Ein Vortrag in Hongkong Sept. 2012

1. Bio-identical Hormones and
Chinese Medicine
for
Women's Health
Dr. Helen Wai-Ngan Ng Schreiber
Hong Kong 1. Sept. 2012

2. Contents
• Introduction: Role and image of women, east & west,
in changing times
• Biology of Hormones
• Physiology of Female Reproductive System
• Clinical aspects, Women's health issues
• Shanyao and Chinese Medicine for Women's Health
• Our clinical study and case examples

3. Hormones
• Chemical messengers (sending signals)
• Produced by cells or a “gland”
• Transferred to “target cells“ with “receptors“
• Binding & activation leads to cell-specific responses
(cell metabolism). Thus the biochemical structure is
decisive!
• Small amounts, big effects on vital functions, also
emotional reactions.

4. Hormone Releasing Glands
Hypothalamus
Pituitary Gland ( anterior, posterior)
Thyroid Gland
Pancreas
Adrenal Glands
Ovaries
Testes

6. List of Human Hormones
e.g.:
Insulin
Thyroid hormones (T4, T3)
Sexual hormones (estrogens, progesterone, testosterone )
Adrenalin
Growth Hormone (GH)
Releasing / Stimulating hormones (from pituitary gland and
Hypothalamus) (TRH, TSH, GnRH, FSH, LH)
Vitamin D …... etc.

7. Hormones, chemical
structure, class and subclass
Chemical class: Peptides / Steroids
Subclass: Thyroid hormones/ catacholamines/
androgens ( 19 C)/ estrogens (18 C) / progestins
(21 C)
Hormones within subclass:
Thyroxin T4/ triiodothyronine T3
Estradiol E2 / Estriol E3/ Estrone E1
Progesterone

9. Cholesterin
Aus Wikipedia die freie
Enzyklopädie©

10. Release & Feedback Mechanisms
TRH (Thyrotropin releasing hormone)
TSH (Thyroid stimulating hormone)
T4 (Thyroxin), T3 (triiodothyronine)
*******
GnRH (Gonadotropin releasing hormone)
FSH (Follicle stimulating hormone)
Estradiol (E2)
LH (Luteinizing hormone)
Progesterone

13. The Female Cycle
„The only constant feature
of the female cycle is
CHANGE.“
(author unknown)
quoted from „Natürliche Hormontherapie“

14. Eisprung(ab 8., ideal 12. – 15. Tag)
1. 14. 15. 28.
day 1 - 14 Estrogendominance Ovulation day 15-28 Progesteronedominance
28 - Day Cycle
©23.6.2012 J.Armbruster

23. Estrogen – the hormone of beauty
• Estradiol (E2) – strongly effects growth
Estriol (E3) – Effects on mucous
membranes and bladder
• Estrone (E1) – the storage Estrogen

24. Estrogen (s)
• Sexual hormonse specific for the female, produced
mainly in the ovaries
• 3 in this subclass are especially important: E1 Estrone, E2
Estradiol, E3 Estriol
• Effect the growth & development of the femal body
• Responsible for the healthy state of the female
reproductive organs and also of the bones, blood
vessels, urinary tract…
• Loosen connective tissues, effect water retention, und fat
accumulation in cells, increase blood clotting

26. Progesterone - “Hormone of
wisdom”
Calls for maturity

27. Progesterone
• Sexually neutral. Produced mainly in the “yellow body” (corpus luteum) of
women & in the placenta during pregnancy. „pro gestra“ = supporting
gestation (pregnancy)
• Precursor for Cortisol, Testosteron & the estrogens. Complementary &
balancing factor of estrogen and terstosterone
• 20% of receptors in the brain, important for emotional balance, improves
concentration, memory and sleep
• Heart and blood vessels, bones, skin and connective tissues. Supports the
thyroid gland
• Increases energy metabolism, excretion of connective tissue fluids,
regulates blood pressure and blood clotting

29. Cholesterin
Aus Wikipedia die freie
Enzyklopädie©

31. Commonly used “false hormones”
• “false estrogens” ( derivatives)
• Ethinyl estradiol
• Estradiol valerate
• “false progesterone” (a progestine)
• Medroxyprogesteron acetate
• Dienogest
• Levonorgestrel

