The menopause is a natural part of female life and women should take it as an opportunity to reassess diet and lifestyle. It is defined by a woman going for one year without a menstrual period. There are three phases to the menopause; the peri-menopasue – menopausal symptoms leading to the eventual cessation of menstruation, the menopause – the absence of menstruation for a full year and post-menopause – the cessation of menstruation and sex hormones from the ovaries. Menstruation can be irregular due to the sex hormones oestrogen and progesterone fluctuating and eventually declining the transition of which may last up to 5 years. Genitourinary tissues are oestrogen dependant and symptoms during this transitional period can vary in intensity and frequency from person to person. Variable symptoms include hot flushes, changing moods, irritability, depression, cognitive changes, vaginal dryness, decreased libido as well as pain during sexual intercourse, reduced energy, sleep disturbances and weight gain. Tissue atrophy due to lack of oestrogen can also increase the risk and frequency of infections, increase urgency and pain during urination as well as cause stress incontinence. Are you experiencing the menopause – do any of these symptoms fit with how you are feeling?
The menopause is perceived as a deficiency disease – something which I disagree with, it is a natural part of female life!! The conventional medical approach to treating menopausal symptoms consist mainly of prescribing hormone replacement therapies (HRT) which are external sources of hormones possibly equine in origin (from horses!!). Studies have proposed that HRT may only be beneficial for first 16 weeks before becoming no different to placebo and side effects of prescribing oestrogen replacements include increasing the risk hormone affected cancers as well as gall bladder disease and thromboembolic disease. Progesterone replacement can increase cholesterol levels, oedema, weight and bleeding.
It is recommended that more foods containing phytoestrogens should be included in the diet during the transition from mother to wise women as they can help to reduce the frequency and severity of hot flushes. Epidemiological studies show low incidences of breast cancer where there’s a high intake in soy. Phytoestrogens can be classified as isoflavones and lignans and are diphenolic compounds, the phenolic ring can bind to oestrogen receptors mimicking oestrogen. Isoflavones are found in soy, pulses, cereals and legumes – and although isoflavones are beneficial I tend to recommend that people reduce the amount of cereals, beans, soy and pulses in their diet as they can cause inflammation. Lignans are found in seeds, cereals, fruit, vegetables and grains such as alphafa – more accessible and digestible food items (minus grains). Flaxseed and evening primrose oil are also oestrogenic.
Oestrogenic herbs can also contain phytoestrogens. They work differently from pharmaceutical drugs and are deemed safer by alternative practitioners such as herbalists and nutritionists as they don’t flood the body with external hormones; instead they seem to help the body utilise the oestrogen and progesterone available more efficiently rebalancing the tissue state naturally. Biochemically they bind to oestrogen receptors and can induce transcription of oestrogen responsive genes. I have written about the biochemical effects oestrogenic herbs can have on the body which you can access towards the end of this blog. Oestrogen has a physiological action on reproductive tissues and on bones, the central nervous system, and the cardiovascular system. Phytoestrogens show weakly oestrogenic activity, can conserve bone and show antibacterial, antifungal, antiviral, and anti-carcinogenic actions as well as reducing cholesterol.
Phytoestrogenic plants can help to stabilise a woman’s hormones. Herbs with hormone normalising phytoestrogens include evening primrose oil, red clover – Trifolium pratense, liquorice root – Glycyrrhiza glabra, agnus castus – Vitex agnus-castus, hops – Humulus lupulus, oats – Avena sativa, elder – Sambucus nigra, and sage – Salvia officinalis there are hundreds of plant sources. Evening primrose oil is hormone regulating, containing alpha and gamma linoleic acid which contribute to the reduction of vasomotor symptoms such as hot flushes; essential fatty acids are used to relieve menopausal symptoms. Liquorice demonstrates oestrogenic activity and can be relaxing or stimulating, energetically it is cooling and moist.
Red Clover demonstrates oestrogenic activity but scientific studies show positive and negative results on its effectiveness to reduce menopausal symptoms. I think that this may be due to how the studies were executed, the number of people in the study and their lifestyles and choices prior to undertaking the study. Variables can include a multitude of everyday choices including what they ate, previous health, family history and levels of stress at the time of the study. The solidity of the study will come under scrutiny too – is it a placebo, double blind study? I also feel that the social views of the people who ran the studies should be taken into account. Hot flushes occur most frequently at night and affect up to 80% menopausal women they can last up to 4 minutes but feel like longer when women experience them. In a positive study of red clover a reduction in number of hot flushes was seen compared to placebo but only showed a statistical difference when documented, explanation of the results included to be coumestin a compound of phytoestrogen. Care should be taken when using red clover as it contains coumarins and can affect warfarin intake. Dosage can be 12g of dried herb or equivalent daily.
Dong quai – Angelica sinensis is a hormone regulator that doesn’t contain phytoestrogens. It enhances the body’s endogenous oestrogen production to help to address symptoms including hot flushes and sweating. Prescriptions can treat painful or suppressed menstruation and hot flushes and relieve menopausal depression and anxiety especially if symptoms are related to deficient kidneys. Mixed results in several studies include statements that dong quai is no different to placebo. The herb may potentiate warfarin and caution should be taken if patients have oestrogen sensitive cancers. Dosage is 4-6ml tincture three times daily.
