Frequently asked questions

Townsend Letter for Doctors and Patients, Jan, 2005 by Tori Hudson

Question: Is it safe to take black cohosh, red clover, soy and my ERT, Estrace .5 mg daily?

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Answer: I'm so glad you wrote in with this question because it is a perfect example of how to combine conventional treatment with natural medicine. This integrative medicine approach that you have come up with on your own is not only safe, but in my opinion, is preferred over increasing your Estrace dose to 1 mg. Guidelines from the North American Menopause Society now currently recommends taking the lowest dose of estrogen possible for the shortest amount of time possible. You are doing that by keeping your estrogen dose low and adding the herbs for additional support to relieve symptoms. Some physicians might raise the question that we do not have any scientific evidence on the combined use of herbs for menopause plus estrogen replacement therapy at the same time. That is true. However, there is no indication from any source that this could pose any problem.

Question: I have very heavy periods and have been treated with a high dose progestin and a dilation and curettage (D and C). There were no fibroids or cancerous cells and no mass. I now have heavy bleeding again and my Dr. believes I have adenomyosis and tells me the only way to verify the diagnosis is to remove the uterus. Can you comment on this?

Answer: It's true that the most definitive way to diagnose adenomyosis is a hysterectomy. Some women have a myomectomy for uterine fibroids and then adenomyosis is also noted on the pathology report for the uterine tissue that is removed. However, an MRI is now able to diagnose adenomyosis much of the time. It may be possible to miss it, but in the hands of an excellent radiologist reading the film, this is your best non-surgical option for diagnosis. As you have experienced, adenomyosis can be difficult to treat so from a surgeon's perspective, the hysterectomy gets you both the treatment and the diagnosis. I have treated several cases over the years now and have been able to successfully manage most but not all cases. The success comes with managing the bleeding better, while not necessarily curing the disease. For a woman in her 40s, if the bleeding comes under better control, then she can usually hold on until she reaches menopause. It may be that a regimen of progesterone, herbs for hemorrhage, vitamin A, bioflavonoids and vitamin C could reduce your bleeding. I would encourage you to look for a licensed naturopathic physician in your area along with an acupuncturist who also uses Chinese Herbs.

Question: I've had recurring bladder infections for 3 years that has been successfully treated in the last year with a topical Premarin cream to the external genital area. I'm concerned about synthetic estrogen and was wondering if there is anything else I could take to prevent those infections.

Answer: Topical estrogen to the genital area is a very good use of estrogen for women with atrophic tissue and recurring bladder infections as well as those menopausal women with recurring vaginal infections. I typically use estriol cream or estradiol cream rather than the Premarin cream. Even your conventional doctor is familiar with estradiol cream called Estrace cream. I use compounded estriol cream from a compounding pharmacy. Estradiol and estriol are plant derived and are called natural estrogens because they are biochemically identical to the body's estrogen. Keep in mind though that these are hormones, not herbs. I say this not because I think they are bad, just that I want you to know that. Since you already tried cranberry, I'm not going to recommend that. It might be that with cranberry plus oral lactobacillus acidophilus capsules plus the Estrace cream or Estriol cream 2-3 times per week you may end up being able to reduce your frequency of infections. The proper amount of lactobacillus species in the vagina not only helps to prevent vaginal infections but also bladder infections. It is also important to know that when you use estrogen cream topically without any progesterone, you should not use it more than 2 or 3 times per week. You will want to let your doctor know if you have any bleeding after not having had menses for 6 months. Don't be afraid of topical estrogen. The concerns that you have and have read about hormones essentially do not apply to this very low dose used in the genital area. In addition, very very little of it is absorbed systemically. Vaginal and/or vulvar estrogen treatment for recurring vaginitis, itching or bladder infections due to a lack of estrogen is one of those situations where estrogen creams are a great treatment for women. There is no good herbal substitute. It is safe and very effective. Give your doctor a call and ask for Estrace cream at least then you know you are using a natural hormone versus the Premarin cream.

Question: I have suffered from vaginal yeast infections on and off for a number of years due to a medical misdiagnosis and a long course of antibiotics. I am an unemployed college student; can you tell me an inexpensive solution to my Candida without the radical diet approach so I can banish this beast from my life forever?