Bioidentical hormones and chinese medicine for women's health
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Transcript of Bioidentical hormones and chinese medicine for women's health
Bio-identical Hormones and
Chinese Medicine
for
Women's Health
Dr. Helen Wai-Ngan Ng Schreiber
Hong Kong 1. Sept. 2012
Contents
• Introduction: Role and image of women, east & west, in changing times
• Biology of Hormones
• Physiology of Female Reproductive System
• Clinical aspects, Women's health issues
• Shanyao and Chinese Medicine for Women's Health
• Our clinical study and case examples
Hormones
• Chemical messengers (sending signals)
• Produced by cells or a “gland”
• Transferred to “target cells“ with “receptors“
• Binding & activation leads to cell-specific responses (cell metabolism). Thus the biochemical structure is decisive!
• Small amounts, big effects on vital functions, also emotional reactions.
Hormone Releasing Glands
Hypothalamus Pituitary Gland ( anterior, posterior)
Thyroid Gland Pancreas
Adrenal Glands Ovaries Testes
List of Human Hormones e.g.:
Insulin
Thyroid hormones (T4, T3)
Sexual hormones (estrogens, progesterone, testosterone )
Adrenalin
Growth Hormone (GH)
Releasing / Stimulating hormones (from pituitary gland and
Hypothalamus) (TRH, TSH, GnRH, FSH, LH)
Vitamin D …... etc.
Hormones, chemical structure, class and subclass
Chemical class: Peptides / Steroids
Subclass: Thyroid hormones/ catacholamines/
androgens ( 19 C)/ estrogens (18 C) / progestins
(21 C)
Hormones within subclass:
Thyroxin T4/ triiodothyronine T3
Estradiol E2 / Estriol E3/ Estrone E1
Progesterone
Aus Wikipedia die freie Enzyklopädie©
Cholesterin
Release & Feedback Mechanisms
TRH (Thyrotropin releasing hormone)
TSH (Thyroid stimulating hormone)
T4 (Thyroxin), T3 (triiodothyronine)
*******
GnRH (Gonadotropin releasing hormone)
FSH (Follicle stimulating hormone)
Estradiol (E2)
LH (Luteinizing hormone)
Progesterone
The Female Cycle
„The only constant feature
of the female cycle is
CHANGE.“
(author unknown)
quoted from „Natürliche Hormontherapie“
Eisprung(ab 8., ideal 12. – 15. Tag)
day 1 - 14 Estrogendominance Ovulation day 15-28 Progesteronedominance
1. 14. 15. 28.
28 - Day Cycle
©23.6.2012 J.Armbruster
Estrogen – the hormone of beauty
• Estradiol (E2) – strongly effects growth
Estriol (E3) – Effects on mucous membranes and bladder
• Estrone (E1) – the storage Estrogen
Estrogen (s)
• Sexual hormonse specific for the female, produced mainly in the ovaries
• 3 in this subclass are especially important: E1 Estrone, E2 Estradiol, E3 Estriol
• Effect the growth & development of the femal body
• Responsible for the healthy state of the female reproductive organs and also of the bones, blood vessels, urinary tract…
• Loosen connective tissues, effect water retention, und fat accumulation in cells, increase blood clotting
Progesterone - “Hormone of wisdom”
Calls for maturity
Progesterone
• Sexually neutral. Produced mainly in the “yellow body” (corpus luteum) of women & in the placenta during pregnancy. „pro gestra“ = supporting gestation (pregnancy)
• Precursor for Cortisol, Testosteron & the estrogens. Complementary & balancing factor of estrogen and terstosterone
• 20% of receptors in the brain, important for emotional balance, improves concentration, memory and sleep
• Heart and blood vessels, bones, skin and connective tissues. Supports the thyroid gland
• Increases energy metabolism, excretion of connective tissue fluids, regulates blood pressure and blood clotting
Aus Wikipedia die freie Enzyklopädie©
Cholesterin
Commonly used “false hormones”
• “false estrogens” ( derivatives)
• Ethinyl estradiol
• Estradiol valerate
• “false progesterone” (a progestine)
• Medroxyprogesteron acetate
• Dienogest
• Levonorgestrel
Medroxyprogesteronacetat (pregn-4-ene-3,20-dione,17-(acetyloxy)-6-methyl-,(6 Alpha)-
=synthetisch verändertes nicht bio-identisches „Progesteron“
Progesteron (pregn-4-ene-3,20-dione)
natürliches, bio-identisches Gelbkörperhormon des Menschen
Künstliches Pseudohormon In der Natur nicht vorkommendes „ Gestagen“
Natürliches Progestational
steroidal Ketone des
Menschen
©23.6.2012 J.Armbruster
Norgestrel Megestrolacetat Norethindronacetat
Artificial C-21/ C 19 Gestagene / Progestine
Human Progesterone
More Progestines: Medroxyprogesteronacetat Lynestrenol Norethynodrel Norethisteron
Nach John Lee, M.D. und Wikipedia
Chemical substances simulating effects of hormones
• The „Anti-Baby Pill“ (contraceptive pill)
• Valette - Ethinylestradiol 0,03 mg.
