Bioidentical hormones and chinese medicine for women's health

85
Bio-identical Hormones and Chinese Medicine for Women's Health Dr. Helen Wai-Ngan Ng Schreiber Hong Kong 1. Sept. 2012

description

Ein Vortrag in Hongkong Sept. 2012

Transcript of Bioidentical hormones and chinese medicine for women's health

Page 1: 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

Page 2: Bioidentical hormones and  chinese medicine for women's health

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

Page 3: Bioidentical hormones and  chinese medicine for women's health

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.

Page 4: Bioidentical hormones and  chinese medicine for women's health

Hormone Releasing Glands

Hypothalamus Pituitary Gland ( anterior, posterior)

Thyroid Gland Pancreas

Adrenal Glands Ovaries Testes

Page 5: Bioidentical hormones and  chinese medicine for women's health
Page 6: Bioidentical hormones and  chinese medicine for women's health

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.

Page 7: Bioidentical hormones and  chinese medicine for women's health

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

Page 8: Bioidentical hormones and  chinese medicine for women's health
Page 9: Bioidentical hormones and  chinese medicine for women's health

Aus Wikipedia die freie Enzyklopädie©

Cholesterin

Page 10: Bioidentical hormones and  chinese medicine for women's health

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

Page 11: Bioidentical hormones and  chinese medicine for women's health
Page 12: Bioidentical hormones and  chinese medicine for women's health
Page 13: Bioidentical hormones and  chinese medicine for women's health

The Female Cycle

„The only constant feature

of the female cycle is

CHANGE.“

(author unknown)

quoted from „Natürliche Hormontherapie“

Page 14: Bioidentical hormones and  chinese medicine for women's health

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

Page 15: Bioidentical hormones and  chinese medicine for women's health
Page 16: Bioidentical hormones and  chinese medicine for women's health
Page 17: Bioidentical hormones and  chinese medicine for women's health
Page 18: Bioidentical hormones and  chinese medicine for women's health
Page 19: Bioidentical hormones and  chinese medicine for women's health
Page 20: Bioidentical hormones and  chinese medicine for women's health
Page 21: Bioidentical hormones and  chinese medicine for women's health
Page 22: Bioidentical hormones and  chinese medicine for women's health
Page 23: Bioidentical hormones and  chinese medicine for women's health

Estrogen – the hormone of beauty

• Estradiol (E2) – strongly effects growth

Estriol (E3) – Effects on mucous membranes and bladder

• Estrone (E1) – the storage Estrogen

Page 24: Bioidentical hormones and  chinese medicine for women's health

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

Page 25: Bioidentical hormones and  chinese medicine for women's health
Page 26: Bioidentical hormones and  chinese medicine for women's health

Progesterone - “Hormone of wisdom”

Calls for maturity

Page 27: Bioidentical hormones and  chinese medicine for women's health

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

Page 28: Bioidentical hormones and  chinese medicine for women's health
Page 29: Bioidentical hormones and  chinese medicine for women's health

Aus Wikipedia die freie Enzyklopädie©

Cholesterin

Page 30: Bioidentical hormones and  chinese medicine for women's health
Page 31: Bioidentical hormones and  chinese medicine for women's health

Commonly used “false hormones”

• “false estrogens” ( derivatives)

• Ethinyl estradiol

• Estradiol valerate

• “false progesterone” (a progestine)

• Medroxyprogesteron acetate

• Dienogest

• Levonorgestrel

Page 32: Bioidentical hormones and  chinese medicine for women's health
Page 33: Bioidentical hormones and  chinese medicine for women's health

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

Page 34: Bioidentical hormones and  chinese medicine for women's health

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

Page 35: Bioidentical hormones and  chinese medicine for women's health

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

Page 36: Bioidentical hormones and  chinese medicine for women's health

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

Page 37: Bioidentical hormones and  chinese medicine for women's health

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)

Page 38: Bioidentical hormones and  chinese medicine for women's health

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)

Page 39: Bioidentical hormones and  chinese medicine for women's health
Page 40: Bioidentical hormones and  chinese medicine for women's health
Page 41: Bioidentical hormones and  chinese medicine for women's health
Page 42: Bioidentical hormones and  chinese medicine for women's health

