Herbs used in the management of menopause


Every culture throughout the world has at some point used healing plants as the basis for its medicines. The plant parts that are used as medicinal herbs may be leaves, seeds, roots or flowers. Herbs including black cohosh, dong quai, ginseng, hops, lavender, linseed, red clover, St John's wort and wild yam are used in the management of health problems such as mood changes or fatigue, and in menopausal symptoms, such as hot flushes, night sweats and vaginal changes.

herbsHerbs or herb mixtures may be dried and combined with boiling water to make teas or infusions, concentrated in alcohol and water to make tinctures or extracts, or made into tablets and powders.

More research on the effectiveness and safety of herbal therapies is needed but there is some evidence to suggest many herbs can help women cope with some symptoms of menopause and they improve overall quality of life.

Over the counter herbal products

Factors to consider when buying herbal products over the counter include:

  • some products available over the counter are not the same herbs that a traditional herbalist would prescribe
  • the quality of most 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 questionable
  • some herbal products may contain herbs that should not be used in conjunction with pharmaceutical therapies but the products may not carry this warning
  • experimenting with over the counter preparations may be more costly than seeing a trained herbalist/naturopath – it may be beneficial to consult a naturopath or herbalists to review your self prescribed herbal preparations
  • the best way to use herbal remedies is under the guidance and advice of an accredited natural therapist

Black cohosh, Cimicifuga racemosa

Hot flushes

Originally used by Native Americans for menstrual cramps and menopausal symptoms, extracts of the black cohosh root have been used in Europe for over 50 years. It is now primarily used for hot flushes. 

Black cohosh is the most researched of all herbs used for the management of menopausal symptoms. The research includes animal data, in vitro (test tube) studies and clinical trials. Many of the clinical studies of black cohosh have used the commercially available product, Remifemin. Clinical trials have found black cohosh can reduce the number and the intensity of hot flushes[1] and it has been used in women with breast cancer.

There are mixed reports in the research as to whether black cohosh is an effective treatment option for menopausal symptoms. A recent review of clinical trials of black cohosh has shown there was no significant difference between this herb and hormone replacement therapy in some trials. This review also stated that black cohosh has no significant benefit over placebo for the control of menopausal symptoms generally. However, in combination with the herb St John's wort it was shown to improve menopausal symptoms.[2] Another review of 16 clinical trials which involved 2,027 perimenopausal women taking black cohosh for an average of 23 weeks, showed there was no significant difference between black cohosh and placebo (dummy pill) in the frequency of hot flushes or menopause symptoms as scored by a questionnaire, and that hormone therapy was more effective than black cohosh in reducing hot flushes and menopausal symptoms. The author concluded there is need for further research into black cohosh, as the quality of the research has not been up to standard to test the effectiveness of this herb.[3]

It has been observed, in rare situations, that black cohosh may be related to liver damage in some people[4] and so its use should be carefully discussed with a doctor, oncologist or qualified naturopath.

Black cohosh may be combined with other herbs to tailor a formula specifically for hot flushes. The herb is generally well tolerated, although higher doses may cause headaches for some women. These usually cease when the dose is reduced.

Vaginal dryness

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

Black cohosh should be taken for only as long as symptoms persist.

It is important you discuss black cohosh with your doctor before commencing treatment.

Chamomile, Matricaria recutita

Sleep

Chamomile, in the form of a herbal tea or tablet, may help with sleeplessness. 

Dong quai, Angelica sinensis

Hot flushes

Dong quai, a traditional Chinese herb, 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 breast cancer.

Evening primrose

Hot flushes

Evening primrose oil is widely self-prescribed and is prescribed by health professionals to treat hot flushes.

In a small (56 women) six month trial using 2,000mg twice a day it was shown to be no better than a placebo.

Korean Ginseng, Panax ginseng

Hot flushes

Panax ginseng, a traditional Chinese herb, may increase the body's ability to cope with physical and mental stress and increase vitality and physical performance.

