Over the counter herbal products

Herbal remedies for use in menopause

Herbal remedies for use in perimenopause

Herbal remedies are used throughout the world and many have been used for centuries.

Herbs or herb mixtures can be dried and combined with boiling water to make teas (infusions and decoctions), concentrated in alcohol and water to make tinctures or extracts, or made into tablets and powders.

Some women with early menopause may consider herbal remedies as an option for the management of perimenopausal symptoms, such as hot flushes, night sweats and vaginal changes. The range and severity of symptoms vary between women and likewise, the effectiveness of herbal remedies will vary. It is important to note that there is very little research on herbal therapies (and natural therapies) specifically for women with early menopause. Even more so, the long term effects of low oestrogen from an earlier age, such as the effect on bone health, have not been studied with regards to herbal therapies. Women with early menopause need to consider this when considering herbal therapies as part of their management of symptoms, and discuss the possible need for additional medical treatment and ensure that dietary and lifestyle factors, including adequate calcium, Vitamin D, a diet high in fruit and vegetables and exercise are maintained to help mimimize the risk of osteoporosis and cardiovascular disease.

Not all symptoms experienced by women during early menopause are the result of declining oestrogen levels. Herbal therapies can help to manage mood changes such as anxious thoughts and depressed feelings, as well as help with fatigue and low energy.

Over the counter herbal products

It is important for women buying herbal products over the counter to remember:

• Some of the herbal products available over the counter are not what a traditional herbalist would prescribe. 

• While the quality of some Australian-manufactured herbal medicines made for naturopaths and herbalists is considered excellent, the quality of medicines made for over the counter use may vary. The quality and source of herbal remedies purchased over the internet may be also be questionable.

• Some herbal products may contain herbs which should not be used in conjunction with pharmaceutical hormone therapies but do not carry any warning. 

• Experimenting with over the counter preparations may be more costly than seeing a trained herbalist / naturopath.

The best way to use herbal remedies for the treatment of symptoms at menopause is under the guidance and advice of a trained natural therapist.

Herbal remedies for use in early menopause 

Black Cohosh, Cimicifuga racemosa

Black cohosh is a North American plant which the Native Americans originally used for menstrual cramps and menopausal symptoms. Extracts of the root have been used in Europe, particularly in Germany, for over 50 years. It is primarily used for hot flushes. 

Black cohosh is the most researched of all herbs used for the management of menopausal symptoms. The research on this herb includes animal data, in vitro studies and clinical trials. Almost all of the clinical studies of black cohosh have used the commercially available product. Remifemin. There is very little research on this herb specifically for women experiencing and early menopause, and this research is predomenantly on women with breast cancer/breast cancer survivors.

Of the small number of trials on Black Cohosh and breast cancer survivors, some have shown it to be effective in the treatment of many menopausal symptoms, including hot flushes. It can be combined with other herbs to tailor a formula specifically for hot flushes. It is also used for vaginal dryness, aches and pains associated with menopause, and formication (sensation as if ants crawling on skin), although evidence of benefits in these areas is lacking. 

The herb is generally well tolerated, although higher doses may cause headaches for some women. These usually cease when the dose is reduced.

Black cohosh, taken orally as well as topically (as a cream or pessary), has been shown to be effective for vaginal dryness.

St John's Wort

St John’s Wort is not an oestrogen-like herb and is usually combined with other herbs such as black cohosh for more effective treatment.

St John’s Wort can be useful for hot flushes that are triggered by anxiety or stress. It can also be used for mild to moderate anxiety and depression - specifically depression associated with menopause.

A recent analysis of randomised clinical trials demonstrated that St John's Wort was more effective than a placebo (dummy or sugar treatment) for the treatment of mild to moderately severe depressive disorders, was as effective as standard antidepressant treatment and had fewer side effects.

A natural therapist would seek to find the cause of mood changes and would encourage behavioural, dietary and lifestyle changes, with the use of herbal remedies or nutritional supplements where necessary.

Herbal remedies for use in early menopause 

Red Clover

Red Clover is a herb that in recent years has been promoted for use in perimenopause. Traditionally, herbalists and naturopaths have not used this herb for perimenopausal complaints, but rather for skin conditions like eczema.
Most of the research that has been conducted on Red Clover, is in the form of the over the counter product Promensil. Some of the research suggests that this herb may be beneficial for hot flushes. Other researchers (who have reviewed all Red Clover research) suggest that there is not enough evidence to show that this herb is effective for hot flushes. There are no trials examining the effects of red clover specifically on women with with early menopause.

