Current Status of Anti-Aging Medicine, Especially Involving

Received: Oct. 9, 2009
Accepted: Nov. 16, 2009
Published online: Dec. 10, 2009
Review Article
Current Status of Anti-Aging Medicine, Especially Involving Management of the Menopause,
as a Component of Complementary and Alternative Medicine in Korea
Hyun Jung Kim 1), Hoon Kim 1), Jung-Ho Shin 2), Seung-Yup Ku 1,3)
1) Department of Obstetrics and Gynecology, Seoul National University College of Medicine
2) Department of Obstetrics and Gynecology, Korea University
3) IRMP, MRC, Seoul National University College of Medicine
Abstract
Recently, many developing countries have had changes in the composition of population and have become aging societies.
Therefore, anti-aging medicine which is believed to have beneficial effect on the risk factors of geriatric associated diseases has
been paid much attention. Complementary and alternative medicine (CAM) has been widely accepted by the general population,
and is consequently known to account for a large share of health care costs in many countries.
Hormone therapy (HT) is the gold standard to alleviate menopausal symptoms, but only 2.3% of Korean menopausal women
are on HT. Many other women seek alternative means, including Korean traditional medicine, phytoestrogen-containing products
such as black cohosh, soy (isoflavone), Dong quai, Ginseng, and evening primrose oil. Bioidential hormone therapy (BHT) is HT
with individually compounded recipes of steroids in various doses. Its efficacy is yet to be confirmed and the risks of developing
endometrial hyperplasia and breast cancer have been reported. Other CAM methods involving lifestyle and behavioral
interventions include exercise, caloric restriction, weight reduction, and ‘mind-body medicine (homeopathy).’ Dermatologic,
plastic, and ophthalmologic interventions have been introduced through the exhibition, as well.
Physicians have ignored this novel trend of patients preference to ‘natural hormonal therapy,’ however, they should be aware
of the pros and cons of CAM and be able to guide their patients to make right choices. Clinical trials, and the evaluation of every
CAM practice should be undertaken.
KEY WORDS: anti-aging, complementary and alternative medicine, CAM, bioidentical hormone
Introduction
Anti-aging medicine, which can neutralize risk factors for
geriatric-associated diseases (e.g., cardiovascular diseases,
diabetes, cancers, senile Alzheimer’s, and arthritis), has emerged
and influenced the health behavior. Therefore, ‘anti-aging’ is one
of the most important issues in society. The Anti-Aging Expo was
held in Seoul on July 2009. This exhibition had such a positive
influence. Many categories of products and services were
presented. For instance, medical markets presented anti-aging
plastic surgery, skin management, and general health screening.
Pharmaceutical companies displayed generic diet supplements,
such as coenzyme Q10 (COQ10), ursodeoxy- cholic acid, and
glucosamine. Moreover, certain biotechnology corporations
advertised stem cell techniques, penile implants for men following
prostate surgery, milk products containing growth hormone,
blood-glucose-level-reducing rice, donepezil, fillers, and various
other goods for the elderly. Through the Expo anti-aging medicine
proved itself as a medicine of the future. Throughout the Expo, it
was the complementary and alternative medicine (CAM) which
received most of the attention. A number of goods, the effects and
side effects of CAM which have not been demonstrated yet, were
vigorously advertised there.
Aging occurs gradually throughout one’s lifespan because of
the apoptosis and down-functioning of cells which make up the
body. These ‘aged’ cells have low metabolic rates and somehow
lose their ability to divide. During the process of aging, the elderly
usually suffer from chronic diseases, which can be relieved with
proper preventive solutions or treatments focusing on painful
symptoms. Postponing clinical illness, as proposed by Fries 1),
requires staying in a good state of health by reducing painful
periods before death. The main aim of health improvement is to
live a relatively healthy life and compress our illnesses into a short
period of time just before death 2).
Recently, many developing countries have been transformed
into an aging society. In Korea, the percentage of the population
which is elderly was 7.1% at 2000, and estimated to be more
than 14% in 2022. This increase in the elderly population and the
accompanying health problems poses an economic threat to
society 2).
The change in the composition of the population toward an
aging society has had a great impact on the healthcare system.
Anti-Aging Medicine 6 (10) : 95-101, 2009
(c) Japanese Society of Anti-Aging Medicine
95
Seung-Yup Ku, M.D., Ph.D. Associate Professor
Dept of OB/GYN, Seoul Natl Univ College of Medicine
28 Yonkeun-dong Chongno-gu Seoul 110-744, Korea
Tel: +82-2-2072-1971 / Fax: +82-2-762-3599 / E-mail: [email protected]
Anti-Aging Medicine in Korea
Although these therapies are unproven in every aspect, CAM
has become more and more popular around the world. Recent
surveys show that CAM is widely used in Korea, with usage rates
ranging from 29%-53% among various patient populations. CAM
also accounts for a large share of health care costs 3). Such a trend
appears to be a ubiquitous phenomenon. An estimated 5.75 million
people per year in the United Kingdom visit to the complementary
practitioner for treatment and ten million per year use some form
of CAM and about 1.6 billion pounds is spent on CAM 4). Four
studies have examined the use of CAM by older adults 5-8). The use
of CAM in the United States varies from 30%-64% and in Japan it
is more frequent than in the United States 8).
