Menopause

For safe use of over-the-counter medicines, herbal remedies and supplements, consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement:
– if you have a serious medical condition
– if you are breast-feeding, pregnant or planning to become pregnant
– if you suffer from allergies

Registered herbal medicines (bearing the THR logo) will have a package insert. Read this before taking the product.

Avoid taking the product if you think you may be allergic to any of the ingredients.

Do not combine over-the-counter medicines, remedies or supplements with prescribed medicines unless you have first checked with your prescriber or a pharmacist.

Seek advice from your doctor or pharmacist:
– If your symptoms do not get better
– if your symptoms get worse
– if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

Given the debate about the risks of HRT, it is not surprising that many women look for alternatives. Several surveys have shown that women are particularly likely to try complementary and alternative treatments during the menopause. Many of these therapies might be worthwhile but, if no clinical trials have been carried out, we can’t be sure whether they really work.

Many of these products may not always be manufactured as strictly as standard medical products. For example, there are some concerns about liver damage from black cohosh (see below). It appears that this this sort of liver damage is linked to inferior and possibly dangerous substitutes for black cohosh. Recent market surveys have shown that one-third of black cohosh products do not contain the real herb. This is an important reminder that you should only to buy products that have been independently certified as coming from reliable suppliers. (In this case there are registered herbal medicines of assured quality available, distinguished by the THR logo).

Check the British Herbal Medicine Association site for the full range of THR products for the menopause.

For a review of various herbal approaches to the menopause see the following

A review of effective herbal medicines in controlling menopausal symptoms. Kargozar R, Azizi H, Salari R. Electron Physician. 2017 Nov 25;9(11):5826-5833

Link to Abstract and Full Paper.

Summary
This herbal medicine from North America is also known as squaw root, and as its name suggests was favoured by indigenous women. Its most active constituents appear to be a complex mix of triterpenes (similar in structure to plant steroids) with a range of interactions on hormonal, nerve transmitter and inflammatory mechanisms in the body. There is no particular evidence of an oestrogenic effect, although some pointers to benefits on bone density after menopause.

Evidence
Some research suggests that black cohosh may help with hot flushes but not all studies show this. Researchers have also found that black cohosh in combination with other herbs (including St John’s wort) appeared more effective than black cohosh alone. Evidence for side-effects was uncertain.

Safety
There have been a few reports of liver disorders among women using products claiming to be black cohosh. However adulteration with different species is common, and although these reactions in the liver appear to be rare, women taking black cohosh should be aware of this possible risk and take special care to use only assured-quality registered herbal medicines with the THR logo.

Cost
A THR black cohosh may cost up to £10 for a month’s treatment.

Further information
Check the British Herbal Medicine Association site for the full range of THR black cohosh products.

Summary
Evening primrose is a yellow, flowering plant that blooms in the evening. It contains gamma-linolenic acid (GLA), an omega-6 essential fatty acid required by the body for growth and development. The body can’t make GLA so we need to get it from our food.

Evidence
There is some evidence suggesting that evening primrose oil may help breast pain associated with the menstrual cycle, and premenstrual syndrome (PMS). But it does not appear to help menopausal problems.

Safety
EPO is generally safe in recommended doses. Reported side-effects are rare and mild. Stomach pain and loose stools may mean you are taking too much.

If you get seizures (e.g. epileptic fits) be careful with omega-6 supplements such as EPO. They may make seizures more likely. EPO should be taken cautiously if you have bleeding problems or a blood disorder.

Cost
A course of EPO at effective levels may cost around £15 per month.

Summary
Research findings on how supplements made from red clover extracts affect hot flushes are mixed. Most studies say that taking them for up to a year does not help hot flushes or night sweats. There is also no evidence that taking red clover supplements for three months to a year will reduce ‘bad’ cholesterol or increase ‘good’ cholesterol or increase bone strength in women.

Evidence
According to two reviews of research, red clover supplements may produce a slight to modest reduction in the number of daily hot flushes.

Safety
Phyto-oestrogen supplements may contain more phyto-oestrogens than foods. Long-term use of these supplements are probably safe and may even reduce the risk of getting some types of cancer, particularly breast cancer. However there is no full safety assessment here.