The ginsengs (also Siberian Ginseng, Eleutherococcus senticosus) may be useful for:

  • hot flushes aggravated by fatigue and overwork
  • night sweats

Panax ginseng is traditionally 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 never be taken during an acute infection (as this may worsen the condition), or with high doses of caffeine.

Siberian ginseng, Eleutherococcus senticosus

Stress

This herb may improve stamina and vitality during times of increased physical and mental demands. It can be taken for several months. Siberian ginseng should not be taken during an acute infection.

Hops, Humulus lupulus

Hot flushes with stress/anxiety

Hops contain a potent phytoestrogen, which animal research suggests may have more oestrogenic activity than other plant oestrogens. Because this particular phytoestrogen has been shown to have an oestrogen stimulating effect in an animal study, caution with the use of this herb in women with breast cancer or history of breast cancer should be exercised.

Hops is prescribed by natural therapists for hot flushes associated with anxiety or stress, and associated insomnia (sleeplessness).

A very small clinical trial showed a hops extract had the same effect as a placebo for reducing menopausal symptoms after eight weeks, but improved all symptoms after 16 weeks.[5]

If severe depression is experienced, it is strongly recommended hops should not be taken.

Lavender, Lavandula angustifolia

There are many varieties of lavender, so see an accredited natural therapist to ensure you have the correct type.

Depression

Lavender, as a herb rather than as an essential oil, is used to help with depression. Lavender is a strengthening tonic to the nervous system.

Headaches

Lavender may be useful for headaches and migraines.

Lemon balm, Melissa officinalis

Stress

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

Licorice, Glycyrrhiza glabra

Night sweats

Licorice may be used for night sweats. Licorice as a herb is licorice root and this is not the same as confectionery liquorice.

Licorice should not be taken long-term or by people with high blood pressure

Linseed or flaxseed

Vaginal dryness

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 including linseeds in your diet is considered safe in women with breast cancer.

The recommended dose for ground linseed is 25g, 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, 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.

Oat straw, Avena sativa

Stress

Oat straw 'feeds the nervous system'. Oat straw as a medicinal herb is different to breakfast rolled oats. However, it is still beneficial to eat oats in the form of porridge or muesli with the added benefit of providing soluble fibre which is good for digestion and helps to lower cholesterol.

Passionflower, Passiflora incarnata

Sleep

Passionflower in the form of a herbal tea or tablet may help with sleeplessness. 

Red clover, Trifolium pratense

For hot flushes

red clover

Traditionally, herbalists and naturopaths have used red clover for skin conditions like eczema. Most of the research conducted on red clover is in the form of the over the counter product Promensil (containing red clover isoflavones). Some of the research suggests red clover may be beneficial for hot flushes. Other researchers (who have reviewed the red clover research) suggest there is not enough evidence to show it is effective for hot flushes.

In a recent trial of 109 postmenopausal women, Red clover isoflavone supplement was shown to be more effective than placebo in reducing daily hot flushes, night sweats and overall intensity of menopausal symptoms.[6] A small study of 72 menopausal Iranian women showed that there was no difference between taking eight weeks of an isoflavone supplement of red clover and placebo on menopausal quality of life.[7] There was significant improvement in menopausal symptoms after four months of treatment with red clover isoflavone supplement in a 12 month study of 120 Brazilian postmenopausal women, but no difference compared to placebo. The red clover isoflavone supplement did not improve sexual satisfaction in postmenopausal women.[8]

The safety of red clover for patients with breast or endometrial cancer has not been established.

For bone & cardiovascular health

There is limited evidence suggesting red clover has a possible effect on maintaining bone health and improving blood vessel health.

This herb has not been proven to protect against bone fracture or cardiovascular disease.

St John's wort, Hypericum perforatum

Depression

St John's wort can be useful for hot flushes triggered by anxiety or stress. It is more likely to be used for mild to moderate anxiety and depression, specifically depressed mood associated with menopause.

