACOG) have updated their clinical guidelines as follows:

• Cervical cancer screening should begin at age 21 years. Screening before age 21 should be avoided because it may lead to unnecessary and harmful evaluation and treatment in women at very low risk of cancer.
• Cervical cytology screening is recommended every 2 years for women between the ages of 21 years and 29 years
• Women aged 30 years and older who have had three consecutive negative cervical cytology screening test results and who have no history of moderate cervical dysplasia (CIN 2) or severe cervical dysplasia (CIN 3), are not HIV infected, are not immunocompromised, and were not exposed to DES in utero may extend the interval between cervical cytology exams to every 3 years.
• Both liquid-based and conventional methods of cervical cytology are acceptable for screening.
• In women who have had a total hysterectomy (all of uterus removed) for a benign indications (ex/ uterine fibroids, endometriosis, abnormal bleeding unrelated to cancer) and have no prior history of a moderate or severe dysplasia, routine cytology testing should be discontinued.
• Co-testing using the combination of cytology plus the HPV test is an appropriate screening test for women older than 30 years. Any low-risk woman aged 30 years or older who receives negative test results on the pap/liquid based pap screen and HPV test should be rescreened no sooner than 3 years subsequently.
• Sexually active adolescents (women younger than age 21) should be counseled and tested for sexually transmitted infections, and should be counseled regarding safe sex and contraception.
• It is reasonable to discontinue cervical cancer screening between 65 years and 70 years of age in women who have three or more negative cytology test results in a row and no abnormal test results in the past 10 years.
• Women treated for moderate or severe dysplasia or cervical cancer are at risk for persistent or recurrent disease for at least 20 years and should continue to have annual screening for at least 20 years.
• Women who have had a hysterectomy with a history of moderate or severe dysplasia should continue to be screened even after treatment.
• ANNUAL GYNECOLOGIC EXAMS ARE STILL APPROPRIATE, EVEN IF CERVICAL CYTOLOSY SCREENING IS NOT PERFORMED AT EACH VISIT.
• Women who have been immunized against HPV-16 and HPV-18 should be screened by the same regimens.

Commentary:  These guidelines are regularly changed based on statistics on incidence of cervical dysplasias and cervical cancer, treatment outcomes, new information on the cause and progress of a disease, and the influence of cost effectiveness and benefits and risks of overtreatment and undertreatment. With the development of liquid based collection systems (ex/ Thin Prep and Sure Path), and the ability to test for low risk and high risk strains of HPV, this has led to some of the guidelines where the pap is needed less often, as long as the cytology and the HPV are negative.  My main concern about this development is that many women, and even practitioners, interpret this to mean they do not still need an annual physical exam.

Source: ACOG practice bulletin Number 109, December 2009

The daily dose of herbal products given were 3 tablets containing 5400 mg of St. John’s wort standardized to contain 990 mcg hypericin, 9 mg hyperforin and 18 mg flavonoid glycosides. The daily dose of chaste tree berry was one tablet of an extract equivalent to 1000 mg of dry fruit. This was not a standardized extract. There was a matching placebo group. Participants recorded the severity of their PMS symptoms using the Abraham’s Menstrual Symptom Questionnaire.

The active treatment group was statistically superior to placebo for total PMS-like symptoms as well as subgroups of PMS depression and PMS food cravings.

Commentary: Based on previous research in PMS and chaste tree berry and PMS and St. John’s wort, as well as my clinical experience, it is not surprising that a combination of the two plants would be effective. PMS symptoms are common in regularly menstruating women, and it is also a common phenomenon in peri-menopausal women whose cycle and hormonal regularity is beginning to change. While this study evaluated a small group of women, it does address a significant population of women— those who are peri-menopausal and newly or still, experiencing PMS symptoms.

Reference:

Van Die M, Bone K, Burger H, et al. Effects of a combination of Hypericum perforatum and Vitex agnus-castus on PMS-like symptoms in late-perimenopausal women: Findings from a subpopulation analysis. J Alternative and Complementary Medicine 2009;15(9):1045-1048.