For unknown reasons, many people have unfounded beliefs
about CAM. Countless menopausal women are hoping for the next
‘black cohosh agent’ instead of seeking traditional medications
from their gynecologists. Indeed, conventional medicine suggests
that such women should take hormone therapy (HT). Because the
benefits of HT are overlooked and drawbacks are extremely
exaggerated among people, they easily fall into an erroneous
assumption that HT is harmful. On the other hand, CAM,
including phytoestrogens, is believed to be safe, regardless of the
lack of information (the drawbacks, and in some cases, even the
benefits are unknown).
Physicians tend to be unaware of their patients’ use of these
therapies. Considering this peculiarity of the health care market
structure, doctors should understand their patients’ preference for
CAM over conventional medicine. They also have an obligation to
make people understand that the majority of anti-aging
medications, including CAM, does not have any scientific or
medical basis, and in addition to everything else, the process of
aging itself remains a mystery which we just begun to unravel and
understand. This act will eventually prevent potential dangers and
the unnecessary expenditure on CAM. Nevertheless, there are a
few promising therapies among the numerous bogus anti-aging
therapies.
In this paper we will examine strategies of alternative
anti-aging medicine from a gynecologic point of view in terms of
the management of menopausal women.
Results
Methods
The literature was searched in the following databases to
locate English language published trial results and systematic
reviews: Medline (Pubmed), KMBASE, Cochrane, the National
Centre of Complementary and Alternative Medicine (NCCAM).
Most of the literature has previously been cited elsewhere many
times. The search strategy was constructed by using a combination
of subject headings and text words relating to CAM for
menopause, or anti-aging for woman. The search terms used
include ‘complementary,’ ‘anti-aging,’ ‘estrogen replacement
therapy,’ ‘phytoestrogen,’ ‘bio-identical hormone therapy,’ ’hot
flushes,’ and ‘alternative.’
The preference and understanding of Korean people was
searched in websites, including ‘naver.com,’ ‘Miznet.daum.net,’
‘miclub.com,’ and many hospital homepages.
96
As society increases in age, the female and male climacterium
will become important issues in health care. In 2015, 45% of
women in the US will be 45 years or older, thus they will spend
one-third of their life after the loss of reproductive activity 9). In
the menopause, female hormone levels are lower than before
menopause.
Not only the reproductive system, but also the cardiovascular
(e.g., coronary artery) and musculoskeletal systems (e.g., bone loss
prevention) are influenced by female hormones. Female hormones
are also known to regenerate skin, modulate pain sensitivity via
opioid receptors in the brain, and govern the metabolism of certain
drugs. These various functions of female hormones are necessary
for women to maintain their health status, in addition to playing a
key role in slowing the aging process.
HT is the gold standard and has been routinely prescribed for
alleviating various menopausal symptoms, such as vasomotor
symptoms (hot flushes), psychogenic manifestations (sleep
disorders or depression), genital atrophy, skin changes, and sexual
symptoms.
HT presents several benefits in various diseases. HT can
prevent the loss of bone mineral density and osteoporotic fracture
10,11). Prevention of colon cancer is also supported by the WHI and
observational studies 12,13). The incidence of cardiovascular disease
in woman is negligible before menopause and increases
dramatically thereafter. Some epidemiologic data have suggested
that HT reduces the occurrence of coronary artery disease 14-17). An
observational study suggested that HT may reduce the risk of
dementia 18), and cerebrovascular diseases by 25%-50% in treated
women compared with a non-treated control group. However,
there are some controversies over these results 12,19). According to
the WHI memory study (WHIMS) the therapeutic group with HT
had twice the risk compared to the placebo group 19). Rapp et al.
reported that there is no additional benefit with respect to
cognitive function in the HT group 20). Thus, the use of HT is not
recommended for women for prevention of cardiovascular disease,
stroke, and dementia.
In Korea, only 23.3% of naturally menopausal women are on
postmenopausal HT 21). Many other women seek alternative
solutions, which include Korean traditional medicines and
phytoestrogen-containing products. Phytoestrogens have been
perceived to be more natural than HT, and very popular among
women who have had doubts about the safety of HT. Some
medical professions have suggested that it is reasonable for
menopausal women to take phytoestrogen agents rather than do
nothing 22). Phytoestrogens are an ingredient in a number of
botanical species, and the subject of current research.
1) Functional Mechanism of Phytoestrogens
Phytoestrogens are diphenolic compounds found in grains,
legumes, and grasses. Because phytoestrogens have a phenolic
ring, they are able to bind to estrogen receptors, mimicking the
effect of estrogen 23,24). However, most phytoestrogens have a
greater affinity for estrogen receptor-β than estrogen receptor-α
. The clinical consequences of these relationships remain to be
elucidated. An important point is that even though phytoestrogens
can bind to the estrogen receptor, they are much weaker than
human estrogens. While many classes of phytoestrogens exist,
those pertinent to treating menopausal symptoms are isoflavones,
lignans, and coumestans. Lignans are found in grains and cereals,
such as alfalfa, and isoflavones are found primarily in legumes,
such as soy beans and soy products 24).
