Dr. Susan B. Kowalsky, N.D.
Natural Menopause
Natural Alternatives to Hormone Replacement Therapy The dangers of hormone replacement therapy (HRT) such as synthetic progestin and conjugated horse estrogen have been well-documented in the medical literature for many years, including in this newsletter. Last summer a highly-publicized landmark study confirmed earlier studies about the dangers of HRT. If the previously known risks of gallbladder disease, deep vein thrombosis, blood clots, heart disease, breast, uterine and ovarian cancer were not deterrent enough, we now have more specific confirmation from this new study that this therapy compared to placebo resulted in a 29 percent increased risk for coronary heart disease, a 41 percent increased risk for stroke, a 26 percent increased risk for invasive breast cancer and a 100 percent increase in the risk for blood clots. I suspect the reason synthetic hormones and horse estrogens have such significant adverse effects is because they are not chemically identical to the hormones in humans.
NATURAL HORMONES: Since maintaining adequate hormone levels may be necessary in some cases for alleviating the symptoms of menopause and preventing osteoporosis, I prescribe "natural hormones" which are molecularly identical to human hormones. They include natural progesterone and the natural estrogens called estradiol, estriol and estrone. I prescribe them as skin creams, vaginal gels or suppositories and in pill form. When indicated I also prescribe other steroid hormones that decline after menopause such as low-dose testosterone and the adrenal hormone DHEA, both of which contribute to bone density and menopause support. Each prescription is tailored to the patient’s specific requirements and may be adjusted as needed. There have been a few studies comparing the natural hormones to the synthetic hormones for osteoporosis and effects on cholesterol and HDL (healthy cholesterol) levels. One study showed better results on lowering cholesterol with natural hormones while results on bone density were very similar. In the past, the protection Premarin, provided from high cholesterol was lost when it became necessary to add progesterone (in this case the synthetic progestin Provera) to reduce the risks for uterine cancer caused by Premarin. This protection from high cholesterol, however, was shown in one study to be maintained when a natural progesterone was used instead of the synthetic Provera. In another double-blind study, the use of natural oral micronized progesterone (OMP) showed a reduction in hot flashes in over 80% of the women in the study. There is also evidence that natural progesterone may decrease anxiety, depression and insomnia while increasing sexual functioning.
HORMONE TESTING: Testing sex hormone levels can be done accurately and conveniently. I will often measure testosterone, DHEA and even the "sleep" hormone melatonin also to further help direct individual therapies. I am especially interested in a new test that measures the ratios of the three estrogens in your body. New studies have shown that maintaining ratios with high levels of "good" estrogen and low levels of harmful estrogen will help reduce breast cancer, cervical cancer and osteoporosis. Natural therapies that improve estrogen metabolism such as fish oil, indoles from certain vegetables and even exercise can be prescribed to normalize the estrogen ratios when the test results indicate increased risk.
NATURAL MEDICINES: In addition to natural hormones I also prescribe other natural medicines that have been scientifically documented to relieve menopause symptoms and prevent and treat osteoporosis. I tailor treatments to address the needs of individual patients based on mental, emotional and social factors as well as their physical health and symptoms. One very popular treatment is Black cohosh, an herb with a great amount of research demonstrating its ability to relieve hot flashes, vaginal dryness, and other menopause symptoms. In one randomized double-blind trial, Black cohosh offered greater relief from menopause symptoms than estrogen. Other nutritional and herbal supplements helpful in treating hot flashes and other menopause symptoms include vitamins C and E, the flavanoid hesperidin as well as gamma-oryzanol from rice bran.
ANXIETY: The herb kava has been shown to be extremely safe and effective in reducing anxiety that can be associated with menopause. Kava has been shown to be as effective as benzodiazepine drugs, without the serious side effects. Concerns regarding the adverse effects of kava are only limited to patients with liver disease, those consuming large amounts of alcohol or those concurrently taking prescription medications that can damage the liver. I will regularly test my patients to determine their liver function for those using kava long-term.
DEPRESSION: Over twenty-six double-blind controlled studies of standardized St. John's wort extract for mild and moderate depression show it to be as effective as drug antidepressants with much fewer side effects. It has also been shown to help with anxiety and insomnia. I will occasionally use vitamin B-12 injections with positive results in some patients, and I test blood levels for iron deficiency, as this can also be a factor in depression. There are many other natural substances that help with depression such as 5-HTP, Omega-3 fats, specific amino acids and homeopathy as well as exercise, a healthy diet and mental and emotional support.
