In today’s episode we talk about women’s health in particular – how we can help women through menopause in new ways using a naturopathic approach and natural medicine.

Dr. Tori Hudson is my guest in this episode. She is my friend, colleague, and mentor who has been in practice as a Naturopathic Doctor for almost 40 years in Oregon. She is a nationally recognized naturopathic physician, speaker, educator, researcher, clinician and the first woman in the United States to become a full professor of naturopathic medicine.

She is also the author of the Women’s Encyclopedia of Natural Medicine: Alternative Therapies and Integrative Medicine for Total Health and Wellness, and has served as a Medical Director, Associate Academic Dean, and Academic Dean at the National University of Natural Medicine (NUNM). Most recently, she has released her new book: The Menopause Companion.

In addition to founding and running her own clinic, A Woman’s Time, Dr. Hudson is the founder and co-director of the Naturopathic Education and Research Consortium (NERC), a non-profit organization for accredited naturopathic residencies. She currently serves as the program director for the Institute of Women’s Health and Integrative Medicine. 

Dr. Hudson also co-founded Vitanica, a supplement company offering formulations based on her decades of clinical experience.

How Has Women’s Health Care Evolved Over the Last 20-25 Years? 

There’s been a considerable shift in menopause management. Specifically, the rise and fall, and rise again, of menopausal hormone therapy. 

Natural medicine started to gain more recognition in the late 80s’. Dr. Michael Murray was very influential in bringing to light the botanical medicine research out of Europe and other parts of the world. Dr. Tori attributes to him the initiation of an awareness of the world of botanical medicine research and the influence it has had on naturopathic practice and the development of integrated physicians. The shift began in using supplements to both reduce the risk of disease and treat disease. 

Women’s health in particular is seeing an immense expansion of options, which can be fantastic, but also more confusing to navigate. 

People are now able to research different approaches online and they’re able to access different practitioners. So, women are more likely to say “I want something different” or “I don’t just want a cookie cutter suggestion”. 

Today, patients are more informed and have more opportunities to be informed. They come more often with their own thoughts, ideas, and opinions. Most the time that can lead to a collaborative process of determining their treatment plan.

Women today have a lot more tools to help themselves. They have new ways to get what they need from their healthcare providers, and they have a lot more ability to question if they really need a treatment or procedure.

Dr. Tori loves when a patient comes in and asks for a second opinion. Recently, she had a patient asking her if she really needed a particular surgery for her bladder and she was able to reassure her that surgery was the necessary next step. 

Naturopathic doctors are trained to recognize the value of conventional medicine and how to incorporate that into a natural approach and a naturopathic medicine context. It’s important to recognize that every paradigm has its strengths, and every paradigm has its weaknesses. 

That’s what is unique about the modern naturopathic physician – we can really help patients navigate the best opportunities for their healthcare. 

Menopause: Naturopathic Medicine as an Individualized Approach

Perimenopause starts at least a decade before the period ends and then comes post menopause. So, for women living till their mid-80’s it’s really most of their lives.

It’s a lot of years of our lives to be navigating hormone shifts, and potential symptoms and women’s health issues, and women really do need help navigating that. Especially because there’s still not enough research, and the information that is available is not always consistent and can be confusing.

Dr. Tori reminds us that there’s rarely a one size fits all approach, which is the beauty of naturopathic medicine. We try to individualize the approach for each person. If there are 10 different women who have hot flashes, there’s going to be some recommendations that are common for them all, but there’s also the nuance of suggestions that match for the rest of their health.

So, hot flashes occur in a context of: does the patient have arthritis, what’s their risk for diabetes, do they have high blood pressure, what’s their risk for Alzheimer’s? There is the quality-of-life issues which can be fairly simple to resolve, and then there’s the disease prevention issues and the disease treatment issues which need to be addressed. 

A naturopathic doctor should help you look at the big picture and then help gather the information to help you make the best decisions possible about what to take and how to support your health. 