2) Black cohosh
5) Ginseng
Black cohosh is an American herb native to eastern North
America. Black cohosh has been traditionally used by Native
Americans to treat gynecologic conditions, including menopause
and menstrual cramps. Currently, black cohosh agents are used to
treat hot flushes in breast cancer patients 24,25). Black cohosh was
commercially marketed in the 19th century as Lydia Pinkham’s
Vegetable Compound, in the 20th century as Huntington’s 11, and
most recently in the 21st century as remifemin (a 20 mg tablet
containing black cohosh) 24). Black cohosh is marketed in Korea
by several pharmaceutical companies. The active ingredients of
black cohosh are terpense and glycosides. Recent studies suggest
that black cohosh may function as a selective estrogen receptor
modulator (SERM) with a mild central estrogenic effect. Black
cohosh may also have activity at serotonin receptors, which may
be a mechanism that can explain how it relieves hot flushes and
improves mood. Some trials shows an improvement in the severity
of hot flushes, sleep disorders, sexual dysfunction, and sweating 25).
Recently, two randomized control trials involving black cohosh (a
phytoherb sometimes classified as a phytoestrogen) failed to
demonstrate a significant benefit with regard to menopausal
symptom management in women with breast cancer 26,27). No
long-term studies with black cohosh exist, and thus it has been
recommended that treatment should be administered no longer
than 6 months. Side effects are limited, but include gastrointestinal
disturbances, bradycardia, headaches, and nausea.
Ginseng is a special product of Korea. It is one of the most
popular anti-aging herbal medicines in Korea. Hong Sam, ginseng
steamed red, is a popular medicine in menopausal women. Korean
red ginseng has been used in the Orient as an elixir for hundreds of
years. Recent data has shown that Korean red ginseng is effective
in treating various perimenopausal symptoms. Noh et al.
performed a study on the efficacy and safety of Korean red
ginseng in women with menopausal symptoms 35). Patients with
symptoms of mild-to-moderate severity showed a clinically
significant improvement in symptoms 35). However, more evidence
and research is needed.
The ginseng root contains saponin, which is a subtype of
isoflavone. The effects of ginseng have been attributed to its
estrogenic effects; alternatively, ginseng may have an effect on
mood by directly affecting the hypothalamic-pituitary axis 36).
However, there are some controversies about its efficacy. Many
studies suggest that ginseng has no significant effect in reducing
menopausal symptoms 37). Some opinions exist that ginseng is
helpful in alleviating psychosomatic symptoms 38); thus, the
findings are conflicting 39).
6) Evening primrose oil
Evening primrose oil is gaining popularity by Korean women.
Many women claim that it is very efficacious. Evening primrose
oil contains alpha and gamma linolenic acid (prostaglandin E1) 30).
Gamma linolenic acid is believed to reduce vasomotor symptoms
31), but its mechanism of action is still unknown and the use of
evening primrose oil has not conclusively demonstrated efficacy
for relieving symptoms in menopausal women. One randomized
double-blind, placebo-controlled trial suggested that evening
primrose oil was no more efficient than placebo 40). More
epidemiologic and biochemical studies need to be done to
determine whether or not evening primrose oil is effective.
3) Soy (isoflavone)
Soy isoflavone extract is effective in reducing the frequency
and severity of hot flushes without stimulation of the endometrium.
Soybeans contain three different types of isoflavones (genistein,
daidzein, and glyciten), and these soy isoflavones are known to
have weak estrogenic activity. Soy isoflavones and other
phytoestrogens can bind to estrogen receptors, mimicking the
effects of estrogen in some tissues and antagonizing (blocking) the
effects of estrogen in others 28).
Interests in soy phytoestrogen have been fueled by
epidemiologic studies that have suggested a low incidence of
breast cancer in countries in which the population has a high soy
intake, and this has been followed by in vitro and in vivo studies
suggesting a potential role for phytoestrogens in preventing breast
cancer development. Although most case-control studies have
indicated some protective effects of soy, the findings have been
inconsistent, and some have failed to show any relationship
between phytoestrogen intake and breast cancer development 29).
There is no establ ished connection between cancer development
and HT. However, people have doubts about the safety of HT, and
they believe that ‘natural’ products are safe. One form of ‘natural
product’ is bioidentical hormone therapy. Natural or bioidentical
hormone therapy (NHT) is used to describe HT with individually
compounded recipes of steroids in various doses, including
dehydroepiandrosterone, pregnenolone, testosterone, progesterone,
estrone, estradiol, and estriol. Based on the study of a person’s
salivary hormone levels, the final composition of the compounded
dose form is individualized to the specific person 41). NHT was
among the first therapeutics used for the relief of menopausal
symptoms in the 1930s, and bioidentical HT (BHT) has attracted
much interest 42,43).
The terms bioidentical and natural may obscure safety to
consumers. A survey involving 82 women at a compounding
pharmacy found that 74 had heard about natural hormones and 37
had used natural hormones. Nineteen women who had heard about
natural hormones believed that natural meant “not synthetic/not
man-made/no chemicals” and 45% thought the term meant
plant-derived. Only 11% agreed that natural meant “identical to
human hormones.” Greater than two-thirds (71.4%) of respondents
believed that natural hormones had fewer risks than
pharmaceutical hormones 44). In a second small survey conducted
among a similar demographic population of postmenopausal
women at compounding pharmacies prior to the WHI published
results, the majority of women reported that they believed that
BHT was equal to or better than HT in efficacy and thought BHT
4) Dong quai
Dong quai is used in China and Korea to treat the female
reproductive system and support for menopausal complaints 30,31).
