by Tori Hudson, N.D.
In light of the recent research from the Women’s Health Initiative, even more women are looking for safe and effective botanical alternatives for symptom relief during menopause.
Botanical therapies for menopause symptoms are taking an increasingly important role. Many women are determined to utilize therapies that are herbal or nutritional, natural hormones, or lower dose hormones in combination with botanicals, in order to create a risk to benefit ratio that they feel comfortable with.
At least four clinical trials have been conducted on the effect of red clover isoflavones on vasomotor symptoms. Two show benefit and two do not. The first two published studies on red clover and vasomotor symptoms showed no statistically significant difference between the red clover standardized extract and the placebo during a 3 month period, although both groups did improve. Two other studies of 40 mg standardized extract of red clover produced a reduction in hot flushes and nightsweats. The most recent study showed that 80 mg of red clover isoflavones per day reduced the frequency of hot flashes by 44%.
Black cohosh has emerged as the single most important herb for the treatment of menopausal symptoms. There have been six well-publicized studies. In one of the largest studies, 629 women with menopausal complaints were given a liquid standardized extract of black cohosh twice per day for six to eight weeks.
As early as four weeks, clear improvements in the menopausal ailments were seen in 80 percent of the women. Complete disappearance of symptoms occurred in approximately 50 percent. Symptoms included hot flashes, night sweats, headaches, insomnia and mood swings. The other studies reported improvements in fatigue, irritability, hot flashes and vaginal dryness.
More recently, black cohosh was studied in eighty-five women diagnosed with breast cancer who were experiencing hot flashes. No benefit of black cohosh over placebo was seen for hot flashes although fifty-nine of them (70%) were taking tamoxifen during the trial. Although the results of this study are not consistent with other studies showing benefit from black cohosh for menopausal symptoms, it is important to acknowledge that the results should take into account that black cohosh may not work in the presence of an anti-estrogen, such as tamoxifen. Other weaknesses in the study that could be pointed out is that the duration was only two months and there was a high dropout rate with most of the women who remained in the black cohosh group taking the tamoxifen.
Panax ginseng, also known as Korean or Chinese ginseng, contains at least 13 different triterpenoid saponins, collectively known as ginsenosides. Whether it involves reducing mental or physical fatigue, enhancing the ability to cope with various physical and mental stressors by supporting the adrenal glands, or treating the atrophic vaginal changes due to lack of estrogen, ginseng is a valuable tool for many menopausal women.
Dong quai is a Chinese herb that has become popularized in the U.S. for menopause symptoms. However, it was tested in a randomized, double-blind, placebo controlled clinical trial in 71 women who received capsules of 4.5 g per day or placebo for six months. Dong Quai was not superior to placebo for hot flashes.
One herbal combination product has been the subject of a clinical trial. It contains dong quai, motherwort, licorice root, burdock root and wild yam root. Seventy-one percent of women taking the herbal formula reported a reduction in the total number of symptoms, while only 17 percent of the women taking placebo reported a decrease in the total number of their symptoms. The botanical formula was most effective in treating hot flashes, mood changes, and insomnia.
Many herbs have been used traditionally by herbalists and women for decades and in some cases centuries to address menopausal symptoms. Although they lack clinical studies for this purpose, the empirical evidence and tradition is strong. These include motherwort, licorice, yarrow, hops and chaste tree to name a few.
Other Botanicals for Specific Symptoms
Insomnia is the most commonly reported sleep problem in industrialized nations and women are at increased risk. Changes in hormonal effects on the brain cause many women to have insomnia problems during perimenopause and postmenopause. Valerian is one of the most well known herbal therapies for insomnia and several clinical trials have documented the sleep efficacy of valerian on sleep latency, quality and sleep structure.
Other common symptoms of perimenopause and menopause include anxiety, depression, fatigue, and joint aches. Kava for anxiety, St. Johns Wort for depression, Ginseng and Rhodiola for fatigue and black cohosh and Boswellia for joint aches are just a few examples of other herbs used for specific symptoms. These are best used in addition to an approach that more holistically addresses menopause.