Dienogest 2 mg
• Belara - Ethinylestradiol 0,03 mg
Chlormadinon acetat 2 mg
• Yasminelle – Ethinylestradiol 0.02 mg
Drospirenon 3 mg
Preparations with „false Hormones“
• The „Hormonring“
• Mirena -
Levonorgestrel 0,52 mg ( 0,02 mg/ Tag)
• Nuvaring –
Ethinyestradiol 2,7 mg (0,015 mg / Tag)
Etonogetrel 11,7 mg (0,12 mg / Tag)
Visanne 2 mg – Dienogest 2 mg
Substances used in „HRT“
- Progestines (e.g. Provera) + CEE (conjugated equine estrogens)
- Premarin = pregnant mares urin (CEE) (Presomin)
- pills, injections, suppositories, subdermal implants, skin patches, gels
- dosages, systemic / lokal effects, side effects, constant/ cyclical level of hormones in blood
- oral intake estrogens: increased risk of thrombosis, especially ethinyl estradiol (pill)
Bioidentical Hormones
• Biochemical structures are identical with our own hormones in the body
• When applied properly – gentle and without side effects
• Over 70 years of experience: (Dr. K. Dalton, Dr. John Lee, Dr Michael Platt, Dr. V. Rimkus, Frau Dr. A. Scheuernstuhl), no known side effects
• from Diosgenin, extracted from the roots of the mexican wild yams (Dioscorea villosa)
7 Decades in the life of a Woman
Childhood
Puberty
Young womanhood
Middle age
Old age
Senile
Developments and Roles of the Female
• 经 jing Menstruation
• 孕yun Pregnancy
• 产chan Birth
• 育 yu Nursing, education
Disturbances of Menstruation
• Onset of puberty – early/ late? Amenorrhea
• Irregular cycles – too short, too long
• Irregular bleeding – too little, too much
• Premenstrual Syndrom (PMS) – lower abdomenal pains, tension in the breast, mood changes (Estrogen dominance)
• Related problem of puberty: acne
Effects of the contraceptive Pill
2 components: an estrogen derivative (e.g. ethinyl estradiol, estradiol valerate), a progestine
The two hormone like chemicals turn off the production of FSH and LH through the feedback mechanism on the pituitary gland – no ovulation! (purpose of contraception)
Thus no „Yellow body“ & no production of progesterone. Consequences of Progesterone deficiency
They simulate the effects of estradiol and progesterone on the uterus, giving rise to an artificial menstrual bleeding
Amenorrhea, Infertility
• Delayed maturity
• Consequence of the pill
. Psychic and emotional Stress
• Thyroid function deficiency
• Other chronic illnesses
• TCM: Kidney deficiency, cold
Disturbances of Pregnancy
Pregnancy sickness (Progesterone
Habitual Abortion Deficiency)
Water retention
Excessive weight gain
Increased blood pressure
Gestational diabetes
Postnatal depression
Other gynaecological problems
Ovarian Cysts (PCOS) (Estrogen-
Uterine Myoma dominance)
Prolapse (Stress incontinence)
Tumor (* breast cancer, ovarian Ca)
Climacterium / Menopause
• A natural stage of life
• Decrease of important hormones of the body
• Symptomes, perception, feelings, attitudes
• „ Women in middle age should not be sad – also in history there came after the Middle Ages the New Age !“