33. Künstliches Pseudohormon Natürliches Progestational
In der Natur nicht
vorkommendes steroidal Ketone des
„ Gestagen“ Menschen
Medroxyprogesteronacetat Progesteron
(pregn-4-ene-3,20-dione,17-(acetyloxy)-6- (pregn-4-ene-3,20-dione)
methyl-,(6 Alpha)-
natürliches, bio-identisches
=synthetisch verändertes nicht bio-
Gelbkörperhormon des Menschen
identisches „Progesteron“
©23.6.2012 J.Armbruster

34. Artificial C-21/ C 19 Gestagene / Progestine
Norgestrel Megestrolacetat Norethindronacetat
More Progestines:
Medroxyprogesteronacetat
Lynestrenol
Norethynodrel
Norethisteron
Nach John Lee, M.D. und Wikipedia Human Progesterone

35. Chemical substances simulating effects of hormones
• The „Anti-Baby Pill“ (contraceptive pill)
• Valette - Ethinylestradiol 0,03 mg.
Dienogest 2 mg
• Belara - Ethinylestradiol 0,03 mg
Chlormadinon acetat 2 mg
• Yasminelle – Ethinylestradiol 0.02 mg
Drospirenon 3 mg

36. Preparations with „false Hormones“
• The „Hormonring“
• Mirena -
Levonorgestrel 0,52 mg ( 0,02 mg/ Tag)
• Nuvaring –
Ethinyestradiol 2,7 mg (0,015 mg / Tag)
Etonogetrel 11,7 mg (0,12 mg / Tag)
Visanne 2 mg – Dienogest 2 mg

37. Substances used in „HRT“
- Progestines (e.g. Provera) + CEE (conjugated
equine estrogens)
- Premarin = pregnant mares urin (CEE) (Presomin)
- pills, injections, suppositories, subdermal
implants, skin patches, gels
- dosages, systemic / lokal effects, side effects,
constant/ cyclical level of hormones in blood
- oral intake estrogens: increased risk of
thrombosis, especially ethinyl estradiol (pill)

38. Bioidentical Hormones
• Biochemical structures are identical with our own
hormones in the body
• When applied properly – gentle and without side effects
• Over 70 years of experience: (Dr. K. Dalton, Dr. John Lee,
Dr Michael Platt, Dr. V. Rimkus, Frau Dr. A.
Scheuernstuhl), no known side effects
• from Diosgenin, extracted from the roots of the mexican
wild yams (Dioscorea villosa)

42. 7 Decades in the life of a Woman
 Childhood
 Puberty
 Young womanhood
 Middle age
 Old age
 Senile

43. Developments and Roles of the Female
• 经 jing Menstruation
• 孕yun Pregnancy
• 产chan Birth
• 育 yu Nursing, education

44. Disturbances of Menstruation
• Onset of puberty – early/ late? Amenorrhea
• Irregular cycles – too short, too long
• Irregular bleeding – too little, too much
• Premenstrual Syndrom (PMS) – lower abdomenal pains,
tension in the breast, mood changes (Estrogen
dominance)
• Related problem of puberty: acne

45. Effects of the contraceptive Pill
 2 components: an estrogen derivative (e.g. ethinyl estradiol,
estradiol valerate), a progestine
 The two hormone like chemicals turn off the production of
FSH and LH through the feedback mechanism on the pituitary
gland – no ovulation! (purpose of contraception)
 Thus no „Yellow body“ & no production of progesterone.
Consequences of Progesterone deficiency
 They simulate the effects of estradiol and progesterone on
the uterus, giving rise to an artificial menstrual bleeding

47. Amenorrhea, Infertility
• Delayed maturity
• Consequence of the pill
. Psychic and emotional Stress
• Thyroid function deficiency
• Other chronic illnesses
• TCM: Kidney deficiency, cold

48. Disturbances of Pregnancy
 Pregnancy sickness (Progesterone
 Habitual Abortion Deficiency)
 Water retention
 Excessive weight gain
 Increased blood pressure
 Gestational diabetes
 Postnatal depression

