Estrogen alternatives

Black cohosh Remifemin preparation) appears modestly effective in menopausal symptom relief, according to several German stupes of up to 6 months duration however, more research is necessary before it can be recommended as an estrogen alternative. Black cohosh is less effective than estrogen for symptom reduction and is not known to have any effect against osteoporosis. 

Burke GL, Legault C, Anthony M, et al. Soy protein and isoflavone effects on vasomotor symptoms in peri- and postmenopausal women The Soy Estrogen Alternative Study. Menopause 2003 10 147-153. 

Burke, G.L. C. Legault M. Anthony D.R. Bland T.M. Morgan M.J. Naughton K. Leggett S.A. Washburn M.Z. Vitolins. Soy protein and isoflavone effects on vasomotor symptoms in peri- and postmenopausal women The soy estrogen alternative study. Menopause 2003, 10, 147-153. Calder, P.C. R.F. Grimble. Polyunsaturated fatty acids, inflammation and immunity. Eur. J. Clin. Nutr. 2002, 56, S14-19. 

AOS responsiveness to hormonal influences is shown in the action of sodefrin on the lateral nasal sinus of newts (Cynops). The receptors in the accessory pocket are differentially affected by pituitary and ovarian hormones (Toyoda et al., 2000). The local EOG response to the pheromone (Fig. 5.1) was enhanced by the presence of prolactin or of estrogen alone. Receptor sensitivity increase is perhaps an alternate strategy to AOS receptor density increase several alternate routes of signal receptor adaptation (Fig. 7.1) have been hypothesised (Sorenson and Stacey, 1998). 

Toremifene is a recently marketed antiestrogen whose primary advantage is a lower estrogenic antiestrogenic ratio than tamoxifen (based on laboratory data).41 Toremifene (60 mg orally daily) has been found to have efficacy similar to that of tamoxifen in metastatic disease and a generally similar side-effect profile.42 Currently, toremifene is indicated as an alternative to tamoxifen in patients with metastatic breast cancer, but studies are ongoing that evaluate its safety and efficacy in the adjuvant setting. 

Note that the dried rhizome of Cimicifuga racemosa (British Pharmaceutical Codex, 1934 black cohosh) has been used as a bitter and mild expectorant in the form of a liquid alcoholic extract (1 in 1 dose 0.3-2 mL) and is sold as alternative remedy for the treatment of menopausal syndrome at dose of 40-80 mg/day. The active constituents of black cohosh, and, therefore, the precise molecular mechanism of action involved in the climacteric property of Cimicifuga racemosa, are still unknown. The most recent data suggest that the plant is not estrogenic sensu stricto (126). 

Oral contraceptives containing both an estrogen and progestin are used as an alternate treatment for moderate acne in women. Contraceptive agents currently FDA approved for this indication include norgestimate with ethinyl estradiol and norethindrone acetate with ethinyl estradiol. 

Alternatives to estrogen for hot flushes are shown in Table 31-6. Progesterone alone may be an option in women with a history of breast cancer or venous thrombosis, but side effects limit their use. For women with contraindications to hormone therapy, selective serotonin reuptake inhibitors and venlafaxine are considered by some to be first-line therapy, but efficacy of venlafaxine beyond 12 weeks has not been shown. 

Women taking estrogen or estrogen-progestogen combined therapy are at increased risk for cholecystitis, cholelithiasis, and cholecystectomy. Transdermal estrogen is an alternative to oral therapy for women at high risk for cholelithiasis. 

Alternative mRNA maturation is frequent in tumor tissue expressing ER. In some cases it would give rise to truncated receptors that would maintain the capacity to bind hormones but would have lost their capacity as a transcription factor. Additionally, truncated receptors would be produced that would lack the capacity to bind hormones but would conserve intact their capacity to interact with DNA. In this case, the truncated receptors can become tumorigenic by stimulating the proliferation of cells uncontrolled by hormones. These receptor variants have been the object of exhaustive study at the level of mRNA in tumors of the breast, mainly estrogen-dependent tumors (Clemons et al. 2001 Garcia et al. 1988 Palmieri et al. 2002), but tests for the existence of receptor protein with these characteristics have not corroborated the expectation created by their theoretical interest. 

Marin R, Guerra B, Alonso R, Ramirez CM, Diaz M (2005) Estrogen activates classical and alternative mechanisms to orchestrate neuroprotection. Curr Neurovas Res 2 287— 301... 

Bryant HU, Dere WH (1998) Selective estrogen receptor modulators an alternative to hormone replacement therapy. Proc Soc Exp Biol Med 217 45-52... 

In summary, available scientific evidence on the effects of tamoxifen on human bone seems to parallel data collected in animal trials. Tamoxifen, acting as a partial estrogen agonist, seems to have beneficial effects on the preservation of bone mass in postmenopausal women, while in premenopausal women it might act as an estrogen antagonist. An alternative explanation could be that... 

Some crucial steps in the biology of CVD have demonstrated sensitivity to estrogen agonists. Some of these actions have shown to be mediated by the classical pathway of estrogen receptors (ERs), though in other cases the involved mechanisms seem more complex and require the consideration of alternative options (Mendelsohn 2002). The available evidence concentrates on actions on lipids or on direct actions on the vascular wall. 

When the residual depression is mild to moderate, then the risks of using lithium are probably not warranted. A less aggressive approach using a safer but less proven augmenting medication is best. The alternatives include adding T3, buspirone, pindolol, a second antidepressant, a stimulant, estrogen, or an anticonvulsant. 

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