Navigating the Ladder of Intervention in Women’s Health

Dr. Tori’s new book outlines what changes might be happening in your body, how to ask the right questions of your health care provider, what might be problematic in the world of tests and treatments, and more. 

She compares it to a map, as opposed to a strict sequence. There are many options for how to get on from point A (where you are starting) to point B (feeling better). This is important because we are all coming to the table with a different set of cards, and we may all have similar pathways to navigate, but at the end of the day, each of our approaches needs to be individualized. 

It is tempting to talk to other women and hear a particular intervention that worked well for them, but your menopausal journey will probably look very different from your friends’ or even your family members’ journey – and what may have worked well for them, may not have the same impact for you. 

It’s great to share stories and share experiences with other women, but no one else’s experience will be your exact prescription. 

That’s where the ladder of intervention becomes helpful. On this ladder you can consider where you are starting and what makes sense in your case. Consider what symptoms you are experiencing, what your family history predisposes you to, your own medical history, and what you’ve already tried to help you see where you should begin. 

The beauty of this process is to determine the most minimally invasive intervention we can introduce that will lead to the intended improvements. It’s not just a hierarchy for all circumstances, as in we do not always start on the first rung of the ladder. Each person or situation will have their own hierarchy. 

Maybe you’ve already been implementing diet and exercise but still experiencing night sweats, or hot flashes, or have osteoporosis. In these cases, we move up the ladder of intervention to see what steps are needed to produce the necessary changes. 

Multitasking Herbs for Menopause 

Since our body is an ecosystem, symptoms do not usually occur in the singular. Taken together, the totality of symptoms can provide a more complete picture of what herbs might be most helpful. 

Dr. Tori refers to these combinations as twofers, three-fers, and four-fers. For instance, if a woman is experiencing hot flashes we will also ask, is she struggling with her mood, does she have achy joints as well, or is she experiencing memory issues.

Then we look for herbs or formulas that will cover the most issues for a specific patient. Black Cohosh, for example, has by far more research than any other single herb, but that doesn’t mean it’s going to work for everyone. Maybe curcumin will be the remedy for someone who has hot flashes as well as joint pain.

Better Understanding of Hormone Replacement Therapy

Is hormone replacement therapy right for you? 

Women are often hesitant about hormone replacement for one reason or another, as it can feel drastic. There’s newer research that’s helping us, even as providers, become more comfortable with hormone replacement therapy. 

If you have been following a treatment plan, and you’ve tried herbs and formulas that can help with perimenopausal symptoms, but you’re still experiencing night sweats or vaginal dryness and your symptoms are not improving, then we can start talking about some form of bioidentical hormone replacement therapy. 

It’s important to understand the benefits and the risks of menopausal hormone therapy. Age will be one of the most important determining factors. How old is the patient, when did she become menopausal, does she have other coexisting health issues or what other coexisting health problems does she have, and what are her risks for what Dr. Tori calls the big three: Osteoporosis, Heart Disease, and Alzheimer’s Disease. 

Additionally, there are three buckets of information that are important to evaluate: what are your quality-of-life issues, what diseases are you at increased risk for, and what conditions or diseases do you already have. All of that informs the decision making on the benefits and the risks of menopausal hormone therapy. 

If you’re within the first ten years of your last menstrual period, less than 60 years old, you haven’t had breast cancer, a stroke, or clot, or DBT, then the risks of hormone replacement therapy are negligible. There are a few other risks to consider, like fatty liver, but those are the fundamental considerations. From there we can determine whether menopausal hormone therapy is safe for that person. 

The risk of breast cancer from going on menopausal hormone therapy is very low if you’re in the group just described. In fact, it is much more likely to get breast cancer if you drink alcohol every day, smoke, you don’t exercise and you’re overweight.

There are very few women for whom systemic menopausal hormone therapy is actually contraindicated. There are cautions on delivery methods, for instance if you have a gallstone, we shouldn’t give oral hormones, and if you have fatty liver or elevated triglycerides, we shouldn’t give oral, but we can give transdermal hormones instead. 

