“The 21st century female is almost constantly in motion,” emphasizes Michael Schwartz, president, Michael’s Naturopathic Programs, San Antonio, TX. “Most of the once-daily type supplements in today’s marketplace do not fully take into account the physiologically unique circumstances in a woman’s life, such as pregnancy and menstruation.”
A woman’s biology presents different issues and symptoms throughout her adult life. Here’s how to help provide natural support through the years.
Vaginal Health BalanceIn the opinion of women’s health specialist, lecturer and author Tori Hudson, ND, who serves as director of research and development for Vitanica, based in Portland, OR, bacterial vaginosis (BV) is the most common cause of vaginal imbalance. Second to that is yeast vaginitis. Customers who may be experiencing these for the first time should be aware neither is a sexually transmitted infection. As women enter their postmenopausal years, Dr. Hudson adds, atrophic vulvovaginitis becomes more common. This involves thinning, drying and inflammation of the vaginal walls due to decreased estrogen levels.
“There are many reasons the vaginal environment becomes imbalanced in the microbial makeup; hormone changes — monthly with menstruating women and big shifts with postpartum and menopausal women. Hormonal contraception, semen and vaginal douching all make it more challenging for the vaginal ecology to maintain its normal optimal balance of Lactobacilli and other microbes,” Hudson explains.
“For some women, susceptibility to vaginal yeast infections can be frustrating, especially if they are reoccurring,” emphasizes Cheryl Myers, chief of education and scientific affairs at EuroPharma, Inc., Green Bay, WI. Another issue, vaginal dryness, occurs often when women age and can be problematic.
In this case, she recommends omega-7 from sea buckthorn. This is a rich source of the rare omega-7 fatty acid, as well as other beneficial plant nutrients and essential fatty acids from both the seed and berry of sea buckthorn (Hippophae rhamnoides). “This complete sea buckthorn extract promotes healthy mucosal membranes in the vagina,” Myers says, referring to Europharma’s product, Omega-7. The extract has also been shown to reduce the burning, itching, and dryness of Sjogren’s syndrome, an immune disorder characterized by dry eyes and dry mouth.
A published double-blind, placebo-controlled clinical study found that women taking 3 grams of the patented sea buckthorn berry and seed oil (SBA24) daily had significant improvements in vaginal moisture and the integrity of the mucosal tissue (1). “The researchers considered it the appropriate nutrient for postmenopausal women who can’t use estrogen for excessive vaginal dryness,” Myers explains. “Given this, I think that Omega-7 should be used proactively to avoid the vaginal dryness that tends to increase with age and can be a very serious concern for women experiencing menopause or perimenopause.”
David Winston RH (AHG), founder and president, Herbalist & Alchemist, Washington, NJ recommends his firm’s tincture blend of nutritive and moistening (yin tonics) herbs called Replenish Compound that helps to prevent vaginal dryness. It contains Fresh Milky Oat, which was used by the Eclectic Physicians (1830s-1940s) to enhance sexual performance in women and men. It also has Shatavari, the great Ayurvedic female reproductive tonic.
Shatavari when taken orally, enhances hormonal levels, moistens dry tissue and promotes healthy sexual functioning. Other ingredients include licorice, which helps to re-regulate hormonal levels and dong quai, which promotes pelvic circulation and cornification of vaginal tissue. The last ingredient is white pond lily, an old remedy for atonic, irritated mucous membrane tissue. This combination gently improves the health and normal lubrication of vaginal mucous membranes.
Urinary Tract InfectionsUrinary tract infections (UTIs) affect both the urinary tract and vagina, points out Jay Levy, director of sales, Wakunaga of America Co., Ltd., Mission Viejo, CA. UTIs are the second most common infection diagnosed in women; UTIs affect one in five adult women. A UTI is immediately uncomfortable and painful, and can pose serious risks if left untreated or treated improperly.
A urinary tract infection can develop when pathogenic bacteria (usually E. coli) enters the urethra and travels into the bladder or kidneys; where it may opportunistically colonize in the urethra, bladder or if not stopped, kidneys, and thus cause the symptoms. “If a UTI infection goes untreated it can spread up from the bladder into the kidneys,” warns Levy. “Symptoms of a kidney infection include lower back pain, chills, fever, nausea, and vomiting, along with the previously discussed symptoms of a lower urinary tract infection.”
