Women's Health Specialists of St. Louis
Obstetrics and Gynecology

Articles - Herbal Therapy for Menopausal Symptoms

Botanicals can help to ameliorate mild menopausal symptoms such as hot flashes, night sweats, vaginal dryness, sleep disturbances, and mood changes. There are a few cautions to anyone considering a trial of herbal supplements. First, natural does not necessarily mean safe. Supplements are not considered to be foods or drugs and therefore are not policed by the food and drug administration (FDA). This means that the manufacturers of the supplements are not regulated to standardize the dose, prevent contamination, or prove efficacy.

Many of the supplements used to treat menopausal symptoms are phytoestrogens. These are compounds that exert a weak estrogenic activity in animals. For this reason, women with severe menopausal symptoms may not respond to supplements. Soy products are a very good source of phytoestrogens. Specifically, the biologically active isoflavones are what help to reduce menopausal symptoms. Generally, consumption of 1 gram of soy protein will yield 1.2-1.7miligrams of isoflavones. Soy products have also shown some benefit for lowering cholesterol. A diet of 20-50 grams per day of soy products is appropriate. Unfortunately, the processing of soy products during the manufacture of tofu, soy milk, and other products often removes the biologically active isoflavones. Look for products that list the isoflavone content. Similarly, if looking for a soy supplement to reduce symptoms, look for a supplement that lists the isoflavone content. Many women will notice some relief with 20 milligrams of isoflavones a day. There are no studies regarding the long term safety with use of supplements high in isoflavones. Women with a history of breast cancer should discuss the use of herbal remedies with their physician prior to initiating therapy.

Other commonly used supplements for menopausal therapy have more limited data on efficacy. These supplements include: include Black Cohosh, Evening Primrose Oil, Chasteberry, Dong Quai, St Johns Wort, and Ginseng. Black Cohosh is the leading herbal remedy in Germany for the treatment of menopausal symptoms. Though the evidence is limited, there appears to be benefit for women with hot flashes, mood disorders, or sleep disturbances. Black Cohosh has no reported drug interactions or toxicities. It should not be confused with Blue Cohosh which is potentially toxic. Evening Primrose Oil may also help with menopausal symptoms. It may be especially helpful for breast tenderness. It should be used cautiously in women who are on anticoagulants such as coumadin as it has some anticoagulant (blood thinning) activity. Studies regarding the use of Chasteberry (vitex) during menopause are limited. This supplement has been reported as having more of an improvement for headaches, mood alterations, and breast fullness. It has not been effective for the treatment of hot flashes or night sweats. Dong Quai is the most commonly used supplement in traditional Chinese medicine to treat female problems. Dong Quai has not been shown to reduce hot flashes or other menopausal symptoms more than a sugar pill (placebo). It is also potentially toxic and is known to have anticoagulant activity. It can cause excessive bleeding by interactions with other blood thinning medicines such as coumadin. There are several studies that support the effectiveness of St Johns Wort for the treatment of moderate depression. Doses of 2.7mg per day produced a 75% improvement. It is not advised to use this supplement in addition to antidepressant medications. Ginseng has been one of the most misrepresented supplements on the market. Many of the supplements contain little or no active ingredient but rather contain high levels of caffeine or other stimulants. Studies revealed that Ginseng alone does not improve athletic performance, energy levels, or weight loss.

In closing, herbal supplements do have a place in medicine and can be useful for the treatment of menopausal symptoms. We must be educated consumers when choosing supplements. Read the labels to see what other ingredients are present. As with anything we put into our bodies, there is always the possibility of too much of a good thing. Anytime a supplement is used in dosages to produce a desired effect, undesirable effects may occur. Always disclose the supplements that you use to your physicians so that they may help you avoid drug interactions and also may counsel you if new data is available about safety or efficacy.