For many women, menopause brings relief from monthly periods, freedom from worry about unplanned pregnancy, and excitement about entering a new phase of life. For many others, menopause brings physical and emotional upheaval linked to changes occurring as the female body makes its transition out of the child-bearing years.
Whether you’re among the former or the latter or somewhere in between, chances are that you will at some point seek relief from the symptoms of menopause, which include insomnia, depression, stiff joints, bloating, vaginal dryness, sore breasts, and hot flashes. Hot flashes, which are characterized by a sudden increase in heart rate, peripheral blood flow, and sweating, are for many women the most uncomfortable aspect of menopause. Research suggests that about 75 percent of menopausal women are affected at one time or another by hot flashes, 15 percent of them seriously so. These figures suggest that four to five million U.S. women currently are severely affected by hot flashes.
Modern science has linked hot flashes to a decline in estrogen levels, which in menopausal women are only about 10 percent of their former levels. For the past several decades, conventional medicine has treated hot flashes and other menopausal discomforts with estrogen replacement therapy (ERT). Because ERT is contraindicated for women with a history of cancer, hormone replacement therapy (HRT), which combines estrogen with a synthetic progesterone, is often used instead. But many women don’t want to take the potential increased risk of cancer associated with ERT, or they dislike the cyclical bleeding often caused by HRT, or they don’t want to take pills. Some women can’t tolerate the side effects associated with these treatments. Despite the high interest of women in alternatives to ERT and HRT, however, little scientific investigation of alternatives has been done.
Traditional herbal medicine has for years offered a variety of treatments to ease hot flashes. Few of them have been sufficiently researched, but black cohosh (Cimicifuga racemosa) and vitex (Vitex agnus-castus), or chaste tree–both of which contain estrogen-like compounds–have shown promise in relieving menopausal complaints. Further work is needed to determine how effective these herbal remedies are as actual substitutes for ERT. Dong quai (Angelica sinensis), an herb commonly used in traditional Chinese medicine, has been shown to relieve menopause symptoms in many women; how it works is not clearly understood.
North American Indians and eclectic physicians of the nineteenth century alike used black cohosh in decoctions to treat gynecological problems. Today’s herbalists and homeopaths also value it for this purpose; herbalists also prescribe it as a hormone regulator and as a diuretic to relieve water retention.
Studies carried out in Europe have verified black cohosh’s effectiveness in reducing the secretion of LH, which has been implicated in causing hot flashes. Experiments with rats in the 1980s showed that a methanol extract of black cohosh contains substances that bind to estrogen receptors, causing a selective reduction in luteinizing hormone (LH), which has been implicated in causing hot flashes. Experiments with rats in the 1980s showed that a methoanol extract of black cohosh causing a selective reduction of LH. In 1991, researchers at the University of G”ttingen in Germany performed a study of a commercial ethanol extract of black cohosh called Remifemin. The study involved 110 menopausal women between the ages of 50 and 54 who had received no estrogen replacement therapy for at least six months and complained of menopausal symptoms. The researchers found that the product reduced LH, and they isolated three active, as yet unidentified compounds in black cohosh that work together to suppress the hormone.
Today in Germany, black cohosh is a main ingredient of three commercial drugs used for menopausal discomforts. Germany’s Commission E, a governmental panel that studies and makes recommendations about medicinal herbs, has found black cohosh to be a safe and reasonably effective treatment of nervous conditions associated with menopause. However, the U.S. Food and Drug Administration in 1986 found no pharmacologic evidence of therapeutic value in black cohosh and cautioned against its overuse.
(also known as black snakeroot, bugbane, rattleroot, rattleweed, bugwort)
Botanical name: Cimicifuga racemosa
Family: Ranunculaceae (buttercup family)
Parts used: Rhizomes and roots
Therapy: The German Commission E has found black cohosh to be effective in the treatment of nervous conditions associated with menopause. In animal and human studies, it has reduced levels of luteinizing hormone associated with hot flashes and shown estrogenic activity similar to ERT.
Contraindication: Anyone with heart disease shouldn’t use black cohosh.
Possible side effects: Overdose causes dizziness, nausea, diarrhea, abdominal pain, headache, joint pains, decreased heart rate.
Dosage: Administered as a 40 to 60 percent alcohol extract in a quantity equivalent to 40 mg daily; also in the form of a decoction prepared from 0.3 to 2 g of the herb.
Hippocrates recommended vitex in the fourth century b.c. to treat injuries, inflammations, and swelling of the spleen. Its common name, chaste tree, is derived from the belief that it would suppress libido; European Catholics placed blossoms of the plant at the clothing of novice monks. Like black cohosh, contemporary herbalists value vitex for its hormone-regulating action and often prescribe it to treat not only hot flashes, but depression and vaginal dryness as well.