49. Other gynaecological problems
 Ovarian Cysts (PCOS) (Estrogen-
 Uterine Myoma dominance)
 Prolapse (Stress incontinence)
 Tumor (* breast cancer, ovarian Ca)

50. Climacterium / Menopause
• A natural stage of life
• Decrease of important hormones of the body
• Symptomes, perception, feelings, attitudes
• „ Women in middle age should not be sad – also in
history there came after the Middle Ages the New Age !“
• Indications for treatment

51. Symptoms of hormonal imbalance
 Mood changes, depressive, irritable, loss of interest and
joy
 General feelings of unwell, undue tiredness, not coping
with life
 Sleep disturbances, insomnia
 Hot flushes, excessive sweating, night sweats
 Oedema, generalised swelling
 Headaches, generalised muscle and join pains
 Nervous anxiety, panic attacks, heart complaints

52. Hormone Replacement Therapy (HRT)
- Treatment of surgically, peri- and post- menopausal women,
for discomfort caused by diminished circulating estrogen and
progesterone hormones
- Mixtures of conjugated equine estrogens (CEE) and
progestins vs. “unopposed estrogen therapy”
- Via patches, tablets, creams, troches, IUDs, vaginal rings, gels
or injections
- “sequentially” vs. “continuous” combined HRT
- Side effects: Headache, weight changes, fluid retention,
changes in menstrual flow

53. Women's Health Initiative (WHI)
- Initiated by the US NIH in 1991
- Study effects of HRT: CEE + Progestin,
CEE only (women after hysterectomy)
- Findings: subjects had a greater incidence
of coronary heart disease, breast cancer,
stroke, pulm. Embolism
- Trial was ended in 2002

54. Bioidentical Hormones
• Biochemical structures are identical with our own
hormones in the body
• When applied properly – gentle and without side effects
• Over 70 years of experience: (UK: Dr. K. Dalton, USA: Dr.
John Lee, Dr Michael Platt, Germany: Dr. V. Rimkus, Dr.
A. Scheuernstuhl), no known side effects
• from Diosgenin, extracted from the roots of the mexican
wild yams (Dioscorea villosa)

58. Bioidentical Hormones
 Extraction from Mexican Yams roots: Diosgenin
 Further process in lab to give Progesterone
 Further process in lab from Progesterone to other
hormones e.g. estradiol
 Dispensed according to individual prescription by
„compound pharmacies“
 Available as cremes, gels, capsules, troches
(sublingual, oral, transdermal application)

59. Bioidentical Hormone Replacement
Therapy (BHRT)
 Examples:
 Progesterone cream 3%, 5%, 10%
 Progesterone capsules 50 mg. ( 1 – 2 / day)
 Estradiol capsules 0.1 mg., 0.2 mg. (1 – 2 /day)
 DHEA capsules 5 mg., 6 mg. (1 / day)
 Testosteron cream 1%, 5 %, 10 %

61. Yang Yin
Man Woman

64. Physiological Characteristics
以 血 为 本 Xue (Blood ) is the basis
以 血 为 用 Xue is consumed
阴 常 不 足 Yin is often not enough
阳 常 有 余 Yang is often in (relative) excess

66. TCM Diagnosis 中医辨症
八钢
Yin 阴 / Yang 阳
internal 里 / external 表
cold 寒 / warm 热
deficiency虚 / fullness 实

67. 中医辨症
• 脏腑: 脾 (三阴交, 血海, 阴陵泉)
• 肾 (太溪, 照海)
• 肝 (太冲)
• 卫,气,营,血: 气 血
• 经络: 任脉 (关元, 气海)
• 冲脉

68. women’s health problems, TCM
coldness ! 寒
younger women:
• Qi deficiency (spleen, kidney) 气虚
• Qi Stagnation ( Liver Qi) (PMS) 肝气郁
• elderly women:
• Xue (Blood) deficiency血虚
• Xue Stagnation 血滞
• Yin deficiency ( Liver, kidney) 阴虚

