Dr Steven R. Goldstein is co author of the book “The Estrogen Alternative” and a leading HRT Specialist NYC. He prescribes a form of Hormone Replacement Therapy (HRT) known as Selective Estrogen Receptor Modulators (SERMs) to help patients cope with they symptoms of menopause. They are a class of drugs that are approved by the FDA after undergone long periods of trials.
Many patients ask about a “natural” approach to health after Menopause. Botanical remedies (over the counter remedies derived from herbs and plants) are what they usually mean by “natural”. The remedies most talked about include dong quai, black cohosh, yam root and soy. Before we discuss specific herbs, there is an important point about the difference between natural and risk free.
Natural isn’t risk free. Just because a supplement comes from plants and is available at a health food store doesn’t make it safe. Granted many of the over the counter botanicals are basically diluted medications that happen to come from plants, but this doesn’t guarantee their safety. Herbs and extracts can be potent. All of modern medicine gets its start from plants, however in the wrong doses they can hurt you.
In terms of HRT, there is no reason to believe any of the botanicals are preferable to medication that is FDA regulated, tested on thousands of women, and successful with millions of patients. For the most part, all we have is anecdotal evidence – women taking the substance said it helped them. Before you decide that this is enough for you, realize that we do not, for the most part, have studies comparing women taking the substance to other women taking placebos, with the first group saying it helped them more.
If a substance is relieving your hot flashes, you can bet your liver is seeing it as estrogen even if it is called something else. And if you think you are going to avoid the risk of any side effect by using natural remedies, the reality is, if they’re stopping your hot flashes, they’re affecting your body. They’re also going to pass through your liver on the way through your body, so purity is important. Are they pure? These natural remedies are not subject to the same intense scrutiny the FDA mandates for prescription drugs. Although they are touted as having medicinal properties, they aren’t labeled as such.
Dr Steven R. Goldstein MD is a Menopause Specialist NYC and a Professor of Obstetrics and Gynecology at New York University School of Medicine.
Dr Goldstein is also a past President of the International Menopause Society, a Certified Menopause Practitioner and a Past President of the North American Society.
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