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Dr. Tori Hudson, Portland, Oregon, Blog Healthline Blog

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.

Red Clover

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

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

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.

Combination Products

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.

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