7 Decades in the life of a Woman

Childhood

Puberty

Young womanhood

Middle age

Old age

Senile

Page 43: Bioidentical hormones and  chinese medicine for women's health

Developments and Roles of the Female

• 经 jing Menstruation

• 孕yun Pregnancy

• 产chan Birth

• 育 yu Nursing, education

Page 44: Bioidentical hormones and  chinese medicine for women's health

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

Page 45: Bioidentical hormones and  chinese medicine for women's health

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

Page 46: Bioidentical hormones and  chinese medicine for women's health
Page 47: Bioidentical hormones and  chinese medicine for women's health

Amenorrhea, Infertility

• Delayed maturity

• Consequence of the pill

. Psychic and emotional Stress

• Thyroid function deficiency

• Other chronic illnesses

• TCM: Kidney deficiency, cold

Page 48: Bioidentical hormones and  chinese medicine for women's health

Disturbances of Pregnancy

Pregnancy sickness (Progesterone

Habitual Abortion Deficiency)

Water retention

Excessive weight gain

Increased blood pressure

Gestational diabetes

Postnatal depression

Page 49: Bioidentical hormones and  chinese medicine for women's health

Other gynaecological problems

Ovarian Cysts (PCOS) (Estrogen-

Uterine Myoma dominance)

Prolapse (Stress incontinence)

Tumor (* breast cancer, ovarian Ca)

Page 50: Bioidentical hormones and  chinese medicine for women's health

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

Page 51: Bioidentical hormones and  chinese medicine for women's health

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

Page 52: Bioidentical hormones and  chinese medicine for women's health

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

Page 53: Bioidentical hormones and  chinese medicine for women's health

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

Page 54: Bioidentical hormones and  chinese medicine for women's health

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)

Page 55: Bioidentical hormones and  chinese medicine for women's health
Page 56: Bioidentical hormones and  chinese medicine for women's health
Page 57: Bioidentical hormones and  chinese medicine for women's health
Page 58: Bioidentical hormones and  chinese medicine for women's health

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)

Page 59: Bioidentical hormones and  chinese medicine for women's health

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 %

Page 60: Bioidentical hormones and  chinese medicine for women's health
Page 61: Bioidentical hormones and  chinese medicine for women's health

Yang Yin

Man Woman

Page 62: Bioidentical hormones and  chinese medicine for women's health
Page 63: Bioidentical hormones and  chinese medicine for women's health
Page 64: Bioidentical hormones and  chinese medicine for women's health

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

Page 65: Bioidentical hormones and  chinese medicine for women's health
Page 66: Bioidentical hormones and  chinese medicine for women's health

TCM Diagnosis 中医辨症

八钢

Yin 阴 / Yang 阳

internal 里 / external 表

cold 寒 / warm 热

deficiency虚 / fullness 实

Page 67: Bioidentical hormones and  chinese medicine for women's health

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

Page 68: Bioidentical hormones and  chinese medicine for women's health

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

Page 69: Bioidentical hormones and  chinese medicine for women's health

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)

Page 70: Bioidentical hormones and  chinese medicine for women's health

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

Page 71: Bioidentical hormones and  chinese medicine for women's health

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

Page 72: Bioidentical hormones and  chinese medicine for women's health

• Chuanxiong (Xue

bewegendes Mittel)

Page 73: Bioidentical hormones and  chinese medicine for women's health

• Shudihuang (Yin stützendes Mittel)

Page 74: Bioidentical hormones and  chinese medicine for women's health

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

Page 75: Bioidentical hormones and  chinese medicine for women's health

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

Page 76: Bioidentical hormones and  chinese medicine for women's health
Page 77: Bioidentical hormones and  chinese medicine for women's health
Page 78: Bioidentical hormones and  chinese medicine for women's health

18.08.12 Dres. Helen Wai-Ngan und Michael Schreiber, Aystetten 2004 ©

78

Rosae flos

besänftigt die Leber, löst Stagnation

Page 79: Bioidentical hormones and  chinese medicine for women's health

• Dioscoreae Rhizoma (Shanyao) (Yamswurzel)

Yin und Qi stützendes Mittel

Page 80: Bioidentical hormones and  chinese medicine for women's health
Page 81: Bioidentical hormones and  chinese medicine for women's health

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

Page 82: Bioidentical hormones and  chinese medicine for women's health

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

Page 83: Bioidentical hormones and  chinese medicine for women's health

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.

Page 84: Bioidentical hormones and  chinese medicine for women's health

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.

Page 85: Bioidentical hormones and  chinese medicine for women's health

Thank you

For your Attention!