It’s important to work with a practitioner who understand all the options, delivery methods, and ways to customize your dose based on your health.

What About Local Estrogen for Vaginal Health?

Vaginal estrogen can be a miracle worker for some women. Vaginal estrogen for the purpose of local vulvovaginal problems doesn’t increase the risk of anything if it’s done properly. 

Typically, it is prescribed for local dryness, itching, irritation, painful sexual activity, and/or leaky bladder. In these cases, it’s often a waste of time to attempt vitamin E, moisturizers, or lubricants. You can skip up the ladder of intervention to vaginal estrogen since it is still very minimally invasive. 

There are, of course, still instances where caution should be exercised, for instance if breast cancer is or was present. In that case, a non-hormonal option would usually be the beginning recommendation. But even gynecologist societies and menopause societies say you can use tiny doses of vaginal estrogen safely in a breast cancer patient for vaginal symptoms in many cases. 

A low dose of vaginal estrogen has also been found to be helpful for women who tested positive for HPV and have abnormal cells on their pap smear. With vaginal estrogen, you’re improving the vaginal biome and that means you can prevent bacterial vaginosis or vaginal infections. We’re finding that the vaginal biome and the species of lactobacilli living in the vagina help fend off HPV as well. 

Vaginal estrogen gets you a healthier ecological environment and balance of microorganisms. A healthy vaginal biome relies on healthy estrogen levels in the cells. 

We might first notice vaginal dryness most acutely during sex, but vaginal dryness can be an indicator of other women’s health issues and affect more than just your sex life. Local estrogen can be a preventive medicine that can help with vaginal dryness and a range of other health issues as well. 

The dryness and discomfort put you at an increased risk for vaginitis, urinary tract infections, possibly HPV, bladder leakage, and overactive bladder. You can prevent those things from happening most of the time by using a small dose of vaginal estrogen twice per week. So, it’s not just for sexual comfort, it’s related to your overall bladder and vaginal health as well. 

What Are Some Good Supplements for Menopause and Women’s Health? 

As we mentioned before, Dr. Hudson co-founded Vitanica, a supplement company offering formulations to support women’s health. Some of my favorites are:

• Black Cohosh: The most effective formulation I’ve ever come across for hot flashes and other menopausal symptoms. 
• Chaste Tree Berry:An herb that supports ovulation and helps with symptoms of premenstrual syndrome, breast pain associated with the menstrual cycle, infertility, and perimenopausal menstrual changes. 
• Slow Flow:A formula of herbs and nutrients for heavy menstrual bleeding. 
• CCDG Blend: Tried and true for HPV cases, CCDG contains curcumin, coriolus mushroom, DIM and green tea, all in one.
• Cranstat Extra: Herbal and nutrient formula for bladder infections.
• Candidastat: To support a healthy biome and prevent yeast overgrowth. 

I’ve been working with these formulas for 23 years (Dr. Doni speaking), and I’ve seen time and time again how helpful they are for women. That’s why I recommend them in my practice.

As always, I am here and would love to help you wherever you are in your health and menopausal journey. I’m licensed to help with hormone replacement therapy in several states. Please feel free to reach out with any questions so we can get started on improving your life and your health, together! 

If you want to reach out to Dr. Hudson and learn more about how she can help you, please make sure to check out her website. Also be sure to check out Dr. Tori’s new book, The Menopause Companion, to learn more about how to navigate this process of perimenopause and post menopause, from finding the right practitioner or set of practitioners who can guide you along your journey, and the right questions to ask to take steps in the best direction. 

If you’re interested in learning more about my approach to addressing HPV, including why healing leaky gut is essential, you can find my HPV Recovery Guide here. If you would like more help getting HPV to negative, and are really committed to erasing it from your life forever, you can sign up for the upcoming 5 Days to Heal HPV Workshop here or my Say Goodbye to HPV 12-Week Program here.

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