Sexual intercourse is the most common cause of UTIs in women age 20 to 40. During intercourse, bacteria can be pushed from the rectal area toward the vagina and can then enter the urethra and ascend to the bladder. Careless toilet hygiene, wiping from back to front, can produce the same result.
Also, during pregnancy, women are more prone to develop UTIs that affect the kidneys. The growing baby can put pressure on the bladder, preventing the bladder from completely emptying; hormonal changes during pregnancy can also increase the likelihood of infection. And, many women don’t know it, but allergies to latex used in condoms and some spermicides can be a hidden factor in causing UTIs, Levy notes. Researchers have found that women whose partners use a condom with spermicidal foam also tend to have growth of E. coli bacteria in the vagina.
In addition to E.coli from sex, UTIs in women over age 40 can be attributed to estrogen deficiency.
To support urinary tract health, Levy recommends a probiotic combined with a cranberry extract (Kyo-Dophilus plus Cranberry Extract). Probiotics foster the colonization of beneficial bacteria. Cranberry extract, numerous studies have shown, prevents the E. coli bacteria from adhering to the pili in the urinary tract and multiplying.
Levy explains that preliminary studies evaluated the benefits of cranberry for urinary tract/vaginal health. In the first of the studies, 24 women who suffered recurring UTIs were divided into two groups (2). Women in the first group received doses of antibiotics and cranberry once they developed a UTI; those in the second group received antibiotics alone. The results were impressive. The group taking the cranberry supplement had fewer UTIs than those getting the antibiotic alone and no side effects. A second Czech study went a step further, demonstrating that, on its own, cranberry supplementation significantly lowered the risk of UTIs in frequent sufferers as well as lowering E. coli bacteria counts in those subjects (3).
Los Angeles-based Jarrow Formulas has formulated products to specifically target the vaginal flora. The firm’s Jarro-Dophilus Women Probiotic, for example, says Sky Garmon, marketing associate, contains four clinically documented probiotic Lactobacilli vaginal strains, including H202, that promote optimal vaginal microflora. It also contains Lactobacillus crispatus LbV 88, Lactobacillus jensenii LbV 116, Lactobacillus gasseri LbV 150N, Lactobacillus rhamnosus LbV 96, which “are the prevalent and dominant species of healthy vaginal microbiota. The Lactobacilli species in the supplement acidify the vagina by producing H202 and lactic acid, lowering vaginal pH and together promote normal vaginal flora and a healthy microbial environment. Diminished Lactobacilli, elevated vaginal pH, reduced H202, and antibiotic use can result in recurrent microbial imbalance.”
Jarrow also recommends cranberry extract for urinary tract health, specifically a 25:1 cranberry concentrate containing the organic acids found naturally in fresh cranberries (Cran Clearance); and D-Mannose/Organic Cranberry Powder. D-mannose is a naturally occurring monosaccharide that promotes normal function of the urinary tract by inhibiting certain types of bacteria from adhering to the walls of the urinary tract, and supports the same action as cranberry.
FertilityCreating and expanding a family is often a priority for young women, though stats show that more women are having babies at older ages (mid to late 30s and even 40s). Despite knowing that a healthy diet, exercise and a sound pre-natal vitamin all help the body to create and sustain a pregnancy, many women have some difficulty conceiving.
“With delayed childbearing, infertility has become a significant issue,” says Winston. “The Ayurvedic rejuvenative herb Shatavari (Asparagus racemosus) has a long history of use for enhancing women’s hormonal and reproductive health.”
Schwartz believes a primary issue that delays conception is thoughts — stressors: “’I’m not sure I want to stay in relationship; career may be more important; the house is not big enough; we/I can’t afford another responsibility.’ These are the types of emotional energies that can prevent pregnancies,” he explains.
Of course, retailers are not psychological/relationship counselors, but you are assuredly lifestyle counselors. If women customers turn to you with concerns about their fertility, it is worthwhile to mention that negative thoughts are stressors and can be a factor in delaying conception. You should also recommend that they consult a physician to determine potential physiological reasons.
Poor nutrition may also be to blame. “Certain nutrients are important to overall health during the reproductive cycle and during pregnancy and lactation,” adds Schwartz. A key vitamin for a healthy conception, says Schwartz, is vitamin A. Necessary during both pregnancy and lactation, he maintains, “Since fetal requirements for vitamin A increase maternal needs, a 25% increase over pre-pregnancy intake is advised by many experts.”