RELIEF FROM HOT FLASHES Question: What can I do for hot flashes? Brenda, Vermont There are many treatments for menopausal hot flashes, but none more effective than the standardized herb Black Cohosh, as well as natural bio-identical hormone therapy. Most women taking standardized black cohosh will experience alleviation of hot flashes as well as other uncomfortable menopausal symptoms including insomnia, mood swings, vaginal dryness, fatigue, headaches and night sweats. For women whose symptoms persist, I will often prescribe natural bio-identical hormone therapy. This includes natural progesterone and the natural estrogens estradiol and estriol. When indicated I also prescribe other steroid hormones that decline after menopause such as low-dose testosterone and the adrenal hormone DHEA, both of which contribute to bone density and menopause support. Each prescription is tailored to the patient’s specific requirements and may be adjusted as needed. Other supplements that reduce hot flashes include mixed tocopherols
THYROID & MENOPAUSE Question: I'm exhausted, and I think I might be going through menopause. A natural medicine book suggested that I may have hypothyroidism. Do you have any suggestions? Shelley Z., Rhode Island The symptoms of hypothyroidism and menopause can be overlapping, including the exhaustion you are experiencing, as well as body temperature dysregulation, insomnia, depression, irritability, decreased memory and concentration and vaginal dryness. Since 10% of women going through menopause will also have hypothyroidism it is important for a physician to properly diagnose the cause of your exhaustion. It may also be caused by other issues such as anemia of various sorts (iron, B-12, etc.) or adrenal dysfunction so it's important to have a comprehensive exam including at the very least blood tests for thyroid, iron, ferritin (storage iron), blood counts, blood sugar and electrolytes. I often test adrenal hormones DHEA and cortisol using saliva samples to further pinpoint the source of fatigue. If testing shows hypothyroidism, thyroid supplementation is indicated. Most doctors are still prescribing synthetic thyroid hormones even though they have been shown to be somewhat less effective than natural desiccated thyroid. Also, most only contain T4 and not the important active T3 hormone. If fatigue is more related to menopause then natural treatments that support female hormones and address menopause symptoms may be helpful. The dangers of hormone replacement therapy (HRT) such as synthetic A safer alternative is to use natural or bio-identical hormones if necessary. I may also prescribe other steroid hormones that decline after menopause such as low-dose testosterone and the adrenal hormone DHEA. In addition to natural hormones, I also prescribe natural medicines such as herbs and nutritional supplements that have been scientifically documented to relieve menopausal symptoms, improve thyroid function and increase energy. These include B-12, amino acids, Dong quai, Vitex and others). I adapt treatments to address the individual needs of patients based on mental, emotional and social factors as well as their physical health and symptoms.
MENOPAUSE Question: My doctor told me that while the long-term risk of getting cancer from taking hormones is higher than if I didn't take hormones, the chances are still low. Do you agree? Anonymous, Vermont It is up to each person to decide how much risk they are willing to take for the benefits they would experience with synthetic hormones (HRT). I do want to point out that last year a study published in the Journal of the American Medical Association found that short term (less than 5-year) HRT use was associated with increased breast cancer. I have been reporting in my newsletters since 1998 about the dangers of synthetic HRT, and have successfully treated almost 100% of my patients with menopausal concerns using natural bio-identical hormones and natural medicines from herbs and nutritional supplements. Whether the concerns are related to menopausal symptoms, addressing osteoporosis, preventing heart disease or decreasing risk for cancer, a naturopathic approach is the most prudent and can be the most effective and safest treatment strategy.
