- By John Chen, PhD, PharmD, OMD, LAc
- Premarin (conjugated estrogen) is one of the most frequently prescribed medications in the United States.
Considering that only half of the population can be prescribed this
medication (females), and that only elderly patients need this
medication, it is an astounding number. I am often asked by
practitioners about patients of theirs who are prescribed estrogen but
wish to take herbal alternatives, or patients who are prescribed herbs
but wonder if the estrogenic effects of the herbs will conflict with
their current therapy. I will try to address these issues in three
separate parts. Part one will discuss herbs that have estrogenic
effects, along with possible side-effects; part two will cover herbs
that may be used to treat menopausal signs and symptoms; and part three
will focus on herbs that may be used to treat osteoporosis.
Estrogen is commonly prescribed for numerous purposes, including (but
not limited to) menopausal signs and symptoms, osteoporosis, and
atrophic vaginitis. More recently, the beneficial effects of estrogen
have been observed in patients with Alzheimer's disease (with
improvement up to 16 weeks) and dyslipidemia.
addition to drugs, there are many other alternatives for natural sources
of estrogen. In traditional Chinese medicine, many herbs have
estrogenic effects. Although Chinese herbs are not prescribed
individually for such purposes, the addition of herbs with estrogen-like
effects will definitely supplement a formula and enhance its overall
therapeutic value. According to studies in mice, it has been discovered
that fructus cnidii monnieri (she chuang zi), semen cassiae (jue ming zi) and radicis angelicae sinensis (dang gui) increase estradiol levels; flos carthami tinctorii (hong hua) increases FHS levels; and semen astragali complanati (sha yuan zi) increases the weight of the uterus.
The use of estrogen replacement therapy, despite numerous benefits,
still has many potential conflicts and controversies. One of the biggest
disadvantages associated with the use of estrogen is the staggering
number of side-effects, including, but not limited to, increased risk of
breast and uterine cancer; endometrial carcinoma; malignant neoplasm;
gallbladder disease; thromboembolitic disease; and photosensitivity. Due to these adverse effects, many people opt not to take estrogen supplements; many others cannot take estrogen supplements.
In addition to side-effects, one contraindication of estrogen
supplementation is for patients who have cancer of the breast, uterus or
endometrium. Use of drugs, supplements or foods with hormonal activity
may stimulate the growth of cancer cells, and must be avoided.
Specifically with Chinese herbs, those that increase the secretion of
female hormones or increase the weight of the sex organs should be
avoided. Examples include she chuang zi, jue ming zi, dang gui, hong hua, and sha yuan zi.
Furthermore, patients should be careful eating meat or animal products,
as many of these have been treated with hormones to hasten growth.
In summary, though traditional Chinese medicine and Western medicine
have vastly different diagnostic criteria and treatment approaches, the
medicines used by the two systems are in fact similar in many ways. Both
have similar therapeutic effects and potential conflicts. Protocols
concerning how to incorporate these herbs into formulas for the
treatment of menopause and osteoporosis will be discussed in parts two
and three of this series.
- Buckley B. 34th annual top 200 drugs. Pharmacy Times, April 1999.
Liu J, Gong H. Screening Some of the Estrogen-Like Herbs. Presented at
the 5th Symposium on Research in Chinese Medicine and the 14th Symposium
on Natural Products, Oct. 31-Nov. 1, 1999, Taipei, Taiwan.
- Estrogen supplements. Drug Facts and Comparison, 1999.
- Balch J, Balch P. Prescriptions for Nutritional Healing, 2nd edition, 1997.