Vitamin C needs, Schwartz says, also increase during pregnancy. Post-pregnancy, breast milk also contains vitamin C, which is transferred to the infant. B complex vitamins are needed during pregnancy as blood levels generally decline during pregnancy while fetal levels are generally higher, reflecting active transport through the placenta.
Garmon recommends formulas that incorporate minerals such as calcium, iron, choline, and folate as well as taking omega-3 fatty acids from fish oil to meet a woman’s nutritional needs during pregnancy and lactation.
“When it comes to fertility and prenatal health, it is never too soon or too late to take the utmost care of the baby’s first home; that being mom,” says Trisha Sugarek MacDonald, BS, MS, senior director of research & development/ national educator, Bluebonnet Nutrition Corp., Sugar Land, TX.
Several steps you can advise your customers to take if they want to get pregnant, says MacDonald, include being up-to-date on physical exams, eating a good diet, staying physically active and taking a prenatal multivitamin. It may seem strange to take a prenatal multivitamin before being pregnant, but once conception occurs, zygote/fetal development occurs rapidly, she says. Additionally, prenatal vitamins contain specific nutrients in specific doses to ensure that once conception and implantation in the uterus occur, development is normal and healthy.
Weight gain is another issue and common concern among reasonably healthy and fit women who are actively trying to conceive. “The mother needs to take care of her weight and stay in a safe range, typically 25 to 35 pounds, and continue with light physical activity most days of the week,” MacDonald adds. “In fact, exercise has been shown to help tone muscles that are important throughout pregnancy, especially when a woman is in delivery, making it easier to bring her baby into the world.”
Breast HealthEvents such as Breast Cancer Awareness Month seek to motivate women to have regular mammograms as early detection of cancer is, inarguably, a life saver. Often, mammograms can reveal cysts, fatty deposits that develop in many, but not all, women, says Schwartz, adding that “fat cells are depositories for toxins that enter the body and are not readily expelled.”
Myers notes that breast cancer risk tends to increase with age, and part of the reason for this increase is exposure to environmental toxins that mimic hormones in the body — especially estrogen — as well as the depletion of iodine in our food supply. Not enough iodine is associated with both breast cancer and fibrocystic breast disease.
Today, one in seven American women will develop breast cancer, compared to 30 years ago when iodine was more heavily consumed, and when one in 20 women developed breast cancer. “Scientific tests using estrogen-sensitive breast cancer cells exposed to iodine have shown that they are less likely to grow and spread,” MacDonald says.
While supplements cannot prevent, treat or cure diseases there are breast health formulas that allow at-risk consumers to supplement their lifestyle as an added layer of protection. For example, products that contain curcumin, French grape seed extract, pomegranate seed oil and fruit extract, and vitamin D can be beneficial.
“In the case of breast cancer, there is research [showing] that curcumin inhibits the growth of MCF-7 breast cancer cells,” Myers says. Grape seed oil, according to MacDonald, has been shown to inhibit aromatase, an enzyme that converts androgen into estrogen. Breast tissue typically has higher levels of aromatase. One study, she says, shows that grape seed inhibited aromatase activity and reduced growth in MCF-7 breast cancer cells. Grape seed extract may also inhibit breast cancer cells from connecting to blood vessels, thus depriving them of oxygen and nutrients.
Vitamin D has a role in breast health as well, and several studies have associated vitamin D levels with risk of breast cancer. “Vitamin D3 stops some of the inflammatory factors involved in tumor generation by inhibiting the replication of inflammatory NF-kB, which can lead to increasing tumor risk as well,” MacDonald explains.
Another issue that affects many women, especially women who are menstruating, is painful breast lumps and swelling, known as fibrocystic breasts, Hudson points out. “Of the women who experience this issue, most experience it as a PMS symptom, but some women experience fibrocystic breasts all month long,” she says.
Menstrual/PMS SupportNo matter how healthy a woman’s lifestyle, she is still frequently assaulted by symptoms of her luteal phase — within the two-week post-ovulation also called “pre-menstrual.” The symptoms vary from woman to woman, and even from time to time in the same woman. Younger women who experience nipple tenderness each month may find that after some years that symptom goes away, perhaps replaced by another, such as the appearance of pimples. Collectively, the time and symptoms are known as pre-menstrual syndrome (PMS).
