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Management Complementary therapies Herbal remedies
Herbal remedies for menopausal symptoms
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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.
Herbal remedies are an option for many women in the management of perimenopausal symptoms, such as hot flushes, night sweats and vaginal changes.
Not all the symptoms experienced by women in midlife are the result of declining oestrogen levels. A natural therapist may therefore prescribe herbal therapies to manage mood changes such as anxious thoughts and depressed feelings, or to 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.
- 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 perimenopause or menopause is under the guidance and advice of a trained natural therapist. The following are some of the remedies that may be prescribed by a naturopath or herbalist for management of certain symptoms:
Herbal remedies used to treat hot flushes
Black cohosh (Cimicifuga racemosa)
Black cohosh is a North American plant that 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, primarily 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.
Trials of Remifemin 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.
Black cohosh is generally well tolerated, although higher doses may cause headaches for some women. These usually cease when the dose is reduced.
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Warning: There have been cases of liver toxicity associated with black cohosh use. While such cases are rare, it is recommended that patients taking black cohosh be alert for symptoms of liver injury. For more information, see Safety of black cohosh |
Evening Primrose Oil
Evening Primrose Oil is widely self-prescribed and prescribed by health professionals to treat hot flushes. However, in one small trial (56 women, over six months), taking 2000 mg evening primrose oil twice per day was shown to be no better than a placebo (dummy pill).
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 has used 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.
Promensil has been found to lower LDL-cholesterol (‘bad’ cholesterol), but 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 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).
Others
St John’s Wort and Hops may be prescribed for hot flushes that are triggered by anxiety or stress (see below). Ginsengs and Dong Quai may treat hot flushes that are aggravated by fatigue and overwork (see further below), but Panax Ginseng should be avoided by people who suffer from anxiety or hypertension.
Herbal remedies for stress, anxiety and depression associated with menopause
A natural therapist would seek to find the cause of mood changes and would encourage dietary and lifestyle changes, with the use of herbal remedies or nutritional supplements only where necessary.
St John's Wort
St John’s Wort can be used for mild to moderate anxiety and depression - specifically depression associated with menopause. It is not an oestrogen-like herb, and is usually combined with other herbs such as black cohosh for more effective treatment.
Several randomised clinical trials have 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, and was as effective as standard antidepressant treatment and had fewer side effects.
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Warning: St John's Wort should be avoided by people on certain medications, including:
Because of the risk of adverse reactions between St John's Wort and other medications, it should only be prescribed by a qualified natural therapist. |
Hops
Hops may be useful for hot flushes associated with anxiety or stress. They may also be useful for associated insomnia (see below).
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Warning: Hops contains a potent phytoestrogen that appears to stimulate oestrogen receptors, so should be avoided by women with breast cancer. If severe depression is experienced, it is strongly recommended that Hops should not be taken. |
Lavender
Lavender, as a herb rather than as an essential oil, is used to help to clear depression. There are many varieties of lavender, so 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 and drink as a tea for a home remedy.
Others
Other herbs that a naturopath or herbalist may prescribe to help reduce stress and nervousness throughout the body include Motherwort, Kava-Kava, Skullcap, Lime Blossom and Valerian.
Herbal remedies for tiredness and insomnia (sleeplessness) associated with menopause
Valerian
Valerian, in the form of tablets or herbal tea, may be prescribed to help with sleeplessness. However, in a very small number of people, Valerian has a stimulating effect, rather than inducing sleep.
An Iranian study published in 2011 found that valerian was effective for improving the quality of sleep in postmenopausal women.
Hops
Hops may be useful for insomnia associated with anxiety or stress (see above).
Warning:Hops contains a potent phytoestrogen that appears to stimulate oestrogen receptors, so should be avoided by women with breast cancer. If severe depression is experienced, it is strongly recommended that hops should not be taken. |
Passionflower and Chamomile
Passionflower or chamomile, both in the form of tablets or in herbal teas, may help with sleeplessness.
Herbal remedies for hot flushes associated with fatigue
Panax Ginseng
Panax Ginseng, a traditional Chinese herb, may improve the body's ability to cope with physical and mental stress. Ginsengs may be used for hot flushes that are aggravated by fatigue and overwork.
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Warning: Panax Ginseng should only be taken short-term (two to four weeks at a time) and under the supervision of a herbalist or naturopath. It can raise blood pressure and should therefore be avoided if you suffer from hypertension. It should also be avoided by people who suffer with anxiety. It should never be taken during an acute infection (as this may worsen the condition), or with high doses of caffeine. |
Siberian Ginseng
Like Panax Ginseng (above), Siberian Ginseng may improve stamina and vitality during times of increased physical and mental demands, but it is generally considered to be less stimulating. It can be taken for a longer time than Panax – over several months.
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Warning: Siberian Ginseng should not be taken during an acute infection. |
Dong Quai
Dong Quai may also be useful for hot flushes associated with fatigue and overwork.
