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Holistic_Approach_to_Menopause_and_PMS

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					Alternative and Integrative Approaches to the Woman with Dysmenorrhea, PMS, or Menopause
Victor S. Sierpina, MD Associate Professor Family Medicine UTMB

Alternative
• Source

• Non-conventional
• Professional training limited

Other Terms You May Have Heard
• • • • • Complementary Holistic/Wholistic Traditional/Non-traditional Natural Whole Person care

Integrative
• Combining best of conventional/nonconventional therapies • Patient Centered • Self-responsibility/wellness • Lifestyle as a central concept

Who are these people?
• 40-50% of US adult population use alternative therapies (JAMA 11/11/98Eisenberg) • Educated/informed • History of transformational experience(JAMA 5/20/98-Astin) • Mind-body-spirit /Internal locus of control

How do they use these therapies?
• Greatest areas of growth are in use of herbs, vitamins, support groups, selfhealing, folk remedies, massage, energy healing • Chronic conditions • Use alternative AND conventional therapies but may not discuss with physician

What do I need to know and do?
• A • B • C • D • E’s of Integrative care

ASK

(Don’t Tell)

BE

Willing to Listen

COMMUNICATE COLLABORATE

DIAGNOSE

EXPLORE

Patient and Provider Preferences and Options

The Naturopathic Approach
• • • • • Lifestyle Diet Supplements Botanicals Non-pharmacological methods

Other Alternatives
• Mind Body
– Biofeedback – Imagery – Hypnosis

• Exercise • Acupuncture/Traditional Chinese Medicine, Ayurveda, homeopathy • Natural hormones

The Least You Need to Know
• Supplements, herbs, diet, other methods can help in these conditions • Conventional therapy should not be abandoned • Encourage the patient’s cooperation and understanding • Some of this stuff will seem strange at first

Cultural variability
• Some cultures do not experience these conditions in the same way we do • Society’s roles and expectations of women, aging adults • Celebration of cyclicity of women’s life, respect for aging • Are rhythms of womanhood a disease or condition that need medical treatment?

DYSMENORRHEA and PMS

25 year old Maria Rodriguez
• Bloating,swelling of hands, feet • Breast tenderness • Abdominal and back discomfort • Mood changes • Painful periods

BASICS
• • • • Rule out hypothyroidism/depression Stress management Meditation, relaxation Exercise

Dietary Changes
• Plant-based foods • Soy • Reduce
– caffeine – chocolate – sugar – sodium – fat

Supplements
• Magnesium 500 mg/d • Vitamin B6 100 mg/d
• • • • Vitamin E 400 IU/d Calcium 1000 mg/d Zinc 30-45mg/d Essential Fatty Acids (EPO, GLA)??

Botanicals
• Angelica sinensis (Dong quai) 1-2 g tid • Glycyrrhiza glabra (Licorice) 250-500 mg tid • Cimcifuga racemosa (Black cohosh) 4mg bid (27-deoxyacteine)-40mg/d • Vitex agnus-castus (Chaste berry) 175225 mg/d

MENOPAUSE

49 y/o Rene Porter
• • • • Hot flashes Mood swings Dyspareunia Family history of breast cancer, heart disease, and osteoporosis • Prefers “natural” approach

Basics
• • • • • Regular exercise Social support Meditation, relaxation, sleep Quit smoking/alcohol Dietary phytoestrogens
– Soy – Celery, fennel, parsley – Nuts, seeds – Flaxseed

Supplements
• • • • • Vitamin E 400-800 IU/d Bioflavonoids 900 mg/d (Hesperidin) Vitamin C 1200 mg/d Gamma-oryzanol 300 mg/d Calcium 1500 mg/d

Botanicals
• Angelica sinensis (Dong quai) 1-2 g tid • Glycyrrhiza glabra (Licorice) 1-2 g tid • Cimcifuga racemosa (Black cohosh) 1-2 g tid; 2 mg bid (27-deoxyacteine) • Vitex agnus-castus (Chaste berry)1-2 g tid • Ginkgo biloba 40 mg tid • Ginseng 500-1000 mg/d

Natural Hormones
• May be synthetic but match molecular structure of human hormones • Estrone (Ortho-Est) • Estradiol (Estrace, Estraderm, Climera) • Natural Progesterone Creams (ProGest, Fem-Gest, Progonol) • DHEA • Testosterone

References
• Northrup, C Women’s Bodies, Women’s Wisdom. Bantam, 1994. • Pizzorno N, Murray M. Textbook of Natural Medicine. Churchill Livingstone, 1999 • Murray M. Encyclopedia of Natural Medicine. Prima, 1998

References
• PDR for Herbal Medicines. Medical Economics, 1998 • Spencer JW, Jacobs, JJ. Complementary/Alternative Medicine-An Evidence-Based Approach. Mosby, 1999 • Herbal Gram, American Botanical Council, www.herbalgram.org

UTMB’s Alternative and Integrative Health Care Program Website
http://atc.utmb.edu/altmed


				
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