According to Hudson, the most commons PMS symptoms are mood changes (more intense emotion along with mood swings), breast tenderness, water weight retention, bloating, food cravings (salt, sugar, carbs), cramping/low back pain, and requirement for more sleep sometimes coupled with premenstrual insomnia and/or migraines.
“During menses, uterine cramping is very common, often it can be very intense and immobilizing for some women,” she says. “And, while it doesn’t affect a large percentage of women, some women experience heavy menstrual blood loss which can be dangerous if left unchecked.”
For this phase, Hudson recommends chaste tree berry. Otherwise known as Vitex agnus-castus in Latin, the herb was used for centuries on hormone-related gynecologic conditions, in particular PMS symptoms such as cyclical breast discomfort. One prospective double-blind randomized placebo-controlled trial that addressed breast fullness, though not pain, studies 170 women with a diagnosis of PMS who received a standardized extract of chaste berry fruit or placebo for three menstrual cycles. Results showed that those taking the chaste berry experienced a greater than 50% reduction in symptoms. “Five of the six self assessment items indicated significant superiority for agnus castus (irritability, mood alteration, anger, headache, and breast fullness), other symptoms including bloating being unaffected by treatment,” wrote the authors (4).
The herb has even been studied on women experiencing amenorrhea, which means a woman has stopped menstruating. According to the University of Maryland Medical Center, women with amenorrhea often have higher levels of prolactin, a hormone released by the pituitary gland. Chaste tree berry may help the pituitary gland function properly and reduce the levels of prolactin in the body if taken for periods of 12 – 18 months (5). Of course, if suffering from this condition a woman should seek the help of a medical professional first and foremost.
PerimenopausePerimenopause is a time when women realize that years are whizzing right by. Suddenly, a woman finds herself in her late 40s and early 50s — or even younger sometimes — still somewhat trim, with a youthful, spirited and vibrant mindset, but with weird things happening to her regular monthly cycle. It begins to become irregular, and other annoyances spring forth. Insomnia, tossing and turning because of intense sweating, food cravings and an appetite that won’t quit, thinning hair, deepening facial wrinkles, temper and irritability over the slightest things, being forgetful, and sensations of an internal thermostat suddenly turned up to 100 (hot flashes). No, nothing is “wrong,” she isn’t “sick.” But she is definitely off her balance.
Perimenopause is a time when the female body is preparing for cessation of menses, powering down the baby-making machine. This phase can take several years until the very last period occurs, and for many women, it’s a quality of life impediment.
Women customers who are in or who just started peri-menopause will likely want to start with a multivitamin that is targeted to this life phase. “High potency vitamin B complex supports energy, stress management and brain health,” says Marci Clow, MS, RDN, educator, Rainbow Light, Santa Cruz, CA, describing her firm’s menopause-specific product Menopause One Multivitamin. “1,000 IU of vitamin D3 enhance cardiovascular and bone health, and antioxidants including 150 mg of vitamin C and 5,000 IU of vitamin A support skin, eye and immune health.”
The most common perimenopausal symptoms, says Hudson, are irregular, erratic menses combined with hot flashes/night sweats. “The hormones are fluctuating wildly during this time in a woman’s life, no matter what age she experiences this change in her hormonal landscape,” she explains. “Perimenopause could last anywhere from one to several years. And while most perimenopausal women experience hot flashes during this shift going into menopause, not all women do. Other common symptoms include sleep disruptions, irritability, melancholy, anxiety, low libido and vaginal dryness. Some women who have had PMS, now have this worse, in addition to the new perimenopausal symptoms.”
For symptomatic menopause support, Hudson recommends herbs like black cohosh. Levy agrees, recommending a blend of black cohosh root extract, soy isoflavones, wild yam extract, sage, chasteberry, vervain, astragalus, and motherwort (Wakunaga’s Estro-Logic) created by gynecologist Kathleen Fry, MD and medical herbalist Claudia Joy Wingo to support healthy hormone balance in women enduring peri-menopause symptoms.
Black cohosh is an herb featured in many formulas for women, not just for peri menopause balance but also for PMS; it has been shown to significantly lower luteinizing hormone (LH). In this case, black cohosh can reduce intensity of menopausal symptoms including hot flashes, night sweats, and insomnia.