Vitex is believed to act on the hypothalamus and pituitary, regulating progesterone levels. Most of the clinical studies of vitex have been done in Europe and were noncontrolled. Two surveys of gynecological practices in Germany investigated the effect of vitex on 1,542 women aged thirteen to sixty-two with gynecological complaints. The women took forty drops of a commercial vitex product for an average length of 166 days. Physicians and patients agreed that the vitex product relieved fluid retention, bloating, breast tenderness, headache, and fatigue. Two percent of the patients reported side effects that included nausea, other gastric complaints, and diarrhea. Symptoms improved after an average of 25.3 days of taking the vitex drops. Additional anecdotal clinical reports indicate that vitex may help manage hot flashes, although further investigation is needed.
In Europe, vitex has been used for about forty years in a commercial alcohol-based tincture of the fruits known as Agnolyt; 100 mg of the solution is standardized to contain 9 g of the fruit. Recommended dosage is forty drops with liquid in the morning for several months to offset fluid retention and other discomforts. A solid extract equivalent of the tincture has been developed for those who are sensitive to alcohol.
Side effects from using vitex are rare, and there are no known interactions with other drugs. Commission E has supported the use of chaste-tree berries to treat menstrual disorders and mastodynia (painful breasts).
(also known as chaste tree)
Botanical name: Vitex agnus-castus
Family: Verbenaceae (verbena family)
Part used: Fruit
Therapy: Exact effect on menopause unclear
Possible side effect: Produces an itchy rash.
Dosage: 20 mg of concentrated alcohol extract of the fruit.
Known as a blood-purifying tonic in traditional Chinese medicine, dong quai is one of the best-selling Chinese herbal products in North America. Western herbalists view dong quai as having tonic and regulatory effects on the female reproductive system, and it is often used to treat menopausal symptoms. Scientific investigations have confirmed dong quai’s pain-relieving, antispasmodic, and anti-inflammatory activity. It is generally believed to lower blood pressure and to soothe discomforts associated with menopause.
Herbalists view dong quai as the “female ginseng”, referring to its ability to revitalize and renourish the female body by correcting hormonal imbalances; they call upon this Chinese relative of the herb angelica to regulate and normalize hormonal production.
In traditional Chinese medicine, dong quai is often used in conjunction with other herbs. In a clinical study in China, Si Wu Tang, a well-known formula that contains dong quai, was used in conjunction with herbs that tonify the spleen to treat forty-three menopausal women. Seventy percent of the women reported that the combination relieved hot flashes, dizziness, blurred vision, stomachaches, and constipation.
Dong quai root is small and ivory in color; it can be purchased sliced and pressed, or in powder, tincture, or extract forms.
(also known as dang gui, tang kuei, and Chinese angelica)
Botanical name: Angelica sinensis (formerly A. polymorpha)
Family: Umbelliferae (carrot family)
Part used: Root
Therapy: Uterine tonic; said to bring relief from menopausal symptoms; antispasmodic; treatment for hypertension
Possible side effects: Dermatitis, gastric upset
Dosage: 4.5 to 12 g in decoction or tincture. Extracts, capsules, pills, and powders also are available.
Women who have uncomfortable menopause symptoms or are preparing for menopause should become as knowledgeable as possible about the choices that are open to them. Talk to health-care providers and read more about menopause, its effects, and treatment options. Learning about various herbs’ physiological actions, including side effects and contraindications, can help a woman decide whether herbal remedies are right–and safe–for her. The resources listed below can be a place for you to start; consult the Additional Reading list to learn more about the research referred to in this article.
Books and other resources
These books will offer you a starting place in your research on menopause and treatments for its associated discomforts. Many can be found in your local library or bookstore.
Gladstar, Rosemary. Herbal Healing for Women. New York: Simon and Schuster, 1993.
Griggs, Barbara. The Green Witch: A Modern Woman’s Herbal. London: Vermillion, 1993.
Henkel, Gretchen. Making the Estrogen Decision. Los Angeles: Lowell House, 1992.
Soule, Deb. The Roots of Healing: A Woman’s Book of Herbs. New York: Citadel Press, 1995.
Weed, Susun. Menopausal Years: The Wise Woman Way. Woodstock, New York: Ash Tree, 1992.
Wolfe, Honora Lee. Menopause, A Second Spring: Making a Smooth Transition with Traditional Chinese Medicine. Boulder, Colorado: Blue Poppy Press, 1995.
The following publications also may help; you’ll need to order them:
A U.S. government publication, Menopause, may be ordered from the U.S. Government Bookstore, Room 118, Federal Building, 1000 Liberty Avenue, Pittsburgh, PA, 15222. It costs $3.25.
A pamphlet, Taking Hormones and Women’s Health: Choices, Risks, and Benefits, may be ordered from the National Women’s Health Network, 514 Tenth Street N.W., Ste. 400, Washington, D.C., 20004. It costs $8 for members and $10 for nonmembers.
Belford-Courtney, Kosalba. “Comparison of Chinese and Western Uses of Angelica sinensis.” Australian Journal of Medical Herbalism 1993, 5(4): 87 – 91.
