Perimenopause and menopause alternatives to conventional HRT for symptom management - Women's Health Update

Townsend Letter for Doctors and Patients, Nov, 2002 by Tori Hudson

Black Cohosh

Black cohosh has emerged as the single most important herb for the treatment of menopausal symptoms. Although the bulk of the research has been uncontrolled studies, there have been six well-publicized studies. (25) In one of the largest studies, 629 women with menopausal complaints were given a liquid standardized extract of black cohosh twice per day for six to eight weeks. (26) As early as four weeks, clear improvements in the menopausal ailments was seen in 80% of the women. Complete disappearance of symptoms occurred in approximately 50%. Symptoms included hot flashes, night sweats, headaches, insomnia and mood swings. The other studies reported improvements in fatigue, irritability, hot flashes and vaginal dryness.

A more recent study of Black cohosh was of 85 women diagnosed with breast cancer who were experiencing hot flashes. Fifty-nine of them (70%) were taking tamoxifen during the trial. Participants took either black cohosh standardized extract of 40 mg twice daily or placebo. Both the black cohosh and placebo groups had a decline in the number and intensity of hot flashes during the first month of about 27%. Women in the black cohosh group did report a greater reduction in sweating. Although the results of this study are not consistent with other studies showing benefit from black cohosh for menopausal symptoms, it is important to acknowledge that the results should take into account that black cohosh may not work in the presence of an anti-estrogen, such as tamoxifen. Other weaknesses in the study that could be pointed out is that the duration was only two months and there was a high dropout rate with most of the women who remained in the black cohosh group also taking the tamoxifen.

The latest technology in determining plant constituents has not identified phytoestrogens in black cohosh. In addition, a recent study has demonstrated a lack of significant changes in the levels of gynecologically relevant hormones, a lack of an estrogenic effect on vaginal cytology and in general, a lack of an overall estrogenic effect. This, despite a substantial effect on decreasing the Kupperman Index for menopause symptoms. (28)

Ginseng

Panax ginseng, also known as Korean or Chinese ginseng, contains at least 13 different triterpenoid saponins, collectively known as ginsenosides. Whether it involves reducing mental or physical fatigue, (29-32) enhancing the ability to cope with various physical and mental stressors by supporting the adrenal glands, (33) or treating the atrophic vaginal changes due to lack of estrogen, ginseng is a valuable herb for many menopausal women.

Combination products

Most of the herbal combination products available contain either 5 or more plants, some that contain phytoestrogens and some that have other therapeutic benefit specific to menopause. Other combination products contain a mixture of plants and nutrients such as soy or vitamin E. Most all of these combination products have not been researched, even though an individual ingredient has been. One herbal combination product that has been the subject of a clinical trial contains dong quai, motherwort, licorice root, burdock root and wild yam root. Women were randomly assigned to the herbal combination 2 caps 3 times daily or a placebo for three months. After three months, 100% of the women taking the botanical formula had a reduction in their symptom severity, while only 6% of women receiving placebo showed a decrease. Seventy-one percent of women taking the herbal formula reported a reduction in the total number of symptoms, while only 17% of the women taking placebo reported a decrease in the total number of their symptoms. The botanical formula was most effective in treating hot flashes, mood changes, and insomnia. There were no clear effects of blood levels of estradiol or total estrogens, although there was actually a trend for a decrease in the treatment group. Serum progesterone levels also appeared to decrease in the herbal group. No clear effects of the botanical formula were apparent in HDL cholesterol, triglycerides, or total cholesterol.