About Dr. Kowalsky Dr. Susan B. Kowalsky is a naturopathic physician specializing in cancer and chronic medical conditions. She offers expert solutions integrating the best of alternative and complementary medical care. As a naturopathic doctor she is trained in both conventional medicine and natural therapies, providing her patients with the most holistic, integrative and effective medical care available. MENOPAUSE & WOMEN’S HEALTH Dr. Kowalsky provides comfortable gynecological exams and pap smears. She believes it's important to support a woman with menopausal or other gynecological concerns using safe and natural bio-identical hormones, homeopathy, herbal medicine and nutritional therapies. Her success in treating hot flashes, insomnia, vaginal dryness, memory problems and osteoporosis makes menopause a lot easier for many women. With natural therapies and Dr. Kowalsky's gentle guidance you can make this important time a stepping stone to a meaningful and healthy future! Therapies Include: *Vitamin Therapies
Services Include: *Comprehensive physical exams
The Highest Standard of Care "I provide strong guidance and caring medicine that foster hope and optimal health. My practice is based on a holistic, patient-centered philosophy that emphasizes finding the underlying cause of a patient's medical condition and strengthening overall health as well as providing relief from symptoms. I recommend treatments that work with the inherent healing systems of the body rather than merely suppressing symptoms. I prescribe treatments based on the best scientific evidence available, while also developing a healing and supportive relationship with each patient. I adjust treatments to address the individual needs of each person based on mental, emotional and social factors as well as their physical health and symptoms. Only by really listening can a doctor understand the pieces of the puzzle that make up a patient's health concerns. I believe the highest standard of care can only happen when the doctor is totally dedicated and committed to your health and wellbeing." -- Susan B. Kowalsky, N.D.
COMPREHENSIVE DIAGNOSIS Dr. Kowalsky has built a reputation as a successful “medical detective,” diagnosing persistent, challenging and complex medical cases. With her experience and dedication to uncovering the many factors contributing to health and disease, she has achieved high rates of success helping her patients.
NATUROPATHIC ONCOLOGY Dr. Kowalsky provides a responsible, rational and integrative approach to the treatment of cancer. Naturopathic medicines can help increase longevity, heighten quality of life and reduce the side effects of chemotherapy and radiation while enhancing their effectiveness.
CREDENTIALS Dr. Kowalsky received her undergraduate degree at the University of Wisconsin and earned her doctorate in Naturopathic Medicine from The National College of Naturopathic Medicine. Dr. Kowalsky completed her clinical internship at the Portland Naturopathic Clinic. She completed the Naturopathic Physicians Licensing Examinations through the Oregon Board of Naturopathic Examiners and is a naturopathic physician licensed by the state of Vermont. She is a member of the American Association of Naturopathic Physicians.
WHAT IS A NATUROPATHIC PHYSICIAN? Naturopathic physicians (N.D.s) are general practitioners trained as specialists in natural medicine. They are the only physicians with comprehensive medical training that includes a wide variety of natural therapeutics, such as herbal medicine, nutritional medicine, homeopathy, natural hormones, intravenous supplementation and physical medicine. Naturopathic physicians cooperate with all other branches of medical science, referring patients to other specialists for diagnosis or treatment when necessary. Health and disease come from a complex interaction of physical, emotional, dietary, genetic, and environmental, lifestyle and other factors. Naturopathic physicians treat the whole person, taking all these factors into account. Naturopathic physicians prefer non-invasive treatments which minimize the risks of harmful side-effects. Treatments are tailored to the needs of the individual patient based on a cogent philosophy that acknowledges the patient as participant. Naturopathic medical colleges are four-year postgraduate schools with admission requirements like those of conventional medical schools. Because the coursework in naturopathic theory and natural medicine is added to a standard medical curriculum, naturopathic doctors receive significantly more hours of classroom education than the graduates of leading medical schools, including Yale, Stanford, John Hopkins and Mayo medical schools. Patients are demanding evidence that medical practice be safe and effective. Natural medicine has been demonstrated to be both safe and effective through clinical studies and scientific evaluation. There are over 90,000 medical studies on complementary and alternative medicine, mostly from conventional medicine database resources. In fact, one textbook on naturopathic therapeutics references over 10,000 citations to peer-reviewed scientific literature documenting the efficacy of natural treatments.
To schedule an appointment or to request more information call: (802) 649-1064 16 Beaver Meadow Road Conveniently located near I-91 & I-89
DISCLAIMER: The information contained in the document and website is provided FOR INFORMATIONAL USE ONLY AND MAY NOT BE CONSTRUED, CONSIDERED OR USED IN PLACE OF MEDICAL ADVICE OR INSTRUCTION. No action should be taken based only on this newsletter. Readers should consult a licensed naturopathic physician or medical doctor. The information and editorials in this newsletter are believed to be accurate, but readers who fail to consult with a physician assume the risk of injuries. (C) Copyright 2002 - 2007 Susan B. Kowalsky, N.D. All rights reserved. |