Uterine tonics can be given during the menopause to support reproductive organs and tissues whilst physiological and endocrine changes take place. Vaginal dryness is a common complaint during the menopause; uterine tonics would assist to reduce this discomforting issue with vulneraries. Amphoteric herbs improve the tone of the uterus, regulating bleeding; dong quai is amphoteric. Uterine stimulants improve the tone of the uterine muscles and tissues and include the herbs yarrow – Achillea millefolium, mugwort – Artemisia vulgaris and agnus castus. Other uterine tonics are black cohosh – Cimicifuga racemosa, motherwort – Leonurus cardiaca and raspberry leaves – Rubus ideaus.
Motherwort is a moderate strength relaxing uterine tonic, anti-spasmodic, carminative and emmenagogue. It can be a relaxant or stimulant dependant on the needs of the body and is defined energetically as cooling and drying. Motherwort is a cardio-tonic an action supported by flavones. It supports the heart and circulation, stimulates and strengthens the liver and is prescribed to reduce hot flushes, regulate hormones, relieve anxiety and reduce palpitations.
If the menopausal patient experiences anxiety or tension relaxing nervines can be utilised. Nervines can also relieve menopausal symptoms including forgetfulness, nervousness, weepiness, irritability, lack of concentration, anger, excitability and panic attacks. Nervine relaxants work directly on the nervous system reducing stress and putting the person at ease. When prescribing, each patient need to be treated as an individual, secondary actions and medicinal uses of herbs should be taken into account. Relaxing nervines include: lemon balm – Mellissa officinalis, chamomile – Matricaria recutita, lime flowers – Tilia x cordata, passionflower – Passiflora incarnata, skullcap – Scutellaria lateriflora, St Johns wort – Hypericum perforatum and wild yam – Dioscorea villosa.
Wild yam contains diosgenin, a steroidal sapogenin; clinical studies have found that the body can convert this into progesterone and dehydroepiandrosteron (DHEA) which is a 19-carbon natural steroid hormone. Its phytoestrogens can relieve night sweating, hot flushes and regulate hormones. Wild yam’s sapogenin content helps to relieve spasms, dysmenorrhea and uterine pain.
Anti-depressant herbs can relieve hormone-related depression and anxiety experienced during the menopause. This phase of life affects a woman physically, mentally and emotionally, when experiencing depression during the menopause insomnia, poor appetite, weight loss and low energy can be experienced. Antidepressant herbs include oats, ginseng – Panax quinquefolius, lavender – Lavendula angustifolia, rosemary – Rosmarinus officinalis, St John’s wort, vervain – Verbena officinalis and black cohosh. Clinical studies have shown that St John’s Wort does relieve mild to moderate depression in menopausal women.
Bitters are effective medicines; energetically they are cooling and drying, stimulating digestive secretions throughout the body. Prescribed generally for the menopause as a stimulant, digestion is a vital function of the body and it’s efficiency impacts on our health. Bitter can also improve water retention or depression related to a sluggish digestion. Several bitter herbs include: barberry – Berberis vulgaris, boneset – Eupatorium perfoliatum, dandelion – Taraxacum officinale, feverfew – Tanacetum parthenium, goldenseal – Hydrastis canadensis, holy thistle – Cnicus benedictus and mugwort.
Dandelion is useful as a diuretic reducing water retention. Energetically, dandelion is cooling and drying with tonic and astringent properties.
Herbalists such as myself can prescribe restorative, supportive and nutritious herbs such as oats and nettles – Urtica dioica. Both herbs can assist women going through the menopause. Oats helps to strengthen the nerves, promote sleep and reduce stress levels as well as nourish the bones. Nettles strengthen the adrenals but also supports the liver and kidneys, reduces anxiety and night sweats too. Energetically nettles are cooling and drying, a true stimulant with tonic and astringent actions.
The menopause varies in severity from person to person due to many biopsychosocial factors including diet, exercise, personality type, size, lifestyle and levels of stress; stress can deplete the adrenal glands and affect their functioning. Herbs like Ashwaganda – Withania somnifera can restore adrenal balance acting as a tonic for overworked people improving general and sexual debility supporting the adrenals during their “resistance” and “exhaustion” phases. Other Adaptogens that can benefit women during the menopause includes liquorice, Siberian ginseng – Eleutherococcus senticosus, schisandra – Schisandra chinensis, wild yam and astragalus – Astragalus membranaceus; all help restore the adrenal glands. Astragalus works as a vasodilator and schisandra supports the liver as well as the adrenals and improves memory, mood and sleep.
Research on ginseng has shown benefits improving sleep, mood and sense of wellbeing. Energetically it is a true relaxant herb with tonic properties. Hong Sam Red Ginseng is the root is steamed prior to being dried; this form of the herb is effective in the treatment of mild-moderate perimenopausal symptoms. Results can be dependent on the correct prescribing of ginseng: P. quinquefolius contain phytoestrogens which can be converted into female hormones whilst regulating immunity, P. ginseng’s phytoestrogens can be converted into male hormones and is hypertensive and Eleutherococcus senticosus doesn’t show hormonal qualities.