Dong quai is believed to act by enhancing endogenous estrogen
production 32). A study performed by Hirata et al. showed no
difference in the reduction of menopausal symptoms between
placebo and the Dong quai treatment group 33). In Korean
traditional medicine, some research has demonstrated an
improvement in menopausal complaints by using Dong quai 34),
but more scientific studies about its molecular-based mechanisms
are needed.
Dong quai contains coumarins, and may potentiate the activity
of warfarin. Women with estrogen-sensitive cancers should be
advised to avoid Dong quai as in vitro studies have yielded
conflicting information regarding its estrogenic profile 32).
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Anti-Aging Medicine in Korea
popular formula are available not only at compounding
pharmacies with a prescription, but also OTC at health stores and
from mail-order companies. The quality of these products,
however, varies considerably (some lack bioactive hormones
altogether). Although some proponents of this therapy claim that
progesterone cream is sufficient to eradicate climacteric symptoms,
prevent osteoporosis, improve the lipid profile, and reduce mood
changes 56,57), scientific evidence shows that currently available
creams containing progesterone (compounded and OTC) are not
able to fulfill the necessary criteria to be used in conjunction with
HT 58). A randomized, placebo-controlled, prospective, doubleblind study comprised of 80 patients showed transdermal
progesterone (32 mg/day) did not induce detectable changes in
vasomotor symptoms, mood characteristics, or sexual feelings 58).
The authors suggest that commonly used doses of transdermal
progesterone cream do not allow sufficient amounts of hormone to
enter the body to achieve a biological effect. The safety and
efficacy of testosterone administration have been evaluated in a
number of studies varying in size. In a randomized, parallel-group
study conducted in 20 women dissatisfied with their estradiol or
estradiol/MPA therapy, the efficacy of conjugated estrogens (CE)
alone was compared with CE/testosterone 59). The authors
concluded that combined CE/methyl testosterone therapy
significantly improved the sexual drive compared with previous
estradiol therapy and post-placebo baseline assessments. The
combined therapy significantly increased the concentration of
bio-available testosterone, as well as the scores measuring sexual
interest or desire and frequency of desire. These values were found
to be significantly greater than those achieved with equine
estrogens (EE) alone. Estrogen/testosterone therapy has also been
suggested to increase lean body mass, while decreasing fat mass
compared with estradiol treatment alone 60).
posed fewer or no safety risks. Not surprisingly, based on the
majority of their beliefs and the location of the survey, most had
switched from HT to compounded BHT 45)
Popular books have contributed to misconceptions about
hormones. Actress Suzanne Somers has published three books
promoting BHT in 3 years. In her latest book, Ageless: the Naked
Truth About Bioidentical Hormones, Somers states, “Hormones
are our life force; the decline of hormones is the hallmark of aging;”
“Without hormone replacement, we will end up mere shells of our
former selves;” and “Disease doesn’t develop when hormones are
in perfect balance.” 44-46).
Despite developing breast cancer and undergoing a
hysterectomy for endometrial hyperplasia while taking
bioidentical hormones, Somers remains a hormone enthusiast.
Several physicians promote these hormones. Erica Schwartz, MD,
author of The Hormone Solution: Naturally Alleviate Symptoms of
Hormone Imbalance from Adolescence Through Menopause and
The 30-Day Natural Hormone Plan: Look and Feel Young Again
—Without Synthetic HRT, evaluates patients through telephone
interviews and prescribes hormone treatment. Schwartz states on
her web site that “‘Natural’ bioidentical hormones are exactly the
same as the hormones your body made when you were younger
except they don’t have the same adverse side effects commonly
associated with ‘synthetic’ hormone replacement therapy.” 44,47).
1) Efficacy of BHT
There are no large, prospective, well-controlled clinical trials
to date that address the most commonly compounded ratios and
mixtures of estrogens, such as triest and biest. A substantial body
of clinical evidence, primarily based on branded HT products in
both the United States and Europe, support the use of estradiol in
the treatment of the most common vasomotor-related complaints,
including hot flushes and night sweats; different administrative
forms and preparations appear to provide significant
dose-dependent relief, as demonstrated in randomized,
double-blind, placebo-controlled clinical trials 48,49). Similarly,
well-controlled, randomized trials support the efficacy of
estradiol in preventing menopause-associated bone loss through
various routes of administration 50,51).
In another study, Yang et al. found that 2 mg/day of estriol
succinate improved climacteric symptoms, but failed to prevent
bone loss among 20 Chinese women in a 2-year, open-label,
non-placebo-controlled study 52). This finding was consistent with
another open-label, non-placebo-controlled study reported by
Takahashi et al. 53) of 68 Japanese women administered estriol
cyclically (4 weeks on and 1 week off) during continuous calcium
lactate (104 mg/day) administration, which reported safe, effective
relief of vasomotor symptoms, no effect on lipid levels, and no
effect on markers for bone metabolism during a 50-week period.
In a third double-blind study, estriol hemisuccinate (12 mg/day)
did not appreciably prevent bone loss in 28 postmenopausal
women, leading the study authors to conclude that doses of 14
mg/day are required for efficacy 52). In this same study, estriol (4
mg daily), was ineffective in controlling postmenopausal
symptoms; 35% of the patients required a 14 mg dose, and 5
patients were dissatisfied even with that dose 53,54).
