Author Archives: Dr. Tori Hudson

  • Natural Solutions for Mild-to-Moderate Depression

    Depression is a common women's issue, and can result from a number of different health problems. Here, Dr. Tori Hudson, ND, talks about natural solutions to help you deal with mild-to-moderate depression.

    This video is part of a series of educational videos from members of our Integrative Health Advisory Board.

  • The Benefits of Lactobacillus in Treating Vaginitis

    Vaginitis is one of the most common reasons for women to seek medical attention. It affects all age groups and has a variety of causes. But alone or in combination with other vaginal or oral therapies, selected combination species and strains of a probiotic called lactobacillus can provide the key to establishing normal vaginal microflora, preventing recurring infections, and treating acute candida and bacterial infections of the vagina.

    An initial bout of vaginitis may be easily diagnosed by a qualified health care practitioner, but recurrent vaginitis can be among the most troublesome and challenging conditions for both practitioners and patients. Proper diagnosis is important due to the fact that there could be undetected co-infections and potential consequences of an incorrect diagnosis and treatment. Vaginitis is commonly classified in four ways: as being caused by yeast, as bacterial vaginosis (BV), as Trichomonas vaginalis or as atrophic vaginitis.

    Much like your gastrointestinal tract, the vaginal “ecosystem” is contingent on a delicately balanced relationship between normal microflora, metabolic products of that microflora and the host, estrogen and the pH level.

    The normal microflora of the vagina, dominated by different species of lactobacillus, is capable of inhibiting the adhesion and growth of pathogens (infection-causing organisms), depletes nutrients available to pathogens, and modulates the host immune response and vaginal environment. Lactobacilli perform their role via at least three mechanisms: First, they help to produce lactic acid and other acids, promoting a normal vaginal acidic environment of 3.5-4.5. Many disease-causing microbes cannot survive or flourish in this pH level. Next, many species of lactobacilli produce hydrogen peroxide, which also inhibits microbial growth. Finally, the lactobacilli are competitive with the pathogenic microorganisms for adherence to the vaginal epithelial cells.

    Around seven species have substantial data published on their properties and antipathogen abilities. These Lactobacillus species are L. rhamnosus, L. acidophilus, L. casei Shirota, L. reuteri , L. casei ,  L. plantarum and L. salivarius.  A number of studies have supported the use of lactobacillus in preventing and treating both candida (yeast) vaginitis and bacterial vaginosis (BV).  These have included using the lactobacillus as suppositories and/or oral delivery.

    For simple acute yeast vaginitis or BV, one might consider a lactobacillus suppository (including one or more of the above species), twice daily for seven days, and an oral capsule once daily.  Oral capsules should always include a minimum of L. reuteri and/or L. rhamnosis and L. acidophilus).

    For chronic or recurring infections, the suppository regimen may need to extend to once weekly for several weeks and the oral for 2 to 6 months to ensure recolonization of normal vaginal ecology.

    Speak with a Pharmaca practitioner about selected combination species and strains of lactobacillus that can help prevent and treat recurring vaginal infections.

  • Expert Advice: Hot Flashes in Perimenopause and Menopause

    Dr. Tori Hudson, ND, is a member of Pharmaca's Integrative Health Advisory Board and Medical Director of A Woman's Time Clinic in Portland, Ore.  

    The number of women who are affected by hot flashes in the United States is remarkable. About 75 percent of women experience them at some point, and 15 percent are severely affected by them. Hot flashes and nightsweats in perimenopausal and menopausal women are often referred to clinically as vasomotor symptoms.

    Hot flashes are the most common symptom associated with the menopausal period and the second most common symptom, next to irregular menses, during the perimenopausal period. We still do not understand the physiology of hot flashes, nor can we project the average age of onset, triggers, duration, frequency, or why they are prominent in some cultures and absent in others.

    Hot flashes are sudden, transient episodes that range from simply feeling warm or overheated to intense heat and perspiration. Women tend to describe a wave-like sensation over the body, particularly in the upper torso, face and head. If the hot flashes occur at night, alongside potentially drenching perspiration, we call them night sweats.

    The occurrence of hot flashes is highest in the first two years of postmenopause, although information is scarce on the total time over which hot flashes are experienced. Hot flash frequency is variable, and ranges anywhere from several episodes in a year to every hour throughout each day. Women with surgically induced menopause often report particularly persistent, more intense and more frequent hot flashes. One large study determined that for most women, hot flashes last about two years, although some women experience them for 5-10 years. As many as 15 percent of women may still report hot flashes 16 years after menopause.

    The clearest explanation for hot flashes is that they appear to be the body's response to a sudden but transient downward resetting of the body's thermostat, which is located in the hypothalamus. This temporary alteration of the set point would cause the sensation of intense heat and flushing. What we don't know is what initially triggers this event.