As a specific remedy there is a lot of clinical research on black cohosh – Cimicifuga racemosa doesn’t contain phytoestrogens but assists to balance oestrogen levels, reduce menopausal symptoms and improve emotional states. Positive results have been reported from clinical studies on its effectiveness in reducing menopausal symptoms. The herb may cause headaches and stomach upsets and shouldn’t be given to women with liver disease due to its possible hepatotoxicity; the dosage is recommended at 40-80mg daily for no more than 6 months.
Black cohosh can help to alleviate vasomotor symptoms such as hot flushes and sweating. Black cohosh corresponds medicinally to the reproductive system and it’s relaxing or stimulating adapting to requirements. It is a moderately strength relaxing nervine, alterative, antispasmodic and diaphoretic herb. It is used successfully in treating hot flushes in cancer patients, the active constituents include terpenes and glycosides which may function as Selective Estrogenic Receptor Modulators. The oestrogenic effect is due to its physiological activity on serotonin receptors in the body and may explain hot flushes and mood improving. Black cohosh doesn’t stimulate breast or uterine tissue; the mechanism may be via stimulation of the central nervous system. It is proven to be as effective as oestrogen in the reduction of menopausal symptoms and better than placebo at reducing flushes. Clinical trials have shown improvement in hot flushes, sleep disorders, sexual dysfunction and sweating, although side effects can include gastrointestinal disturbances, bradycardia, headaches and nausea.
There are many other herbs which can support a woman through the transition of the menopause. Herbs prescriptions should be tailored to the individual’s case history and health requirements. The menopause can be viewed energetically as a hot condition with symptoms varying from wet (hot flushes) to dry (vaginal moistness). Many strategies can be utilised to ease the patient from peri- to post-menopausal and care is needed when mixing oestrogenic herbs and pharmaceutical oestrogenic hormone replacement. Women with hormone-dependant cancers such as breast cancer or with any contraindications to HRT or venous thromboembolism should consult a professional when using oestrogenic phyto-medicinals. Herbs without phytoestrogens are available to support the patient including several bitters, adaptogens and uterine tonics. Although scientific studies can be found to discredit several of the herbs mentioned research into herbalism isn’t extensive enough. The use of herbs in the treatment of menopausal symptoms addresses social, emotional, physical and mental factors; symptoms which cannot be measured empirically. The vulnerability of osteoarthritis and countless herbs haven’t been mentioned in this blog, this isn’t to disvalue them, herbal medicine can support and balance women offering preventative options for osteoarthritis and many other symptoms associated with menopause.
Traditional Chinese Medicine diagnoses
Traditional Chinese Medicine (TCM) is used to treat menopausal symptoms, their diagnosed definitions of menopausal women include:
Kidney yin deficiency: The most common diagnosis, women suffer with hair loss, light vaginal discharge, vaginal dryness, dizziness, hot flushes, night sweats and insomnia among other symptoms. Their tongue is red with a light coating and their pulse is thin and rapid.
Liver qi stagnation: Women experience irritability, hypochondriac distension, constipation, palpitations, insomnia and emotional instability. Their tongue is red with a thin yellow coating and they have a wiry pulse.
Blood deficiency: Women suffer with dizziness, hot flushes, sweating and insomnia, dry skin with a sallow complexion, emotional instability and myalgia. Their tongue is pale with a thin coating and they have a thready pulse.
Uprising deficiency heat: Menopausal women who suffer with severe night sweating, hot flushes, irritability, dizziness and nervousness. They have a red tongue with a thin coating and a thready rapid pulses.
Kidney yang deficiency: This is the least common diagnosis in TCM and women experience heavy menstrual bleeding or ceased menstruation, soreness, oedema of face and limbs, cold limbs and appearance, loose stools, polyuria and urinary incontinence. Their tongue is pale with a thin coating and their pulse is deep thready and weak.
Biomedical physiological effects of herbs on the body during menopause
There are several ways in which phyto-medicinals can support and influence the body to improve symptoms and rebalance homeostasis:
- Herbs can bind to oestrogen receptors in the body and include: Pimenta dioica, Artemisia absinthium, Plantago major, Tanacetum parthenium, Hibiscus sabdariffa.
- Herbs can induce transcription of the oestrogen responsive reporter genes and include: Pimenta dioica, Artemisia absinthium, Plantago major, Tanacetum parthenium.
- Herbs can induce transcription of (oestrogen responsive genes) pS2, PTGES and PR and include: Pimenta dioica, Tanacetum parthenium Smilax domingensis, Artemisia absinthium.
- Herbs can modulate the effects of estradiol on (oestrogen responsive genes) pS2, PR and PTGES expression and include: Smilax domingensis, Pimenta dioica, Artemisia absinthium, Plantago major, Hibiscus sabdariffa.
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