Herbal remedies used for night sweats
Zizyphus
Zizyphus is a traditional Chinese herb that may be prescribed for sleep disturbances associated with night sweats.
Licorice (herb)
The herb Licorice root should not be confused with the confectionery liquorice (which is traditionally flavoured with licorice root extract). The licorice herb may be used for night sweats, but should not be taken long-term or by people with high blood pressure.
Panax Ginseng
Panax Ginseng may be useful as part of a treatment for night sweats.
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Warning: Panax Ginseng should only be taken short-term, two to four weeks at a time and under the supervision of a herbalist or naturopath. It can raise blood pressure and therefore should be avoided if you suffer from hypertension. It should also be avoided by people who suffer with anxiety. It should never be taken during an acute infection (as this may worsen the condition), or with high doses of caffeine. |
Herbal remedies for vaginal dryness
Linseed or Flaxseed
Linseed and flaxseed have been shown to reduce vaginal dryness. Based on one research study, the 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.
N.B. The phytoestrogens (called lignans) in linseeds are found in the seed and not the oil, so taking flaxseed/linseed oil will provide you with essential fatty acids but will not be a source of phytoestrogens.
Black Cohosh
Black cohosh, taken orally as well as topically (as a cream or pessary), has been shown to be effective for vaginal dryness.
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Warning: There have been cases of liver toxicity associated with black cohosh use. While such cases are rare, it is recommended that patients taking black cohosh be alert for symptoms of liver injury. For more information, see Safety of black cohosh |
Herbal remedies for low libido
There are many factors that can influence a woman’s libido: including her relationship with her partner, medications, general health and wellbeing, vaginal dryness causing painful sex and body image. It is important to address lifestyle, nutrition and relationship factors that may be playing a role in low libido and not just rely on a herbal medication.
Many cultures use herbs that have traditionally had a reputation for increasing libido. It is not clear whether these herbs actually stimulate a sexual urge, or act as general tonics – increasing energy and vitality and supporting a steady emotional state, thus making the idea of sex more appealing.
Damiana, Saw Palmetto and Sarsparilla, Korean Ginseng, Tribulus, Shatavari and Horny Goat Weed are some of the herbs that have traditionally been prescribed for treating low libido. Ylang Ylang, Neroli and Patachouli are essential oils that are said to be aphrodisiac in nature (stimulating sexual desire).
Unproven hormone remedies – Not recommended
In the past, Progesterone cream and Wild Yam cream were promoted for treatment of menopausal symptoms. Neither were widely used amongst herbalists and naturopaths who are well trained in the management of perimenopause symptoms, and the use of these remedies should be discouraged.
Progesterone creams
Progesterone creams were once available from health food stores but are now only available on prescription from a doctor. Very few doctors actually prescribe progesterone cream, except those doctors who also prescribe so-called ‘bio-identical’ hormone preparations. There is no evidence that progesterone creams can be safely substituted for progestins (synthetic progesterone) as part of hormone therapy.
There is no evidence from the research conducted that progesterone creams provide adequate endometrial protection (protection of the lining of the uterus) for women who are post-menopausal and are using oestrogen hormone replacement therapy (HRT). The amount of progesterone actually absorbed through the skin is totally inadequate to protect the endometrium.
A woman could be putting herself at risk if she replaces progestin tablets or patches prescribed for HRT with a progesterone cream, while continuing to take prescribed oestrogen. It is worth discussing these issues with your health practitioner.
Wild Yam creams
Wild Yam creams are sold in health food stores and by direct distributors.
Wild Yam is not a progesterone, does not contain progesterone and cannot be converted to progesterone in the body. Wild Yam cream contains diosgenin, which can be converted in a laboratory to progesterone but it is not converted to progesterone in the body.
While diosgenin may have oestrogen-like actions, it has not been shown to be beneficial in terms of relieving hot flushes, vaginal dryness or other common symptoms of menopause.
Traditionally, Wild Yam has not been used as a cream but rather taken internally.
‘Bio-identical’ hormones
While marketed as ‘natural’, so-called ‘bio-identical’ hormones are in fact manufactured synthetically, usually from substances extracted from soy or yams, by a similar process to the hormones found in e.g. the oral contraceptive pill. The US Food and Drug Administration (FDA) stated in 2008 that the term ‘bio-identical’ is "a marketing term that carries no scientific or medical merit".
The compounding pharmacists who make ‘bio-identical’ preparations are not required to adhere to the codes of conduct of the professional pharmaceutical body, Medicines Australia, as these codes apply only to pharmaceutical companies. No research evidence has been published to show that the hormone preparations, made by compounding pharmacists are safe or effective.
Prescription of ‘bio-identical’ hormones cannot be recommended until sound pharmacokinetic, efficacy and safety data are available. For more information, see ‘Bio-identical’ hormones.
Further resources
Jean Hailes webpages
External webpages
The National Herbalists Association of Australia
Australian Natural Therapists Association
Books
Alternative Healing: What you should know (Women's Weekly Series) by Sarah Heinzman
Content updated 18 October 2011
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