BHT advocates claim that although progestin significantly
differs from endogenous progesterone in both its molecular
structure and function, bioidentical formulations of this steroid are
natural, and therefore more effective and safer than the latter.
Historically, however, the oral administration of progesterone has
been considered ineffective because of its poor gastrointestinal
absorption and short half-life 55). Transdermal creams with a very
2) Risk of BHT
(1) Risk of endometrial (EM) hyperplasia
Compounding chemists can “hand make” pharmaceuticals in
novel delivery systems. Currently, these compounds are not
directly regulated by the Therapeutic Goods Administration. Thus,
little is known about quality control, pharmacokinetics, safety and
efficacy of these treatments. Compounded HT is often termed
“bioidentical” HT. Typically, BHT contains three estrogens
(estrone, estradiol, and estriol), progesterone, and androgens, such
as testosterone and DHEA, and is usually given either as a cream
rubbed onto the skin or as troches. Often, BHT is monitored using
blood or salivary levels of sex hormones. If the dose of
progesterone is insufficient to prevent estrogen-induced EM
hyperplasia, consequently these treatments can lead to endometrial
carcinoma. When testing new HT regimens, endometrial
assessment is one of the most important safety endpoints. Three
cases reported here raise the possibility that the estrogen
component of the troche was significantly absorbed, but the dose
of progesterone was inadequate, thereby causing EM hyperplasia
61).
(2) Risk of breast cancer
Estriol is believed by BHT proponents to decrease breast
cancer risk. However, six of 24 subjects with breast cancer who
took estriol developed metastases, and 2 developed EM
hyperplasia 33). High levels of endogenous estradiol and estrone
are associated with an increased breast cancer risk 44,62-67), and
estriol has also been implicated in increased risk. In breast cancer
cell lines, estriol stimulates breast cancer cell growth more than
other estrogens. Breast tissue from women with breast cancer,
98
compared to women without breast cancer, contains higher levels
of estriol, estrone, and estradiol 44).
3) Ethical problems with BHT
One of the central ethical problems with BHT surrounds the
principle of respect for persons and the doctrine of informed
consent. The doctrine of informed consent demands that patients
have the genuine capacity to understand and appreciate the
potential risks and benefits of their therapies, and other available
options 68). However, as with Somer’s book (one of the best-selling
books in 2006 and 2007) and the internet, which are the main
sources of misguided beliefs, BHT enthusiasts urge that extracted
porcine and bovine hormones used in BHT are much safer than
HT because it is from nature. They also point out that human
hormones, as used in HT, are artificially made from genetic
engineering and are somewhat less secure than the ‘natural’
hormone extracts. Somers, who touts BHT for ovarian hormone
replacement, advises that porcine thyroid hormone is superior to
bioidentical thyroid hormone (levothyroxine) because it is ‘natural.’
It is easily believed that synthetic hormones have more side effects
than the extracted hormones merely because it is synthetic. This
irrational superstition is the result of biased manipulations and
inappropriate information by CAM practitioners and marketing
advisors. They use this misconception to sell their products. When
statements about BHT are inaccurate or misleading, informed
consent cannot take place. Finally, it remains problematic that the
majority of BHT patients do not understand and appreciate the
differences between standard of care and innovative therapies.
Among the numerous CAM methods, there are but also
methods without drugs. Exercise has proved to have the protective
effect against hormone-related cancer. However, exercise does not
reduce any other menopausal symptoms, like hot flushes or night
sweats 69,70).
Other than exercising, caloric restriction, and weight reduction,
the rest of this field is now known as mind-body medicine, which
includes respiratory training, relaxation training, reflexology, and
biofeedback. Mind-body medicine uses the means of meditation,
guided imagery, biofeedback and autogenic training, breathing and
movement, and self-expression through words and drawings to
achieve self-care and stress management 71). It is also used in
psychiatric fields to treat post-traumatic stress disorder 71);
moreover, it has alleviated menopausal symptoms. Consequently,
lifestyle and behavioral interventions have become a popular
prescription for relief of menopausal symptoms 25). One
randomized, controlled trial has demonstrated a significant
improvement in menopausal symptoms in breast cancer survivors
following comprehensive menopausal assessment and counseling
by a nurse 72). There is another popular CAM, mind-body medicine
(homeopathy). It has roots in the Oriental medical philosophy.
Homeopathic therapy uses drugs that contain natural ingredients or
diluted ingredients for promoting self-healing and self-repair. Is it
useful for climacteric women? The answer is ‘maybe.’ Bordet et al.
conducted a study involving 438 postmenopausal women aged 45
years or older, and suggested that homeopathic therapy reduced
hot flushes significantly and the symptoms of 90% of patients
were reduced or disappeared within 15 days 73). However, a
randomized controlled trial in needed to verify the efficacy of
homeopathic therapy. Thompson and Reilly suggested
homeopathy may help breast cancer survivors suffering from
menopausal symptoms 74). A randomized, double-blind controlled
trial showed no difference between the homeopathy and control
groups. However, the advantage of homeopathy is compliance and
the fact that there are no side effects. Homeopathy can serve as an
alternative therapy when HT is contraindicated. Although, this
field is not based on sufficient results, homeopathic therapy is
trusted by many early stage patients, and seems to have an
enormous potential.