Brown, Donald J. “Vitex agnus castus”. Clinical Monograph. Quarterly Review of Natural Medicine Summer 1994: 111 – 120.
Okker, Eva-Maria, et al. “Effects of Extracts from Cimicifuga racemosa on Gonadotropin Release in Menopausal Women and Ovariectomized Rats”. Planta Medica 1991, 57: 420 – 424.
Kaiser, Kyra. “Cross-cultural Perspectives on Menopause”.
Annals of the New York Academy of Sciences 1990, 592: 430 – 432.
Kronenberg, Fredi. “Giving hot flashes the cold shoulder–without drugs”. Menopause Management April 1993: 20 – 27.
—-. “Hot flashes: Phenomenology, quality of life, and search for treatment options”. Experimental Gerontology 1994, 29(3 – 4):319 – 336.
Menopause, the cessation of menstruation, marks the end of a woman’s childbearing years, but hormonal changes leading up to this milestone have begun several years earlier. Each month for some thirty-five or forty years, follicle-stimulating hormone (FSH) from the pituitary gland stimulates the ripening of an egg in the ovary and an increase in the ovarian hormone estrogen. The increase in estrogen signals the uterine lining (endometrium) to thicken in preparation for receiving a fertilized egg and also stimulates the production of luteinizing hormone (LH) in the pituitary. LH triggers ovulation and production of a second ovarian hormone, progesterone, which continues preparing the endometrium for implantation of the egg. If the egg is not fertilized, however, the production of progesterone declines, and the endometrium is shed as menstrual fluid.
During these years, a feedback system involving the hypothalamus and pituitary (both in the brain) and the ovaries keeps production of the various hormones in balance. At some point, however, usually in a woman’s midforties, the amount of estrogen and progesterone secreted by the ovaries declines. Ovulation and menstrual periods become irregular. When ovulation ceases completely, progesterone no longer is produced, but some estrogen is, so the endometrium continues to build up as usual. Without progesterone to regulate the cycle, however, it grows and grows until it breaks down, causing spotting. Not until estrogen levels become too low to stimulate endometrial growth does menstruation stop once and for all.
What are hot flashes?
Hot flashes usually affect women who are in the transition to menopause or in menopause, either naturally or because of medical intervention. They often occur during the first two years of menopause and decrease over time; for some women, hot flashes begin during menstruation.
The frequency and intensity of hot flashes vary from woman to woman. A “typical” hot flash lasts three to six minutes; it can last thirty. Hot flashes can occur over six months to two years–or up to forty years. They occur spontaneously and without warning signs, although some women link them to psychological stress, a hot environment, and caffeine or alcohol consumption.
The mechanism that causes hot flashes is unclear, although they have been linked to declining estrogen levels. Many women have found that they can deal with them nonmedically. By observing the conditions surrounding you at the time of a hot flash, you may be able to exert some control. You may wish to keep a record of the time and severity of a hot flash to see whether there is a pattern. Dressing (and undressing) in layers can help you tolerate overheated offices and meeting rooms: at least one study has confirmed that the frequency and intensity of hot flashes decline dramatically when women are in a cool environment. Recent research suggests that exercise and healthy eating habits may be just as effective in reducing hot flashes as estrogen and hormone replacement therapy. Smoking also plays a role; it has been shown to reduce estrogen levels, so quitting may help decrease the incidence of hot flashes along with decreasing the incidence of cancer, heart disease, and stroke.
Self-esteem and depression
A recent study performed at the University of Pennsylvania’s Department of Anthropology found that menopausal depression may be linked to cultural attitudes. The study included fifteen sociocultural groups in different parts of the world. It found that in non-Western cultures where older women gain enhanced status, political power, and decision-making authority, the depression associated with menopause in Western societies is often nonexistent. The study concluded that Western “negative stressors”, such as the views that menopause is a time of loss and that aging women have lost their societal value, may work in conjunction with fluctuating hormone levels to exacerbate feelings of low self-esteem.
An Herbal Approach
Here’s a formula developed by herbalist and author Kathi Keville that contains tinctures of black cohosh, vitex, and dong quai, as well as tinctures of other herbs traditionally used to relieve menopausal symptoms:
1 teaspoon black cohosh root tincture
1 teaspoon vitex berry tincture
1/2 teaspoon ginseng root tincture
1/2 teaspoon licorice root tincture
1/2 teaspoon dong quai root tincture
1/2 teaspoon motherwort tincture
You may prepare the tinctures of the individual herbs yourself (see Primer, pages 25 and 26) or purchase them. Take 1 teaspoon of the Menopause Tincture three times a day, mixed in a small amount of warm water.
Alternatively, dried herbs can be combined in the same proportions. To use, pour a cup of boiling water over 1 to 2 teaspoons of the mixture and let it steep; strain. Drink a cup of this tea three times a day.
To relieve water retention, add 1 teaspoon dandelion root tincture. For depression or nervousness, add 1 teaspoon tincture of St.-John’s-wort flowering tops. If making an infusion, use fresh St.-John’s-wort, not dried.