69. 辨症论治
• 驱寒 温阳 (艾灸, 付子, 肉桂)
• 健脾 滋阴 (淮山药, 熟地, 杞子)
• 补血 活血 (当归, 川芎)
• 疏肝 解郁 (白芍药, 玟瑰花)

70. Treatment with TCM
四 物汤 (Si Wu Tang, Dekot der 4 Bestandteile)
1) Dang gui (Angelika sinensis) 当归
2) Chuan xiong (Ligustici chuanxiong) 川芎
3) Shu di huang (Rehmanniae prep.) 熟地黄
4) Bai shao (Paeonia alba) 白芍药

71. Angelicae sinensis radix
Xue erhaltend und ergänzend. Warm. Emporhebend.
Leber Milz Herz Unterer Erwärmer
18.08.12 Dres. Helen Wai-Ngan und 71

72. • Chuanxiong (Xue
bewegendes Mittel)

73. • Shudihuang (Yin
stützendes Mittel)

74. Paeoniae lactiflorae radix
Xue erhaltend und ergänzend. Neutral / Kalt, absenkend.
Leber (Qi Stagnation lösend), Milz
18.08.12 Dres. Helen Wai-Ngan und Tiefe, Unterer Erwärmer
Die 74

75. TCM Treatment principles
Effects of the 4 components of Si Wu Tang:
1) Nourish Xue 补血
(also nourish Qi , Ma36 足三里, Ma30气冲, Le3太冲,
MP6 三阴交, Bl17, Bl18….)
2) Activate Xue (Xue Stase lösen) 活血
MP10 血海, MP1 隐白
3) Nourish (kidney & liver)Yin 滋(肾肝)阴
KG3关气, KG4气海, (Moxa), Ni7 复留
4) remove Liver Qi Stagnation解(肝气)郁
Gb足临 泣41, Gb34阳陵泉, KS6内关, Xi Punkte

78. Rosae flos
besänftigt die Leber, löst Stagnation
18.08.12 Dres. Helen Wai-Ngan und 78

79. • Dioscoreae Rhizoma (Shanyao)
(Yamswurzel)
Yin und Qi stützendes Mittel

81. BHRT / TCM comparison
• Bioidentical Hormontherapy
= Replacement therapy (passive)
填补性治疗
Chinese Medicine (herbal teas, Acupuncture,
• Dietetics) = Regulatory therapy (active)
调理性治疗

82. Our clinical Study 2012
 About 90 patients, 70 + women, 10 men, 8 children
 Hormone profile of 3 groups: thyroid hormones, sexual
hormones (estrogens, progesterone, testosterone), Insulin,
DHEA, cortisol, Andrenalin (blood sample on 21. day of cycle)
 Most common problems: Overweight, gynaecological
symptoms, depressive moods, exhaustion, palpitations,
insomnia
 Findings: low Progesterone levels, Estrogen dominance, Insulin
resistance
 Treatment: BHRT, Progesterone good for moods, PMS,
estrogen good for hot flushes, sweating, balance is important,
Thyroid function also

83. Case example 1 (A.G.)
 23 f, Student (Sport)
 Aug. 11: Mood changes, depressive, irritable; hot flusches,
excessive sweating, since about 2 months
 has the „Nova Ring“ recently, the pill since few years, saliva
test: low progesterone, high testosterone
 No more such symptoms after removal of the ring
 But, amenorrhea still after 1 year
 Recent blood test: low T4
 Treatment: Thyroxin 50 mcg.

84. Case Example 2 (D.R.)
- 50 f., owner of Fitness Studio
- Hysterectomie 12 years ago because of heavy menstrual bleeding,
Myoma
- 2 y. later, hot flushes, sleep disturbance, depressive to aggressive mood
changes, hair loss, weight gain (in spite of sport)
- prescribed different estrogen preparations and pill, T4 75mcg., still
severe depression 2005, weight gain ++
- 2011: discovered the literature about bioidentical hormones, importance
of progesterone
- started treating herself with progesterone creme, stopped estradiol, T4 +
T3, Testosterone cream for stress incontinence. Weight loss.

85. Thank you
For your Attention!