During research, it seems obvious that the interests of many
women have converged upon anti-aging ‘outward’. A number of
dermatologic, plastic surgery, and ophthalmologic clinics at the
Anti-Aging Expo has verified that point. Dermatologic clinics
vigorously advertise laser procedures which can be done for face
lifts, skin firming, chloasmata relief, overweight management, and
skin peelings. They even have various cosmetic products under
their own clinic names. In ophthalmologic clinics, surgical
reversal of presbyopia (SRP) and cosmetic eye whitening
procedures are the main advertising materials. Also, in plastic
surgery clinics, fillers, prosthetics, structural fat graft, and
numerous facial lift surgeries are representative of surgical
procedures of anti-aging. Through this exhibition, a number of
anti-aging procedures available in Korea were investigated.
Conclusions
Aging is an important health care issue in Korea. Women
represent a greater proportion than men in the aging population.
Therefore, anti-aging for women will definitely be a huge market
for anti-aging medicine, and may even play a role in scholastic
breakthroughs.
CAM is thought to increase its market share in the future. It is
no longer possible for doctors to practice medicine without CAM.
Most patients who visit a doctor’s office ask about CAM, visit
CAM practitioners, or purchase CAM products. In addition, a
portion of CAM is now used as clinical procedures. For example,
CAM is proven to decrease or diminish vasomotor symptoms,
sleep disorders, and CNS symptoms with help from clonidine and
SSRIs 25), and an increasingly greater number of clinicians
incorporate these findings into their clinical procedures. However,
the supporting evidence is insufficient; clinical trials must be done
quantitatively and also qualitatively. Every CAM practice should
be evaluated for risks and benefits. Moreover, menopausal
symptoms vary between human races; specifically, Caucasians
have hot flushes, and Asians have joint pains, therefore bioactive
phytoestrogen agents (soy extract, evening primrose oil, black
cohosh, and Dong qaui) should be verified regarding ethnic
differences.
Acknowledgements
This is a product of 2009 Elective Coursework ‘Perspectives
in future medicine for female reproduction and aging management’
in Senior Year Curriculum at Seoul National University College of
Medicine.
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Anti-Aging Medicine in Korea
References
1) Fries JF: Aging, illness, and health policy: implications of the
compression of morbidity. Perspect Biol Med 31; 407-428: 1988
2) Ku BS: Antiaging medicine-basic principle and clinical practice. 1st
ed, Calvin books, Seoul, Korea: 2003
3) Hong CD: Complementary and alternative medicine in Korea: current
status and future prospect. Seoul J Altern Complement Med 7;
S33-40: 2001
4) Dooley M: Complementary therapy and obstetrics and gynaecology: a
time to intergrate. Curr Opin Obstet Gynecol 18; 648-652: 2006
5) Foster DF, Phillips RS, Hamel MB, et al: Alternative medicine use in
older Americans. J Am Geriatr Soc 48; 1560-1565: 2000
6) Loera JA, Black SA, Markides KS, et al: The use of herbal medicine
by older Mexican Americans. J Gerontol Med Sci 56; M714-718:
2001
7) Astin JA, Pelletier KR, Marie A, et al: Complementary and alternative
medicine use among elderly persons: one year analysis of blue shield
Medicare supplement. J Gerontol Med Sci 55A; M4-9: 2000
8) Flaherty JH, Takahashi R, Toeh J, et al: Use of alternative therapies in
older outpatients in the United states and Japan:prevalence, reporting
patterns, and perceived effectiveness. J Gerontol Med Sci 56A;
M650-655: 2001
9) Legato MJ: Eve’s rib: the new science of gender-specific medicine
and how it can save your life. 1st ed, Harmony books, New York: 2002.
10) Cauley JA, Robbins J, Chen Z, et al: Effects of estrogen plus
progestin on risk of fracture and bone mineral density: the Women’s
Health Initiative randomized trial. JAMA 290; 1729-1738: 2003
11) Jackson RD, Wactawski-Wende J, LaCroix AZ, et al: Effects of
conjugated equine estrogen on risk of fractures and BMD in
postmenopausal women with hysterectomy: results from the women's
health initiative randomized trial. J Bone Miner Res 21; 817-828:
2006
12) Butler RN, Fossel M, Harman SM, et al: Is there an antiaging
medicine? Gerontol A Biol Sci Med Sci 57; B333-338: 2002.
13) Nelson HD, Humphrey LL, Nygren P, et al: Postmenopausal hormone
replacement therapy : scientific review. JAMA 288; 872-881: 2002
14) Ettinger B, Friedman GD, Bush T, et al: Reduced mortality associated
with long term postmenopausal estrogen therapy. Obstet Gynecol 87;
6-12: 1996
15) Grodstein F, Manson JE, Stampfer MJ: Postmenopausal hormone use
and secondary prevention of coronary events in the nurse’s health
study. A prospective. Observational study. Ann Intern Med 135; 1-8:
2001
16) Grodstein F, Stampfer MJ, Colditz GA, et al: Postmenopausal
hormone therapy and mortality. N Engl J Med 336; 1769-1775: 1997
17) Schairer C, Adami Ho, Hoover R, et al: Cause-specific mortality in
women receiving hormone replacement therapy. Epidemiol 8; 59-65:
1997
18) LeBlanc ES, Janowsky J, Chan BKS, et al: Hormone replacement
therapy and cognition-systematic review and meta-analysis. JAMA
285; 1489-1499: 2001
19) Shumaker SA, Legault C, Rapp SR, et al: Estrogen plus progestin and
the incidence of dementia and mild cognitive impairment in
postmenopausal women: the Women’s Health initiative Memory
study: a randomized controlled trial. JAMA 289; 2651-2662: 2003
20) Rapp SR, Espeland MA, Shumaker SA, et al: Effect of estrogen plus
progestin on global cognitive function in postmenopausal women: the
Women’s Health Initiative Memory Study: a randomized controlled
trial. JAMA 289: 2663-2672: 2003
21) Park YM, Choi H, Lee HK: The HRT Awareness and Acceptance
in Korean Postmenopausal Women - Results of Korean Gallup
Epidemiologic Survey on Menopause and HRT. J Korean Soc
Menopause 81; 3-18: 2002
22) Jeon SH: Phytoestrogen, solution for women’s climacteric period. The
Weekly Han-guk, Seoul, Korea: 2008 Feb 28.