Cost
Red clover supplements can usually be obtained for less than £10 per month.

Summary
The active ingredients in soy are called isoflavones. Supplements containing concentrated isoflavones are available in pharmacies and health food shops. But there is no guarantee that the content shown on the label is accurate.

Evidence
A review of research compared women on HRT with women taking soy-based supplements. Women on HRT had 24 fewer hot flushes per month. Women on soy supplements had 12 fewer, and all had fewer than those who took a ‘dummy pill’. The study did not look at whether eating soy rich foods has the same effect on hot flushes.

Safety
Soy supplements may contain far more phyto-oestrogens than foods. Long-term use of these supplements may reduce the risk of getting some types of cancer, particularly breast cancer, but the full evidence is not clear. Some women get nausea, bloating, and constipation when they take soy supplements.

Cost
Soy-based supplements should not be expensive compared to other supplements.

Summary
Wild yam creams are advertised as a natural form of HRT to be rubbed into the skin. But, despite such claims, this plant does not contain any progesterone-like ingredient. The confusion arises because the root of the plant is used in laboratories as raw material to synthesise progesterone and the contraceptive pill. Although wild yam (like black cohosh) contains oestrogen-like substances, the human body cannot convert them into female hormones.

Evidence
According to research carried out to date, using wild yam cream for three months does not help with hot flushes or night sweats.

Safety
Some commercial herbal wild yam products, especially those bought from Internet retailers, may contain illegal prescription progesterones.

Summary
Menopause is not often referred to as a problem in traditional texts or anthropological accounts. This is unlikely to be due to a bias against women’s problems as there is much else on other aspects of women’s health. So one conclusion is that there was less such trouble in the past, and that menopausal problems are more a modern condition.

There are plausible reasons why menopause may be more problematic today. There are different sorts of pressures on the system which may affect a key component of the stress response. During a woman’s reproductive life there are two pairs of glands that produce steroid hormones: the adrenal cortex and the ovaries (it is the testes in men). They overlap in their function and can be seen as partners in the steroid production business: not only for reproductive functions but for stress management and fluid balance. At menopause one pair leaves the field. One way to describe the majority of women who go through the menopause easily is that they have good adrenal capacity to make up the slack. A woman who is having difficulties may have had other stresses on her adrenal functions.

Nowadays there are less large family units where women can keep an active role in complex relationships. The wider community networks of the traditional societies are also less diverse. Women are now more often unsupported and have to cope with major life transitions alone. They are more likely to be worn down.

This link is picked up in traditional approches. A consistent theme through the ages was that symptoms such as hot flushes and particularly night sweats that we now associate with menopause, were due to a wider depletion of energies. The favoured remedies for such symptoms were therefore ‘tonics’. A classic example is St John’s Wort, which was consistently understood to be a tonic remedy, especially in convalescent recovery from illness or injury but in some traditions was also associated with women’s health.  (Note there are possible interactions between St John’s wort and conventional medication.) Other consistently favoured tonic remedies that might have relevance to women at this stage of their lives include the following.

Shatavari (Asparagus racemosus) – a widely used tonic for women in India, used at all stages of reproductive life, and including into later years.

Ashwagandha (Withania somnifera) – a very popular remedy in India and around Asia, including as restorative tonic, tissue healer.

Safety
There are few known risks in taking most of the herbs above. Apart from St John’s wort there are unlikely to be interactions with conventional treatments. However they should always be seen as part of a bigger picture.

It is also advisable not to buy herbs online unless from suppliers with prominent reputation (they will be concerned to protect this by ensuring quality for their products). Unfortunately there are few controls on herbal sales and many cases of adulterated or wrong products. It is always a good policy to look for a registered herbal medicine, with the THR logo on the pack. This will have its quality independently assured.

A good approach in choosing traditional herbal approaches for menopause is to see a qualified herbal practitioner. You will find well trained practitioners from a number of traditions from the website of the main umbrella body the European Herbal and Traditional Practitioners Association. This will entail extra costs but will allow you to have herbs you might not find elsewhere, and tailored to your needs.

Cost
Most herbs should be inexpensive and can be bought from specialist suppliers. A registered herbal medicine (THR) if available, will cost more – round £15 per month.  Seeing a practitioner may cost around £50 for a first visit.