Brief Answer:
Do not recommend to use black cohosh...

Detailed Answer:
Hi,

Hot flushes and intense perspiration are indeed, signs of menopause. Primerose evening is a good choice to reduce these symptoms, especially when it comes to breast pain. The optimal dosage is up to 2 grams/day; the maximum up to 4 grams/day.

Now, in your case, you have a history of subarachnoid brain hemorrhage. One of the side effects of primrose oil is increasing the chances for bleeding. This is my big concern in your case.

I do not recommend to take black cohosh taking into consideration your current health problems.

Vitamin E is a good choice as an anti-oxidant for liver detox. However, I recommend to evaluate the current liver condition first before deciding if you need vit.E supplementation:
- abdominal ultrasound
- liver enzymes

Having fatigue might be related to Prozac side effects. Usually, antidepressants use is associated with fatigue.

You should get further examined sinusitis and frequent headaches to evaluate possible changes to the site of brain hemorrhage.

Hope it answered to your queries!
Dr.Albana

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Brief Answer:
Following answers to your queries...

Detailed Answer:
Hi back XXXX

Thank you for following up questions.

1. I understand black cohosh being effective in reducing your hot flushes. I do not deny this affect. But, you have a previous history of brain hemorrhage. Since black cohosh is altering blood clotting properties, I would be very cautious in advising to take it.

However, I do not know the exact cause of hemorrhage:
- blood clot problems
- blood vessels issues
- high blood pressure
- trauma?
- others?

It is also true that black cohosh is shown safe if used regularly for up to 1 year (studies have confirmed this); but, I want to make sure that black cohosh is not altering your blood-clotting properties. So, regular blood clot testing are advised to prevent any other bleeding episode.

Next, you are also using Crestor, which is statin used to lower high blood cholesterol. It will affect your body muscles, and alter liver enzymes (as already mentioned earlier). Black cohosh has another bad side effect on altering liver function. At the end, I would suggest 2 alternatives:
- stop Crestor
- continue black cohosh
- routine liver/blood clot testing (every month, every 3 months or every 6 months according to the results).

You can discuss this with your doctor too.

2. Usually, menopause is also associated with breast changes due to hormonal oscillations (slight inflammation, - not infection). You might not feel a proper pain, but, you can feel your breast tender than usual. Or you might feel nothing at all. That is perfectly normal.

Primrose oil contain omega-6-fatty acids: linoleic acid (LA) and gamma-linolenic acid (GLA). The only good fatty acid here is GLA which is thought to be fighting inflammation, stimulate metabolism and improving reproductive function.

To my opinion, if you decide to go for black cohosh, you can take it but run the above mentioned tests (be careful). Do not use primrose oil while taking it.

3. Now, with regards to anti-oxidants, there is a long talk. Personally, I agree with Natural Balance.

In other words. Everything comes to a balance. You take primrose oil, a source of omega-6 fatty acids; definitely, you will break this balance. Omega-3 and omega-6 should be in a balance; you take one in excessiveness, the other will lack, and body will suffer; can imagine the other part of the story.

The same happens to the anti-oxidants. Our body has its own mechanisms of self-regulating: if something is wrong (or anti-oxidants are lacking); signals will be given to start producing and secreting others.

In your case, you are breaking this balance: you are taking crestor because of high cholesterol, causing stress to your liver. You are also taking black cohosh adding more stress to your liver. The end result: liver will suffer (inflammation). If the blood tests will result at higher borderline or higher than normal; then, can take anti-oxidants in therapeutic dosage.

I do not recommend using them on regular basis, as if taken in excessiveness, they will cause more harm than good. You take the anti-oxidants using other diet sources and not just supplements. Supplements are needed only when we see that the balance is broken. In your case, you can use them occasionally, not on regular basis.

Hope I answered to your queries!
Dr.Albana

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Brief Answer:
Use Crestor with caution if start taking Loserol..

Detailed Answer:
Hi back XXXX

Thank you for following up.

Now, I should understand what your doctors mean by "overstress":
- is it spike in blood pressure?
- is it atherosclerosis?
- or fragile blood vessels?

As your doctor put on Crestor, this makes me think over atherosclerosis problems caused by high blood cholesterol. That's why it is important to have the tests reports you did (ct-scan of head, etc.) to understand at what extent atherosclerosis has damaged your blood vessels.

If you are having high cholesterol problems, and if doctor though it was due to high cholesterol that lead to brain hemorrhage, I do not advise to stop using it on your own. You can discuss this further with your doctor to understand :
- what happened to you?
- what caused hemorrhage?
- how come overstress caused hemorrhage?
- what's your current situation with blood pressure?

The answers to these questions will help you take the most appropriate decision on what to use.

With regards to herbal supplements for lowering cholesterol, Loserol contains the dry extract of Guggul. To my personal opinion, you can start taking them, but should adjust dose of Crestor as per your blood cholesterol levels.

Apart medications and supplements, it is important to follow a healthy lifestyle and diet regimen. Including other herbs that have lowering cholesterol properties is also advised (garlic, policosanol, artichoke, XXXXXXX turmeric, ginger, etc.).

I usually recommend to take them along with diet and not as a supplement as the dose of supplement is higher than taking from foods/herbs on daily basis.
Thus, the bad effect on liver would be less, while providing natural anti-oxidant properties.

At the end, as it is difficult to find such supplements on the place you live, I always recommend my patients to use local herbs and foods with lowering cholesterol properties.

Hope it answered to your queries!
Dr.Albana

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