Isoflavones found in soy are significantly more effective than placebo in reducing the frequency and severity of hot flashes, according to numerous studies. For example, offers Levy, one large meta-analysis showed that consuming soy isoflavones for six weeks to 12 months significantly reduced the frequency of hot flashes by more than 20% compared with placebo (6). Soy isoflavones also significantly reduced hot flash severity by more than 26% compared with placebo.
Sage was included in the formula, says Levy, because it is also effective in helping to reduce menopausal symptoms such as hot flashes and night sweating. An eight-week clinical trial showed that the mean number of mild, moderate, severe, and very severe flashes decreased by 46%, 62%, 79%, and 100%, respectively. Brain fade, mood swings, and urogenital issues also decreased significantly by 43%, 47%, and 20% respectively, he reports (7).
Chaste berry appears to act directly on the pituitary gland to inhibit the secretion of follicle stimulating hormone (FSH) and promote LH levels. “Research shows that combining chaste berry with black cohosh for at least three months was particularly effective for safely relieving hot flashes and sleep disturbances in pre- and postmenopausal women,” Levy says.
The formula also contains astragalus, which is an adaptogen (providing balance by reducing overall symptom intensity, and it supports the adrenal glands, lessening stress manifestation). Its wild yam, vervain, and motherwort also may help relieve mild to moderate hot flashes. Further, a few studies have suggested that motherwort reduces anxiety and promotes sleep.
The combination is important says Winston. “Many people think black cohosh is the ‘menopause herb’,” he says. “Sadly this is not really true. While black cohosh offers some benefits for reducing the number and severity of hot flashes, as a standalone herb it is often underwhelming. Perhaps the single most effective herb for hot flashes and night sweats is chaste tree, which works via the pituitary re-regulating FSH and LH levels. The combination of these two herbs is far superior to either by itself.”
Another formula that helps restore balance, from Reserveage of Boca Raton, FL combines resveratrol and dong quai, “to support a youthful cellular structure while calming the body as it copes with changes,” says Niki Simoneaux, vice president of marketing. The product also features a patented genistein (GeniVIDA), an allergen-free form of isoflavone and phytoestrogen that provides relief against menopausal symptoms. In research, genistein helped minimize hot flashes by more than half and helped ease intensity by over a third.
“Chronic issues associated with menopause include hypothyroidism, metabolic syndrome and increased risk of cardiac disease,” says Winston. “While some women easily pass through this transition, many others suffer from disrupted sleep, weight gain, fatigue, hormonal depression, intense hot flashes and profuse perspiration that requires changing their clothes multiple times per day. The difference between the women who have few or no symptoms and severe symptoms, may be in part genetic, but poor diet, nutrient deficiencies, unhealthy lifestyle choices (smoking) lack of exercise, obesity and exposure to xenoestrogens can all worsen perimenopausal symptoms.”
Women in all life phases want to be able to enjoy being physically, mentally, and emotionally fit. Supporting the female reproductive system as well as maintaining vaginal and urinary tract health with the most appropriate dietary supplements and natural remedies will help reassure their sense of well-being.WF
References
- Larmo P, Yang B, Hyssälä J, Kallio H, Erkkola R. Effects of sea buckthorn oil intake on vaginal atrophy in postmenopausal women: A randomized, double-blind, placebo-controlled study. Maturitas (2014), http://dx.doi.org/10.1016/j.maturitas.2014.07.010.
- Hejzlar L, Poduska J. The effect of prophylactic administration of cranberry extract (Swiss Cran-Max 7500mg) on the occurrence of recurring infections of the urinary tract. Unpublished. Available at cranmaxinfo.com
- Stothers L. A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. The Canadian Journal of Urology. 2002;9(3):1558.
- R Schellenberg. “Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study.” BMJ. 322(7279): 134–137. 2001.
- “Amenorrhea.” http://www.umm.edu/health/medical/altmed/condition/amenorrhea, Accessed 8/4/2017.
- Taku K, Melby MK, Cronenberg F, et al. Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials. Menopause. 2012;19(7):776-90.
- Bommer S, Klein P, Suter A. First time proof of sage's tolerability and efficacy in menopausal women with hot flushes. Adv Ther. 2011;28(6):490-500.
