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 symptoms experienced by women in midlife are the result of declining oestrogen levels. Herbal therapies can help to manage mood changes such as anxious thoughts and depressed feelings, as well as 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 menopause is under the guidance and advice of a trained natural therapist.
Herbal Remedies for Use in Menopause
Black Cohosh, Cimicifuga racemosa
Black cohosh is a North American plant which the 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. It is primarily used 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 using 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.
The herb is generally well tolerated, although higher doses may cause headaches for some women. These usually cease when the dose is reduced.
Black cohosh, taken orally as well as topically (as a cream or pessary), has been shown to be effective for vaginal dryness.
Warning: Toxicity may occur from black cohosh. For more information see: Safety of Black Cohosh
St John’s Wort
St John’s Wort is not an oestrogen-like herb and is usually combined with other herbs such as black cohosh for more effective treatment.
St John’s Wort can be useful for hot flushes that are triggered by anxiety or stress. It can also be used for mild to moderate anxiety and depression – specifically depression associated with menopause.
A recent analysis of randomised clinical trials 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, was as effective as standard antidepressant treatment and had fewer side effects.
Warning: St John’s Wort should be avoided by people on a number of different 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.
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 where necessary.
Herbal Remedies for Use in Perimenopause
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 is in the form of 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 shown 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).
Hops may be useful for hot flushes associated with anxiety or stress. It may also be useful for associated insomnia (sleeplessness).
Warning: If severe depression is experienced, it is strongly recommended that Hops should not be taken.
Passionflower, Chamomile, or Valerian
Passionflower, Chamomile, or Valerian in the form of a herbal tea or tablet may also be considered to help with sleeplessness.
However, in a very small number of people, Valerian has a stimulating effect, rather than inducing sleep.
Panax Ginseng, a traditional Chinese herb, increases the body’s ability to cope with physical and mental stress. The Ginsengs are useful for hot flushes that are aggravated by fatigue and overwork.
Panax Ginseng increases vitality and physical performance. It may be useful as part of the treatment for night sweats.
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 never be taken during an acute infection (as this may worsen the condition), or with high doses of caffeine.
Like Panax Ginseng this herb may improve stamina and vitality during times of increased physical and mental demands, though it is generally considered to be less stimulating. It can be taken for a longer time than Panax, over several months.
Warning: Siberian Ginseng should not be taken during an acute infection.
Dong Quai may be useful for hot flushes associated with fatigue and overwork.
Licorice, may also be used for night sweats.
(The herb Licorice root should not be confused with confectionery liquorice. Licorice should not be taken long-term or by people with high blood pressure.)
Linseed or Flaxseed
Linseed or flaxseed has been shown to reduce vaginal dryness. The correct 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 attatchment of a blender or an electric coffee grinder) and store in the fridge in an airtight container.
Lavender, as a herb rather than as an essential oil, is used to help to clear depression. There are many varieties of Lavender, therefore 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, used as a herbal tea, has traditionally been considered to ‘lighten depression’. It helps relieve tension and stress, and is easy to grow as a home remedy.
Oat Straw ‘feeds the nervous system’ and is different to the rolled oats we have for breakfast. However, women should be encouraged to eat oats in the form of porridge or muesli to gain benefit. If you are gluten intolerant, you should avoid oats as it is a gluten-containing grain.
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