Herbal Information

The acceptance of hormone replacement therapy (HRT) as a perimenopausal treatment has not been without controversy. Many women choose not to undertake HRT as a treatment of first choice, preferring instead to try what appear to them to be softer options offered by natural and complementary medicine. The treatment of the symptoms of menopause by herbal medicine has a long history of usage and is often clinically the only intervention required.

Naturopaths and herbalists do not prescribe ‘natural’ HRT, but rather use remedies and supplements that ease the transition to and through menopause. Herbs and supplements are used to effectively facilitate the transition from the reproductive to the post-reproductive phase of life.

A number of simple herbal preparations, which can be safely recommended to women as a starting point, are available on the shelves of most health food shops. Herbs that stand out as being particularly popular in over-the-counter preparations include St John’s Wort (Hypericum perforatum) and black cohosh (Cimicifuga racemosa).

St John’s Wort This herb has been used traditionally for anxiety and mood disturbance particularly in the menopausal years. A number of controlled clinical trials have supported this claim, showing it to be effective in cases of mild to moderate depression. No significant side effects have been observed.

1.Black cohosh: Black cohosh has been shown to have demonstrable oestrogenic effect. A preparation of dried aqueous ethanolic extract, Remifemin=AE, was shown to significantly lower LH without affecting FSH, implying an oestrogenic effect.
2. While no serious side effects have been observed, the British Herbal Compendium suggests that treatment not exceed six months and that it be avoided during pregnancy and lactation.
3. In the cases of both these herbs, there is a long tradition of use during menopause, and traditional therapeutic benefits have been confirmed in clinical trials. While for some women this provides adequate treatment, for others problems are more complex, requiring professional assessment and individualized prescriptions.

Wild yam The use of wild yam (Dioscorea villosa) is not so clear cut. Traditionally viewed as of minor importance in menopausal problems, it is an effective antispasmodic to the gut and a gentle liver stimulant, with a reputed mild oestrogenic action. It is currently promoted as a useful source of progesterone when used externally as a cream. There is no history of traditional use in this form, nor has scientific research been undertaken to back up these claims. Herbalists who have investigated the constituent profile of wild yam have found no relationship between its known constituents and the claimed progestogenic action, either via ingestion or external application.

Anecdotes suggest that women are benefitting from its use, and the creams are very popular, particularly it seems, in the Northern Rivers region. This raises questions that need to be addressed. Consequently, the School of Natural and Complementary Medicine at Southern Cross University is interested in developing clinical research in this area, and hopes to have a research project underway during 1998.

Herbal medicine has much to offer women in the treatment of symptoms associated with menopause. For many it is the therapy of choice. In this area of herbal treatment, a blending of tradition and science has begun, which has the potential to allow practitioners and patients to be confident in a wider range of effective therapeutic interventions.

Sue Evans,
Lecturer