A recent analysis of randomised clinical trials demonstrated St John's wort was:

  • more effective than a placebo for the treatment of mild to moderately severe depressive disorders
  • as effective as standard antidepressant treatment and had fewer side effects

St John's wort should be avoided by people on a number of different medications, including:

  • warfarin (blood thinning medication)
  • digoxin (medication taken for heart rhythm)
  • anti convulsants (anti seizure drugs)
  • antidepressant drugs referred to as SSRIs (Selective Serotonin Re-uptake Inhibitor)
  • cyclosporin (an immune suppressing drug)
  • HIV medication

Because of the risk of adverse reactions between St John's wort and other medications, it should only be prescribed by a registered natural therapist.

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.

Valerian, Valeriana officinalis

Sleep

Valerian in the form of a herbal tea or tablet may help with sleeplessness. Valerian has been shown to improve the quality of sleep in postmenopausal women experiencing insomnia[9]. In a very small number of people valerian has a stimulating effect, rather than inducing sleep.

Wild yam, Dioscorea villosa

Menopausal symptoms

Wild yam cream contains diosgenin that can be converted in a laboratory to progesterone and oestrogen in the contraceptive pill and hormone therapy but it is not converted to progesterone in the body.

Even though 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.

Herbal remedies for low libido

Many cultures use herbs with a reputation for increasing libido. It is not clear whether these herbs actually stimulate a sexual urge or act as general tonics to increase energy and vitality and support a steady emotional state that may help to improve sexual desire.

Many factors 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 particularly relationship factors that may be playing a role in low libido, and not just rely on a herbal medication.

Damiana, saw palmetto and sarsparilla, Korean ginseng, tribulus, shatavari and horny goat weed are some of the herbs used for treating low libido. There are many formulas marketed to women claiming to improve sex drive. There is no research to support the use of these herbs for improving libido in women. Ylang ylang, neroli and patachouli are essential oils said to be aphrodisiac in nature (essential oils should not be taken internally, but rather used in an oil burner designed for essential oils).

References

  1. Walji R et al. Black cohosh (Cimicifuga racemosa [L] Nutt.): safety and efficacy in cancer patients. Support care Cancer 2007; 15(8):913-21

  2. Laakmann E, Grajecki D, Doege K, Eulenburg CZ, Buhling KJ, 2012. 'Efficacy of Cimicifuga racemosa, Hypericum perforatum and agnus castus in the treatment of climacteric complaints: a systemic review' Gynecol Endocrinol Mar 2 [Epub ahead of print]

  3. Leach MJ, Moore V 2012. 'Black cohosh (Cimicifuga spp.) for menopausal symptoms.' Cochrane Database Syst Rev 12:9:CD007244. doi:

  4. www.tga.gov.au/cm/0705blkcohosh.htm

  5. Erkkola R, Vervarcke S, Vansteelandt S, Rompotti P et al 2010. 'A randomized, double-blind, placebo-controlled cross-over pilot study on the use of a standardized hops extract to alleviate menopausal discomforts'. Phytomedicine 17(6): 389-96.

  6. Lipovac M, Chedraui, Gruenhut C, Gocan A et al 2012. 'The effect of red clover isoflavone supplementation over vasomotor and menopausal symptoms in postmenopausal women' Gynecol Endocrinol 28(3): 203-7.

  7. Ehsanpour S, Salehi K, Zolfaghari B, Bakhtiari S 2012. ' The effects of red clover on quality of life in post-menopausal women' Iran J Nurs Midwifery Res 17(1): 34-40

  8. Del Giorno C, Fonseca AM, Bagnoli VR, Assis JS et al 2010. ' Effects of trifolium pratense on the climacteric and sexual symptoms in postmenopausal women' Rev Assoc Med Bras 56(5):558-62

  9. Taavoni S et al. Effect of valerian on sleep quality in postmenopausal women: a randomized placebo controlled trial. Menopause. 2011 18(9): 951-5

Last updated 27 February 2017 — Last reviewed 22 February 2014

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at February 2014.

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