23) Setchell KD: Phytoestrogens: the biochemistry, physiology, and
implications for human health of soy isoflavone. Am J Clin Nutr 68;
1333S-1336: 1998
24) Bieber EJ, Gell JS: Complementary and alternative medicine in the
perimenoapuse and menopause. In: Yuan CS, Bieber EJ, editors.
Textbook of Complementary and Alternative medicine. 1st ed, Taylor
100
& Francis, New York, 319-330: 2002
25) Wong VC, Lim CE, Luo X, et al: Current alternative and
complementary therapies used in menopause. Gynecol Endocrinol 25;
166-174: 2009
26) Pockaj BA, Gallagher JG, Loprinzi CL, et al: Phase III double-blind,
randomized, placebo-controlled crossover trial of black cohosh in the
management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol 24;
2836-2841: 2006
27) Jacobson JS, Troxel AB, Evans J, et al: Randomized trial of black
cohosh for the treatment of hot flashes among women with a history
of breast cancer. J Clin Oncol 19; 2739-2745: 2001
28) Wang LQ: Mammalian phytoestrogens: enterodiol and enterolactone.
J Chromatogr B Analyt Technol Biomed Life Sci 777; 289-309: 2002
29) Duffy C, Perez K, Partridge A: Implications of phytoestrogen intake
for breast cancer. CA Cancer J Clin 57; 260-277: 2007
30) Kang H, Ansbacher R, Hammoud M: Use of alternative and
complementary medicine in menopause. Int J Gynaecol Obstet 79;
195-207: 2002
31) Geller S, Studee L: Contemporary alternative to plant estrogens for
menopause. Maturiitas 55; 3-13: 2006
32) Amato P. Christophe S. Mellon P: Estrogenic activities of herbs
commonly used as remedies for menopausal symptoms. Menopause 9;
145-150: 2002
33) Hirata JD, Swiersz LM, Zell B, et al: Does dong quai have estrogenc
effects in postmenopausal women? Fertil Steril 68; 981-986: 1997
34) Park JM, Yang JM, Kim DI: A clinical trial to verity the quality of life
improvement efficacy of Dangguijakyak-san and Gyejibongnyeong-hwan
granulation in postmenopausal women. J Soc Oriental Ob Gyn 20;
213-228: 2007
35) Noh HT, Son SK, Ko JH, et al. Clinical efficacy of Korean Red
Ginseng on postmenopausal syndrome. J Korean Soc Menopause. 8;
46-58: 2002
36) McBane S: Easing Vasomotor symptoms: besides HRT, what works?
JAAPA 21; 26-32: 2008
37) Wiklund IK, Mattsson LA, Lindgren R. et al: Effects of a
standardized ginseng extract on quality of life and physiological
parameters In symptomatic postmenopausal women, a double-blind,
placebo-controlled trial. Int J Clin Pharmacol Res 19; 89-99: 1999
38) Nedrow A, Miller J, Walker M, et al: Complementary and alternative
therapies for the management of menopause related symptoms: a
systematic evidence review. Arch Intern Med 166; 1453-1465: 2006
39) Hartley D, Elsabagh S, Se F: Gincosan (a combination of Gingko
biloba and ppanax ginseng) : the effects on mood and cognition of 6
and 12 weeks’ treatment in post-menopausal women. Nutr Neurosci 7;
325-333: 2004
40) Chenoy R, Hussain S, Tayob Y, et al: Effect of oral gamolenic acid
from evening primrose oil on menopausal flushing. BMJ 308;
501-503: 2004
41) Boothby LA, Doering PL, Kipersztok S: Bioidentical hormone
therapy: a review. Menopause 11; 356-367: 2004
42) Stefanick ML: Estrogens and progestins: Background and history,
trends in use, and guidelines and regimens approved by the US Food
and Drug Administration. Am J Med 118; 64-73: 2005
43) Campbell S: Bioidentical hormones; Achieving the perfect fit. Adv
Nurse Pract 14; 25-29: 2006
44) Fugh-Berman A, Bythrow J: Bioidentical hormones for menopausal
hormone therapy: variation on a theme. J Gen Intern Med 22;