• Indications for treatment
Symptoms of hormonal imbalance
Mood changes, depressive, irritable, loss of interest and joy
General feelings of unwell, undue tiredness, not coping with life
Sleep disturbances, insomnia
Hot flushes, excessive sweating, night sweats
Oedema, generalised swelling
Headaches, generalised muscle and join pains
Nervous anxiety, panic attacks, heart complaints
Hormone Replacement Therapy (HRT)
- Treatment of surgically, peri- and post- menopausal women, for discomfort caused by diminished circulating estrogen and progesterone hormones
- Mixtures of conjugated equine estrogens (CEE) and progestins vs. “unopposed estrogen therapy”
- Via patches, tablets, creams, troches, IUDs, vaginal rings, gels or injections
- “sequentially” vs. “continuous” combined HRT
- Side effects: Headache, weight changes, fluid retention, changes in menstrual flow
Women's Health Initiative (WHI)
- Initiated by the US NIH in 1991
- Study effects of HRT: CEE + Progestin,
CEE only (women after hysterectomy)
- Findings: subjects had a greater incidence of coronary heart disease, breast cancer, stroke, pulm. Embolism
- Trial was ended in 2002
Bioidentical Hormones
• Biochemical structures are identical with our own hormones in the body
• When applied properly – gentle and without side effects
• Over 70 years of experience: (UK: Dr. K. Dalton, USA: Dr. John Lee, Dr Michael Platt, Germany: Dr. V. Rimkus, Dr. A. Scheuernstuhl), no known side effects
• from Diosgenin, extracted from the roots of the mexican wild yams (Dioscorea villosa)
Bioidentical Hormones
Extraction from Mexican Yams roots: Diosgenin
Further process in lab to give Progesterone
Further process in lab from Progesterone to other hormones e.g. estradiol
Dispensed according to individual prescription by „compound pharmacies“
Available as cremes, gels, capsules, troches (sublingual, oral, transdermal application)
Bioidentical Hormone Replacement Therapy (BHRT)
Examples:
Progesterone cream 3%, 5%, 10%
Progesterone capsules 50 mg. ( 1 – 2 / day)
Estradiol capsules 0.1 mg., 0.2 mg. (1 – 2 /day)
DHEA capsules 5 mg., 6 mg. (1 / day)
Testosteron cream 1%, 5 %, 10 %
Yang Yin
Man Woman
Physiological Characteristics
以 血 为 本 Xue (Blood ) is the basis
以 血 为 用 Xue is consumed
阴 常 不 足 Yin is often not enough
阳 常 有 余 Yang is often in (relative) excess
TCM Diagnosis 中医辨症
八钢
Yin 阴 / Yang 阳
internal 里 / external 表
cold 寒 / warm 热
deficiency虚 / fullness 实
中医辨症
• 脏腑: 脾 (三阴交, 血海, 阴陵泉)
• 肾 (太溪, 照海)
• 肝 (太冲)
• 卫,气,营,血: 气 血
• 经络: 任脉 (关元, 气海)
• 冲脉
women’s health problems, TCM
coldness ! 寒
younger women:
• Qi deficiency (spleen, kidney) 气虚
• Qi Stagnation ( Liver Qi) (PMS) 肝气郁
• elderly women:
• Xue (Blood) deficiency血虚
• Xue Stagnation 血滞
• Yin deficiency ( Liver, kidney) 阴虚
辨症论治
• 驱寒 温阳 (艾灸, 付子, 肉桂)
• 健脾 滋阴 (淮山药, 熟地, 杞子)
• 补血 活血 (当归, 川芎)
• 疏肝 解郁 (白芍药, 玟瑰花)
Treatment with TCM
四 物汤 (Si Wu Tang, Dekot der 4 Bestandteile)
