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The current approach to women's hormonal conditions in conventional medicine can sometimes be limited by the use of synthetic hormones or hysterectomies to alleviate common hormonal conditions such as fibroids, endometriosis and post-menopausal bleeding.[1,2] Some alternative therapists also use herbal remedies with the same limitations when their treatment is focused on substituting hormonally active herbs like Cimicifuga racemosa (black cohosh), Trifolium pratense (red clover), and Angelica sinensis (dong quai) for synthetic hormones to stabilize or compete with the imbalance of women's hormones. Both of these approaches have a potential to cause women to experience complications of symptoms when hormones are treated as an entity of their own, without the wider understanding of the endocrine system becoming part of the treatment plan. Where hormone imbalance exists, and no malignancies detected on investigation, it is more advantageous for women to bring an integral balance to the endocrine system, to see if symptoms can be reduced, before the common practices of prescribing synthetic hormones or hysterectomy are attempted.[3]

With a more complete understanding of the workings of the endocrine system, it becomes clear that many common hormonal conditions are not solely imbalances of one hormone or one gland, but more of a complex interaction that stretches wider than even the endocrine system itself. The endocrine system is comprised of a number of distinct glands, all widely spread out throughout the body, all unique in function, and yet all intrinsically linked in communication by their hormones. It consists of the pituitary gland and the pineal gland in the brain, the thyroid gland in the neck, the thymus gland in the chest, the pancreas gland in the abdomen, the ovaries/testes in the pelvic cavity, and the adrenal glands in the mid back; all regulated by the hypothalamus in the brain. Each gland produces hormones which are released into the blood stream, where they circulate and become signals for a specific task at distant tissue or organs that help maintain body processes. In this way, hormones become the modulators of the endocrine system, generating activity and change when their levels are high in the blood stream, and becoming inhibitors, slowing down glandular processes, when their levels are low. The fluctuations this generates facilitates the cycles and rhythms of women's lives and some of the most important processes of the body - those having to do with reproduction, immunity, metabolism, digestion and growth and development.[4,5]

All these internal activities require a consistent level of functioning for health to be maintained, a process referred to as homeostasis. It is the role of the endocrine system and its hormones to ensure that these bodily processes are maintained, no matter how negatively influenced they could be by the excessive changes caused by women's external life experiences. To perform such a task the endocrine system collaborates with the nervous system where all external stimuli are initially perceived through the senses or emotions. The intensity and level of what women see, hear and feel in their everyday lives, may at times necessitate changes to be made to their hormones so that their internal body processes are maintained. Very often it is just these changes where the origins of some hormonal conditions can be found.[6]

Of interest then, is the point at which the endocrine system and the nervous system interact - the hypothalamus, an organ which functions as both a gland of the endocrine system and as a part of the brain and central nervous system. It is through the hypothalamus that impulses from the nervous system interact and influence hormones and glands of the endocrine system, changing women's chemistry and hormonal balance. Through the hypothalamus, the workings of the limbic brain which controls emotions, and the autonomic nervous system which influences unconscious processes and the stress response, get translated into hormonal changes through the discharge of releasing hormones that have far reaching affects on women's physical and emotional health and wellbeing.[7]

The significance of this important relationship can be seen in the types of symptoms that women present with in consultation. Rarely do they come in with just one symptom like irregular bleeding, tender breasts, lower back pain, or migraine; but very often these symptoms are associated with mental and emotional complaints such as depression, moodiness, apathy, irritability, change in appetite and loss of concentration. This variety of hormonal symptoms often causes confusion in diagnosis and treatment, as the origins of these symptoms can seem ambiguous. Many times menstrual pains, premenstrual syndrome, menstrual irregularity and infertility are treated with synthetic hormones at the ovarian level, when their origins may be found in the nervous system through the emotional stresses of women's lives.