Women in the perimenopause transition years who are beginning to experience various and episodicsymptoms and symptomatic menopausal women are in a good position to try botanical therapies. In the perimenopause and postmenopausal years, choices about nutritional supplements and herbal therapies versus natural hormones versus conventional HRT can be made on an individual basis. A health care practitioner who is educated about all the options can assess more complicated individual needs regarding symptom management and individual risks for osteoporosis, heart disease, Alzheimer’s and breast cancer, to determine which therapy or combination of therapies is appropriate.
- Knight D, Howes J, Eden J. The effect of Promensil, an isoflavone extract, on menopausal symptoms. Climacteric 1999;2(2):79-84.
Baber R, Templeman C, Morton T, Kelly G, West L. Randomized placebo-controlled trial of an isoflavone supplement and menopausal symptoms in women. Climacteric 1999;2:85-92.
- Jeri A, deRomana C. The effect of isoflavone phytoestrogens in relieving hot flushes in Peruvian post-menopausal women. 9th International Menopause Society World Congress on Menopause, Yokohama, Japan 1999.
- Nachtigall LB, La Grega L, Lee W, Fenichel R, Nachtigall L. The effects of isoflavones derived from red clover on vasomotor symptoms and endometrial thickness. 9th International Menopause Society World Congress on the Menopause . Hokohama, Japan 1999
- van de Weijer P, Barentsen R. Isoflavones from red clover (Promensil) significantly reduce menopausal hot flush symptoms compared with placebo. Maturitas 2002;42:187-193.
- Lieberman S. A review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause. J Womens Health 1998;7(5):525-9.
- Stolze H. An alternative to treat menopausal complaints. Gyne 1982;3:14-16.
Jacobson J, Troxel A, 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 2001;19:2749-45.
- Hikino H. Traditional remedies and modern assessment: The case of ginseng. In Wijeskera R, ed. The Medicinal Plant Industry. Boca Raton, Fla.: CRC Press 1991;149-166.
- Shibata S, et al. Chemistry and pharmacology of Panax. Econ Med Plant Res 1985;1:217-284.
- Hallstrom C, Fulder S, Carruthers M. Effect of ginseng on the performance of nurses on night duty. Comp Med East West 1982;6:277-282.
- Dâ€™Angelo L, et al. A double-blind, placebo-controlled clinical study on the effect of a standardized ginseng extract on psychomotor performance in healthy volunteers. J Ethnopharmacol 1986;16:15-22.
- Bombardelli E, Cirstoni A, Lietti A. The effect of acute and chronic )Panax) ginseng saponins treatment on adrenal function; biochemical and pharmacological. Proceedings 3rd International Ginseng Symposium 1980; Korean Ginseng Research Institute: 9-16.
- Punnonen R, Lukola A. Oestrogenlike effect of ginseng. Br Med J 1980;281:1110.
Hirata J, et al. Does dong auai have estrogenic effects in postmenopausal women? A doubleâ€™blind, placebo-controlled trial. Fertil Steril 1997;68:981-986.
- Hudson T, Standish L, et al. Clinical and endocrinological effects of a menopausal botanical formula. J Naturo Med 1997;7(1):73-77.
- Vorbach E, et al. Therapie von Insomnien. Wirksamkeit aund Vertraglichkeit eines Baldrianpreparats. Psychopharmakotherapie 1996;3:109115.
- Leathwood P, et al. Aqueous extract of valerian root (Valeriana officinalis L.) improves sleep quality in man. Pharmacol Biochem Behav 1982;17:65-71.
- Donath F. Critical evaluation of the effect of valerian extract on sleep structure and sleep quality. Pharmacopsychiatry 2000;33:47-53.
- Kuhlmann J. The influence of valerian treatment on reaction time, alertness and concentration in volunteers. Pharmacopsychiatry 1999;32:235-241.