1030-1034: 2007
45) Adams C, Cannell S: Women’s beliefs about “natural” hormones and
natural hormone replacement therapy. Menopause 8; 433-440: 2001
46) Sommers S: Ageless: the naked truth about bioidentical hormones. 1st
ed, Crown Publishers, New York: 2006
47) Erika.com. Available at http://www.drerika.com/index.aspx. Accessed
8 Oct 2009.
48) Notelovitz M, Lenihan JP Jr, McDermott M, et al: Initial 17-estradiol
dose for treating vasomotor symptoms. Obstet Gynecol 95; 726-731:
2000
49) Mattsson LA, Bohnet HG, Gredmark T, et al: Continuous, combined
hormone replacement: randomized comparison of transdermal and
oral preparations. Obstet Gynecol 94; 61-65: 1999
50) Ettinger B, Ensrud KE, Wallace R, et al: Effects of ultralow-dose
transdermal estradiol on bone mineral density: A randomized clinical
trial. Obstet Gynecol 104; 443-451: 2004
51) Ettinger B, Genant HK, Steiger P, et al: Low-dosage micronized 17
beta-estradiol prevents bone loss in postmenopausal women. Am J
Obstet Gynecol 166; 479-488: 1992
52) Yang TS, Tsan SH, Chang SP, et al: Efficacy and safety of estriol
replacement therapy for climacteric women. Zhonghua Yi Xue Za Zhi
(Taipei) 55; 386-391: 1995
53) Takahashi K, Manabe A, Okada M, et al: Efficacy and safety of oral
estriol for managing postmenopausal symptoms. Maturitas 34;
169-177: 2000
54) Lindsay R, Hart DM, MacLean A, et al: Bone loss during oestriol
therapy in postmenopausal women. Maturitas 1; 279-285: 1979
55) McAuley JW, Kroboth FJ, Kroboth PD: Oral administration of
micronized progesterone: A review and more experience.
Pharmacotherapy 16; 453-457: 1996
56) Lee JR: Use of Pro-Gest cream in postmenopausal women. Lancet
352; 905: 1998.
57) Wetzel W: Human identical hormones: real people, real problems, real
solutions. Nurse Pract Forum 9; 227-234: 1998
58) Wren BG, Champion SM, Willetts K, et al: Progesterone creams: Do
they work? Menopause 10; 13-18: 2003
59) Sarrel P, Dobay B, Wiita B: Estrogen and estrogen-androgen
replacement in postmenopausal women dissatisfied with
estrogen-only therapy. Sexual behavior and neuroendocrine responses.
J Reprod Med 43; 847-856: 1998
60) Dobs AS, Nguyen T, Pace C, et al: Roberts CP. Differential effects of
oral estrogen versus oral estrogen-androgen replacement therapy on
body composition in postmenopausal women. J Clin Endocrinol
Metab 87; 1509-1516: 2002
61) Eden JA, Hacker NF, Fortune M: Three cases of endometrial cancer
associated with “bioidentical” hormone replacement therapy. Med J
Aust 187; 244-245: 2007
62) Endogenous Hormones and Breast Cancer Collaborative Group:
Endogenous sex hormones and breast cancer in postmenopausal
women: reanalysis of nine prospective studies. J Natl Cancer Inst 94;
606-616: 2002
101
63) Zeleniuch-Jacquotte A, Shore RE, Koenig KL, et al: Postmenopausal
levels of oestrogen, androgen, and SHBG and breast cancer:
long-term results of a prospective study. Br J Cancer 90; 153-159:
2004
64) Manjer J, Johansson R, Berglund G, et al: Postmenopausal breast
cancer risk in relation to sex steroid hormones, prolactin and SHBG
(Sweden). Cancer Causes Control 14; 599-607: 2003
65) Key TJ, Appleby PN, Reeves GK, et al: Body mass index, serum sex
hormones, and breast cancer risk in postmenopausal women. J Natl
Cancer Inst 95; 1218-1226: 2003
66) Onland-Moret NC, Kaaks R, van Noord PA, et al. Urinary
endogenous sex hormone levels and the risk of postmenopausal breast
cancer. Br J Cancer 88; 1394-1399: 2003
67) Yu H, Shu XO, Shi R, et al. Plasma sex steroid hormones and breast
cancer risk in Chinese women. Int J Cancer 105; 92-97: 2003
68) Etchells E, Sharpe G, Elliott C, et al: Bioethics for clinicians: 3.
Capacity. CMAJ 155; 657-661: 1996
69) Daley A, Macarthur C, Mutrie N, et al: Exercise for vasomotor
menopausal symptoms. Cochrane Database Syst Rev 4; CD006108:
2007
70) Schmitz KH, Warren M, Rundle AG, et al: Exercise effect on
Oxidative Stress Is Independent of Change in estrogen Metabolism.
Cancer Epidemiol Biomarkers Prev 17; 220-223: 2008
71) The center of mind body medicine:
http://www.cmbm.org/holistic_medicine_PROFESSIONAL_TRAINI
NG_EDUCATION/mind_body_medicine_description.php
72) Ganz PA, Greendale GA, Peterson L, et al: Managing menopausal
symptoms in breast cancer survivors: results of randomized controlled
trial. J Natl Cancer Inst 92; 1054-1064: 2000
73) Bordet MF, Colas A, Marijnen P, et al: Treating hot flushes in
menopausal women with homeopathic treatment--results of an
observational study. Homeopathy 97; 10-15: 2008
74) Thompson EA, Reilly D: The homeopathic approach to the treatment
of symptoms of oestrogen withdrawal in breast cancer patients. A
prospective observational study. Homeopathy 92; 131-134: 2003