When long-term stress is perceived through the nervous system, it is the role of the hypothalamus to try to reduce any physiological impact on body processes by stimulating the pituitary gland to release adrenocorticotropic hormone (ACTH), which targets the cortex of the adrenal glands to release the stabilizing stress hormone cortisol. Through the stimulation of this hormone, body processes are maintained.[8]  Although its actions are initially beneficial, over time, cortisol can cause deterioration of the body through its stimulating affects, while also interfering in normal hormonal balance. Besides regulating the stress response, the cortex of the adrenal glands also manufactures the sex hormones oestrogen, progesterone and testosterone for the endocrine system. When repeatedly called upon to synthesis cortisol to enable women to cope with their stressful life experiences, the cholesterol building block which cortisol is made from can become depleted and reduce the production of the other sex hormones which also use this same building block. The excessive cortisol also competes for carrier molecules and receptors that are essential for all sex hormone functioning. All these situations can lead to many oestrogen dominant hormonal imbalances including fibroids, endometriosis, premenstrual syndrome and irregular bleeding patterns in the cycle.[9]
 
Given this series of events, the key to a therapeutic approach to balancing hormones should focus on improving the nervous response of women, enabling them to cope better with the world around them, so that there is a gentle and gradual normalization of hormones coming from both the nervous system and the endocrine system. How this can be accomplished is through herbal remedies that foster restoring, toning and nourishment of these two systems. Treatment should include nervous system restoratives such as Scutellaria lateriflora (skullcap), Hypericum perforatum (St. John's wort), Verbena officinalis (vervain), Avena sativa (oats) to help women feel better in themselves and improve the way they experience their external worlds. The functioning of the endocrine system and adrenal gland is improved by herbs such as Hydrocotyle ascianta (gotu kola), Eleutrococcus senitenous (Siberian ginseng), Ociumum sanctum (sacred basil, or Astragalus membranaceus (milk vetch), that help reduce the level of stress women feel, while taking the burden off stress hormone production.[10, 11] The remainder of the therapeutics should be focused on alleviating the predominant symptoms and improving health of the organs or tissues involved.

To best illustrate the therapeutic potential that is possible with this type of treatment, two case histories are presented in which both patients came for consultations after been given no further recourse other than a hysterectomy for their hormonal conditions.

Case Studies

Patient 1 was a 44 year old woman with an 8 cm uterine fibroid, experiencing heavy menstrual bleeding and a dragging discomfort, who had previously been prescribed progesterone but stopped after becoming depressed, tired and very irritable. Upon returning to her GP she was advised that her other option was a hysterectomy. In our first consultation, it was the circumstances of her present life situation that seemed most in need of support. With her partner she ran a successful gift shop while raising their 10 and 7 year old children in the flat upstairs from the shop. She had spoke of a longing to spend more time with her children and provide them with a more appropriate home, and her resentment at her partner's insistence that the business must come first.
   
Patient 2 was a single 56 year old practice manager for a busy dental practice who has been experiencing intermittent periods of bleeding over a 6 month period, after having 4 years of no bleeding and feeling confident she was past menopause. After full medical investigation, no pathology was found, but she continued to bleed. On consultation, we were able to pinpoint the time of bleeding to coincide with her having to move her widowed mother into sheltered housing close to her own flat, and her deep worry that she would not be able to handle the needs of her mother and the stress of her job.

Herbal Remedies

Patient 1 with Fibroid

Dose: 5ml (1 teaspoon) 3 times a day before food   

Patient 2 with Post Menopausal Bleeding

Dose: 5ml (1 teaspoon) 3 times a day before food

In both of these cases the symptoms were reduced within months of starting treatment and both women felt confident in not requiring hysterectomies. Both herbal remedies concentrated on helping these women cope better with the lives they were leading through nerve tonics and adrenal gland support that was individually appropriate for them. Each was advised to include vitamin C- rich fruits and vegetables and/or supplementation of Vitamin C and bioflavonoid, and to improve the workings of the adrenal glands and to reduce uterine bleeding; and both strongly advised to reduce simple sugars and the impact they have on the stress response. Included were antispasmodic herbs that reduced uterine tension to support the muscular structure of the uterus, which is influenced by the stress response, creating tension, spasm and constriction in its walls and blocking circulation. In terms of fibroids, reduced circulation in the uterus can cause a build-up of toxins and the inability of blood born immune compounds that inhibit abnormal growth to reach the uterine tissue. In the case of post menopausal bleeding, the tension and spasm in the uterus can cause damage through weakening of the blood vessels as they become depleted of oxygen and nutrients and begin to weaken and cause bleeding.[12] On a more emotional level, the easing and opening that is felt when the uterus is relaxed helps when there are internal anxieties that women are finding hard to express externally.