    A logical correlation between low estrogen levels and hot flashes exists. Estrogen levels have been found to be lower in premenopausal women with hot flashes than in those without hot flashes. But there are some contradictions in the low estrogen theory. For example, prior to puberty, girls have low estrogen levels, but not hot flashes. Hot flashes are also reported during pregnancy, when the estrogen level is high. As a result, some researchers believe that hot flashes are due to an imbalance in beta-endorphins and other opiates in the brain that in turn may influence the temperature regulation center. Estrogen and progesterone may alter the activity of these naturally occurring opiates, and it is possible that lower levels of estrogen and progesterone cause a withdrawal of opioids, triggering a hot flash.

    Interestingly, not all cultures report the same incidence of hot flashes or other menopausal symptoms. For example, Japanese and Indonesian women report far fewer hot flashes than do women from Western societies. Mayan women in the Yucatan do not report any symptoms at menopause other than menstrual cycle irregularity. Many researchers have attributed these differences to biological, psychological, social and cultural factors.

    Keep in mind that there are other causes of hot flashes, including thyroid disease, epilepsy, infection, insulin-producing tumors, pheochromocytoma, carcinoid syndromes, leukemia, pancreatic tumors, autoimmune disorders or allergic disorders.

    Natural therapies are very well suited for hot flashes and/or nightsweats, and simple changes and awareness can often make a difference. For example, hot flashes can be aggravated by warm drinks, hot weather, stress, salt, alcohol and spicy foods. Women who have more body fat may have fewer hot flashes than lean women. Increasing the soy foods in the diet may decrease hot flashes. In addition, increasing intake of essential fatty acids--through nuts and seeds especially--can aid in other menopause-related concerns such as reducing calcium loss and improvinge calcium absorption while also being protective against heart disease.

    There are also many medicinal plants and dietary supplements that have shown benefits in improving hot flashes and/or nightsweats.

    Black cohosh is the most well studied herb for hot flashes, and has been included in more than 100 studies. Although not all studies show benefit, it often shows at least a 50 percent reduction in hot flashes. Black cohosh is also considered safe in breast cancer patients because it does not increase estrogen levels and has actually been able to inhibit breast cancer cells in the test tube.

    A combination of black cohosh and St. John's wort has been able to improve not only hot flashes but menopausal mood changes as well.

    A special maca root extract has several studies showing significant benefit in reducing hot flashes.

    Kava is a good choice when the hot flashes are occurring alongside anxiety symptoms.

    There are also over-the-counter natural progesterone creams that have shown excellent benefits in reducing hot flashes.

    Other research has been done on the benefits of red clover, pine bark (pycnogenol), fish oils,  siberian rhubarb, kudzu and at least one combination herbal product (dong quai +licorice + wild yam + burdock + motherwort).

    In addition to these natural therapies, numerous prescription hormone replacement therapy medications are available. They come in all sizes, combinations and delivery methods.

    One of the specialty areas of a compounding pharmacy like Pharmaca is in preparing customized doses, combinations and delivery methods according to the patient's needs. Whether the hormones are synthetic, semi-synthetic or bioidentical (when the hormone is chemically identical to the hormones the body makes), they come with both potential risks but many benefits. To best understand the benefits and risks for you, educate yourself and talk with a practitioner or pharmacist with expertise in menopause.

    When searching for symptom relief, there are excellent dietary supplements to utilize for hot flashes in the perimenopause transition and in menopause. Usually, you should feel improvement within one month. If not, consider moving on to another option until you find something that works well for you.

  • Ask the ND: Managing Menopause

    We asked Dr. Tori Hudson, ND, to answer some of the most common questions about menopause symptoms and treatment. Dr. Hudson is a member of Pharmaca's Integrative Health Advisory Board and Medical Director of A Woman's Time Clinic in Portland, Ore.

    What herbs and supplements should I consider to control my menopause symptoms?

    It always depends on your symptoms, but here's how I approach it. First I have to determine that someone's symptoms are related to perimenopause or menopause. If she's 40-something and has a familiar collection of symptoms (e.g. hot flashes, anxiety, irritability) and her periods are starting to change in some fashion, it's probably related to menopause.

    If so, there are some core products I like to use as a foundation: black cohosh extract, Femmenessence MacaPause or Vitanica's Women's Phase II. These three products have been well researched for a diverse array of menopause symptoms.

    If needed, I would give additional supplements based on other symptoms that need addressing. Really can't sleep? Add valerian or a sleep formula right before bed. If depression is a more dominant symptom, add St. Johns wort (which has been researched to work especially well with black cohosh).

    You also have to make sure you're addressing the correct symptom. If your hot flashes are causing insomnia, you have to quell the hot flashes before you can address any remaining sleep issues.

    Are there lifestyle changes or other modifications I can make to help alleviate symptoms?

    There are definitely some lifestyle changes that have research behind them. Research has shown that relaxation techniques like yoga and meditation can ease sleep problems and hot flashes. On the other hand, hot and spicy foods have been shown to trigger hot flashes, as have alcohol, caffeinated beverages and smoking.