1) Dang gui (Angelika sinensis) 当归
2) Chuan xiong (Ligustici chuanxiong) 川芎
3) Shu di huang (Rehmanniae prep.) 熟地黄
4) Bai shao (Paeonia alba) 白芍药
18.08.12 Dres. Helen Wai-Ngan und Michael Schreiber, Aystetten 2004 ©
71
Angelicae sinensis radix
Xue erhaltend und ergänzend. Warm. Emporhebend. Leber Milz Herz Unterer Erwärmer
• Chuanxiong (Xue
bewegendes Mittel)
• Shudihuang (Yin stützendes Mittel)
18.08.12 Dres. Helen Wai-Ngan und Michael Schreiber, Aystetten 2004 ©
74
Paeoniae lactiflorae radix
Xue erhaltend und ergänzend. Neutral / Kalt, absenkend. Leber (Qi Stagnation lösend), Milz Die Tiefe, Unterer Erwärmer
TCM Treatment principles
Effects of the 4 components of Si Wu Tang:
1) Nourish Xue 补血
(also nourish Qi , Ma36 足三里, Ma30气冲, Le3太冲, MP6 三阴交, Bl17, Bl18….)
2) Activate Xue (Xue Stase lösen) 活血
MP10 血海, MP1 隐白
3) Nourish (kidney & liver)Yin 滋(肾肝)阴
KG3关气, KG4气海, (Moxa), Ni7 复留
4) remove Liver Qi Stagnation解(肝气)郁
Gb足临 泣41, Gb34阳陵泉, KS6内关, Xi Punkte
18.08.12 Dres. Helen Wai-Ngan und Michael Schreiber, Aystetten 2004 ©
78
Rosae flos
besänftigt die Leber, löst Stagnation
• Dioscoreae Rhizoma (Shanyao) (Yamswurzel)
Yin und Qi stützendes Mittel
BHRT / TCM comparison
• Bioidentical Hormontherapy
= Replacement therapy (passive)
填补性治疗
Chinese Medicine (herbal teas, Acupuncture,
• Dietetics) = Regulatory therapy (active)
调理性治疗
Our clinical Study 2012
About 90 patients, 70 + women, 10 men, 8 children
Hormone profile of 3 groups: thyroid hormones, sexual hormones (estrogens, progesterone, testosterone), Insulin, DHEA, cortisol, Andrenalin (blood sample on 21. day of cycle)
Most common problems: Overweight, gynaecological symptoms, depressive moods, exhaustion, palpitations, insomnia
Findings: low Progesterone levels, Estrogen dominance, Insulin resistance
Treatment: BHRT, Progesterone good for moods, PMS, estrogen good for hot flushes, sweating, balance is important, Thyroid function also
Case example 1 (A.G.)
23 f, Student (Sport)
Aug. 11: Mood changes, depressive, irritable; hot flusches,
excessive sweating, since about 2 months
has the „Nova Ring“ recently, the pill since few years, saliva
test: low progesterone, high testosterone
No more such symptoms after removal of the ring
But, amenorrhea still after 1 year
Recent blood test: low T4
Treatment: Thyroxin 50 mcg.
Case Example 2 (D.R.)
- 50 f., owner of Fitness Studio
- Hysterectomie 12 years ago because of heavy menstrual bleeding,
Myoma
- 2 y. later, hot flushes, sleep disturbance, depressive to aggressive mood
changes, hair loss, weight gain (in spite of sport)
- prescribed different estrogen preparations and pill, T4 75mcg., still
severe depression 2005, weight gain ++
- 2011: discovered the literature about bioidentical hormones, importance
of progesterone
- started treating herself with progesterone creme, stopped estradiol, T4 +
T3, Testosterone cream for stress incontinence. Weight loss.
Thank you
For your Attention!