With tension eased and the muscular uterus more open, the lymphatic herbs are able to reduce toxins and move circulation, while tone of the uterus is improved and blood vessels strengthened with the use of the astringent herbs. Hormonal balance is further encouraged when the digestion system is roused after repression by the stress response, aiding the detoxification process and metabolism of hormones in the liver with bitter herbs. These actions were supported with the nutritional advice to add more organic fresh and vegetables to the diet, especially liver cleansing foods such as carrots, lemons and beet root; to be moderate with alcohol and caffeine to reduce impact on liver function; to only eat meats, poultry and dairy that have been reared without growth hormones; and to reduce reliance on processed foods.[13]

After approximately three months of taking the herbal remedies and following dietary advice, both patients felt more in control of their conditions. Bleeding had eased in the fibroid patient and did not return in the patient with post menopausal bleeding. Both reported a great reduction in discomfort and both felt a greater sense of wellbeing. With their confidence in themselves restored, neither felt a hysterectomy was necessary. 
   
With this greater appreciation and understanding of the workings of the endocrine system, a more well-rounded approach can be presented, where hormones and the underlying nervous response of women are respected and appropriately strengthened. With these therapeutic considerations, women are given the opportunity to try less invasive approaches to their hormonal conditions before considering taking hormone or having hysterectomies, while bringing them more control over the management of their bodies and lives.

References

1.    Istre O and Qvigstad E. Current treatment options for abnormal uterine bleeding: an evidence-based approach. Best Pract Res Clin Obstert Gynaecol 6: 905-13. 2007.
2.    S Williams et al. Developing a robust and efficient pathway for the referral and investigation of women with post-menopausal bleeding using a cut-off of <or = 4mm for normal thickness. Br J Radiol 80(957): 719-23. Sep 2007. 
3.    Evans P and Brunsell S. Uterine fibroid tumors: diagnosis and treatment. Am Fam Physician. 75(10): 1452-3. May 2007.
4.      Berne R and Levy M. Principles of Physiology. 2nd ed. Mosby, London, pp 641-657. ISBN 0-8151-0523-1. 1996.
5.    Crockett L. Healing Our Hormones, Healing Our Lives, Solutions to common hormonal conditions. O-Books, Winchester. pp 7-27. IBNS 978-84694 168 9. 2009.
6.    Gannon L. Menstrual Disorders & Menopause. Praeger, New York. IBNS 0-3-003878-2. 1985.
7.    Asso, D. The Real Menstrual Cycle. John Wiley & Sons Ltd, Chichester UK, ISBN 9780471901754. 1983.
8.    Griffin J and Ojeda R. Textbook of Endocrine Physiology, editors. 3rd ed. Oxford University Press, London. pp 101-113. ISBN 0-19-510754-3. 1996. 
9.    Murray M and Pizzorno J. Encyclopedia of Natural Medicine. 2nd ed. Prima Health. ISBN 07615-1157-1. 1998.
10.    Winston D and Maimes S. Adaptogens, Herbs for Strength, Stamina, and Stress Relief. Healing Arts Press, Rochester, Vermont. ISBN 978-1-59477-158-3. 2007.
11.    Bone K. Clinical Applications of Ayurvedic and Chinese Herbs. Phytotherapy Press Queensland, Australia. ISBN 0 646 29502 0. 1996.
12.    Hudson T. Women's Encycolopedia of Natural Medicine. Keats Publishing, Los Angeles. pp. 265-276. ISBN 0-87983-788-8. 1999.
13.    Pitchford P. Healing with Whole Foods, Oriental Traditions and Modern Nutrition. North Atlantic Books, Berkeley, California. ISBN 0-938190-64-4. 1993.