There are possible benefits from Red Clover for women with early menopause as Promensil has been shown to lower LDL-cholesterol (‘bad’ cholesterol) and triglycerides and increase HDL-cholesterol (good Cholesterol), although again not specifically in women with early menopause. Other researchers suggest that there is not enough evidence to support this. The safety of this herb for patients with breast or endometrial cancer has not been established. There has been one clinical trial over 3 years, where women with a first degree relative with breast cancer, took Promensil, which showed a neutral effect on breast density.

There is also some limited evidence suggesting a possible effect on maintaining bone health and improving blood vessel health which is a risk factor for atherosclerosis (build up of fatty plaque on the arteries which contributes to heart disease) which again may possibly benefit women who experience an early menopause as a preventative strategy. This herb or other phytoestrogens have not been proven to protest against bone fracture or cardiovascular disease.

Hops

Hops contains a potent phytoestrogen which animal research suggests may have great oestrogenic activity than other plant oestrogens. It is prescribed by natural therapists for hot flushes associated with anxiety or stress, and associated insomnia (sleeplessness). A very small clinical trial showed that a hops extract had the same effect as a placebo (dummy pill) for reducing menopausal symptoms after 8 weeks, but improved all symptoms after 16 weeks.

Passionflower, Chamomile, or Valerian

Passionflower, Chamomile, or Valerian in the form of a herbal tea or tablet may also be considered to help with sleeplessness. 

However, in a very small number of people, Valerian has a stimulating effect, rather than inducing sleep.

Panax Ginseng 

Panax Ginseng, a traditional Chinese herb, increases the body's ability to cope with physical and mental stress. The Ginsengs are useful for hot flushes that are aggravated by fatigue and overwork. 

Panax Ginseng increases vitality and physical performance. It may be useful as part of the treatment for night sweats. 

Siberian Ginseng 

Like Panax Ginseng this herb may improve stamina and vitality during times of increased physical and mental demands, though it is generally considered to be less stimulating. It can be taken for a longer time than Panax, over several months. 

Dong Quai

Dong Quai may be useful for hot flushes associated with fatigue and overwork. There is some conflicting evidence from animal and test tube studies that Dong Quai may have some oestrogenic activity and therefore should be avoided by women with early menopause associated with breast cancer.

Licorice

Licorice, may also be used for night sweats. 

(The herb Licorice root should not be confused with confectionery liquorice. Licorice should not be taken long-term or by people with high blood pressure.)

Linseed or Flaxseed

Linseed or flaxseed has been shown to reduce vaginal dryness. Linseeds contain phytoestrogens called lignans. Human and animal studies show an inhibitory effect on breast cancer from linseeds, suggesting that eating linseeds in the diet is considered safe in women with breast cancer.

The recommended dose for ground linseed is 25 g, or about two heaped dessertspoons, which can be sprinkled on breakfast cereals or added to smoothies.

Linseeds are also a good source of the oils we cannot make in our bodies (essential fatty acids).  When seeds are ground, these good oils are lost over time (oxidise) - two weeks after grinding, the oils are completely destroyed.  To avoid the loss of these good oils, it is suggested that you freshly grind the amount of seeds you would eat within two weeks (in a food processor, nut grinding attachment of a blender or an electric coffee grinder) and store in the fridge in an airtight container.

Lavender

Lavender, as a herb rather than as an essential oil, is used to help to clear depression. There are many varieties of Lavender, therefore it is essential that it be prescribed to ensure the correct type. Lavender is a strengthening tonic to the nervous system, and is useful for headaches and migraines, especially those associated with menopause.

Lemon Balm

Lemon balm, used as a herbal tea, has traditionally been considered to 'lighten depression'. It helps relieve tension and stress, and is easy to grow as a home remedy.

Oat Straw

Oat Straw 'feeds the nervous system' and is different to the rolled oats we have for breakfast.  However, women should be encouraged to eat oats in the form of porridge or muesli to gain benefit.  If you are gluten intolerant, you should avoid oats as it is a gluten-containing grain.

Further Resources

Books

Alternative Healing: What you should know
by: Sarah Heinzman

Websites

The National Herbalists Association of Australia - www.nhaa.org.au/

Australian Natural Therapists Association - www.australiannaturaltherapistsassociation.com.au/

Content updated February 7, 2011