    At what point should I consider hormone replacement therapy?

    The primary indication for HRT is hot flashes and/or night sweats and/or vaginal dryness--these are the primary approved symptoms for estrogen administration. But doctors use hormones in this population to help all kinds of symptoms, not just what the FDA has approved it for.

    In addition, there's some compelling new evidence that says that estrogen can help prevent Alzheimer's. Even though it's not approved for that yet, if a patient has a family history of Alzheimer's, I would be more prone to prescribe estrogen for her.

    Things are complex with each individual patient, so we look at the whole picture before we decide on a course of treatment.

    If I choose to use hormone therapy, what are the advantages and disadvantages of the various routes of administration?

    If a patient has local genital symptoms that we think are estrogen related (dryness, itching, pain), then the best solution is a topical estrogen that's applied in or outside of the vagina. We always try to address a symptom as locally as possible before pumping a medication through the rest of the body.

    In terms of oral pills, the main advantage is they're easier, generally cheaper, and if we're doing compounding, we can blend all different hormones and doses into one pill. And in general, we get more predictable results from pills.

    On the other hand, transdermal patches, creams or gels have the advantage that they avoid passing through the liver, the route that oral hormones go. Experts believe this interaction with the liver can increase tryglicerides, blood clotting, liver enzymes and c-reactive proteins (a marker for inflammation). These increases don't necessarily happen, but they can. So if someone already has elevated liver enzymes--from obesity or high alcohol consumption--I would opt for a transdermal delivery so we don't add to the burden of the liver.

    The drawback to transdermal hormones is that people can be allergic to the adhesives, they can be more expensive, and most of the patches are estrogen only, so you would have to supplement with an oral progesterone.

    What is bio-identical hormone therapy? Is it safer than the standard hormone therapy?

    These hormones are made in a manufacturing facility--an ingredient is extracted out of a plant, either soy or Mexican wild yam, then converted into a hormone that is biochemically identical to human hormones. (The word "plant" can be confusing to some, but the finished product is not a plant hormone, it's a human hormone.)

    Is it safer? Bioidentical estrogen has not been proven to be safer, but progesterone does have some potential safety advantages. Fewer women have side effects with it, and it seems to have a friendlier effect on the coronary arteries since bioidentical progesterone doesn't lower good cholesterol (though synthetic progestin does). Additionally, there are two French studies that have shown that when you give any kind of estrogen along with a synthetic progestin, you get a slightly increased risk of breast cancer. But when you give any estrogen with bioidentical progesterone, the risk is not there.

    Some bioidentical hormones are available through commercial drug companies (such as Estradiol, Estrace and Prometrium), and are often less expensive than compounded versions. But the advantage to compounded hormone replacement therapy is that we can offer specialized doses, create infinite combinations of different hormones and customize the delivery system. You can't get a cream or pill with both bioidentical estrogen and progesterone from a drug company. Compounding also allows us to address sensitive patients who are allergic to a certain filler in the brand name drug, or to the patch adhesive.

    I recommend compounded hormones most often, but when people's budgets are involved, sometimes the commercially available bioidenticals are the best bet.

    Are there side effects of hormone therapy? How does my individual health/family history affect my decision to take hormone therapy?

    If a patient starts hormone therapy within the first 10 years of menopause, we don't think it will increase your risk of heart disease or Alzheimer's. But waiting longer than that may increase that risk.

    Here are some other side effects we know about:
    If you take a combination of estrogen and progesterone for longer than four years it can slightly increase the risk of breast cancer, though studies show combining any estrogen and bioidentical progesterone won't.
    If you take estrogen only (which is the approach if you do not have a uterus), then your risk for breast cancer slightly increases after seven years.

    In the first year of taking oral estrogen, there is a slight risk of blood clot or stroke. If a patient has a history of blood clots, I won't prescribe oral estrogen--I'll try a lot of other options before I try even transdermal estrogen.

    When talking with your doctor about the benefits and risks of HRT, make sure you discuss any family history of breast cancer, heart disease, Alzheimer's and osteoporosis.

    Are there other prescription options if I can't do HRT?

    There is scientific evidence to show that selective serotonin re-uptake inhibitors (SSRIs) can be helpful. Medications like Prozac and Paxil are being used especially with women who can't take estrogen for another medical reason.

    They don't work as well as estrogen, but can work for hot flashes. We usually only go that route if we've worked through all the herbal options and dismissed hormone replacement therapy as an option.

    How do I know my symptoms are related to menopause and not another health issue?

    Given that there's a long list of possible symptoms, it's true that many of them could be caused by something other than menopause. Hot flashes can be caused by hyperthyroidism, for example, and even certain cancers can have heat associated with them.

    Irregular bleeding would be the most worrisome thing that could be caused by something else, like polyps, cancer or endometriosis. So it's prudent to do due diligence with your practitioner to see if your collection of symptoms is indicative of menopause or something else (or both).

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