Natural Menopausal Treatments:
What's Hot, What's Not

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

From The December 1999 Issue of Natural Foods Merchandiser

Linda Knittel

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As postmenopausal women rapidly become one of the largest sectors of this country's population, so too grows the number of consumers searching for safe, natural approaches to treating the symptoms of this hormonal change. Fortunately for retailers, manufacturers now offer a large number and variety of plant-based tinctures, creams and supplements that are said to gently alleviate the vaginal dryness, night sweats, mood swings and headaches that menopause often brings. However, the trick is managing to avoid your own hot flashes while deciphering which of these natural products are useless and which will bring your customers real relief.

The growing interest in natural menopausal treatments is partly because standard synthetic hormone replacement therapy has been linked to symptoms such as vaginal bleeding, bloating, and breast tenderness, as well as higher risks of breast and endometrial cancers. And although the scientific proof backing alternative treatments is not yet as extensive as it is on HRT, there is considerable evidence that natural remedies can indeed reduce the number and intensity of symptoms, all with mild or no side effects.

To date, the most powerful of these natural products seem to be those that include phytoestrogens—plant-based substances containing plant hormones or hormone precursors. Because they are similar in structure to naturally occurring estrogen, phytoestrogens can exert beneficial effects in two ways, depending on a woman's hormone levels. In his book Menopause: Getting Well Naturally, naturopathic physician Michael Murray explains this phenomenon: "Phytoestrogens have a balancing action of estrogenic effects [causing] an increase in estrogen effects if estrogen levels are low. Since phytoestrogens bind to estrogen receptor binding sites, they compete with estrogen. Therefore, if estrogen levels are high, estrogen effects decrease."

Perhaps the most publicized class of phytoestrogens is the isoflavones such as genistein and daidzein, which are found in certain herbs and legumes, as well as soyfoods and soy-based powders and supplements. Initially, anecdotal reports comparing Asian and American women's menopausal experiences suggested that diets high in soy isoflavones were responsible for preventing many unpleasant symptoms. More recently, numerous clinical studies have clearly linked soy isoflavone consumption with reductions in cholesterol, lower incidence of breast cancer, prevention of osteoporosis and relief of menopausal complaints.

"Consuming the recommended daily dose of soy products can bring about practically pharmaceutical-like results," says Regina Lellman, a naturopathic physician and licensed acupuncturist from the Natural Childbirth and Family Clinic in Portland, Ore. "And although what constitutes the correct dose is still unclear, taking 30-60 mg of soy isoflavones a day should effectively ease menopausal symptoms, especially hot flashes," Lellman says.

The herb red clover (Trifolium pratense) whose constituent isoflavones are genistein and daidzein, is another menopausal treatment flooding the market. Like soy products, red clover's phytoestrogens have been shown to exhibit symptom-relieving estrogenic effects in the body. "I often use red clover in menopausal tinctures," says Lellman. "It is unbeatable at relieving hot flashes." Furthermore, in a study conducted by P.J. Nestle and colleagues at the Baker Medical Research Institute in Melbourne, Australia, menopausal women who were given a daily dose of 80 mg of red clover-derived isoflavones also showed decreased arterial compliance—one of the major risk factors for cardiovascular disease. For most women, however, a daily dose of just 40 mg of red clover—in tincture or capsule form—will drastically reduce the number of hot flashes and may help protect against heart disease.

Even though the mechanism behind black cohosh's (Cimicifuga racemosa) effects is no longer believed to be phytoestrogenic, as it is in soy and red clover, this menopausal treatment has clearly been shown to relieve hot flashes, night sweats, headaches, heart palpitations, depression, anxiety and vaginal dryness. "Surprisingly, this herb actually has no estrogenic effects," says Steve Bratman, M.D., a Fort Collins, Colo.-based physician. "But there is no question that it works."

Extracted from the root of a North American forest plant, black cohosh contains triterpenes and flavonoids that appear to act on a woman's pituitary gland. "It works by suppressing the secretion of the pituitary's luteinizing hormone," says Bratman. Since LH is responsible for causing several of the most bothersome menopausal symptoms, black cohosh actually prevents symptoms from occurring rather than simply soothing them. However, the keys to reaping this herb's rewards are patience and consistency, as it usually takes three to four weeks for its effects to fully kick in.

"Consistently using a daily dose of standardized black cohosh is one of the best ways to naturally treat menopausal symptoms," says Bratman. "Follow the dosage instructions on the product label, and make sure never to confuse this herb with its potentially dangerous cousin blue cohosh (Caullophyllum thalictroide)," he advises.

"Flaxseed is another dietary supplement that can deliver side effect-free menopausal relief," Bratman says. Interestingly, an altogether different type of plant estrogen called lignans is behind this seed's ability to ease hot flashes and relieve vaginal dryness. By simply milling a handful of seeds in a coffee grinder each day and adding them to baked goods, cereals or shakes, your customers can prevent uncomfortable menopausal symptoms, while also increasing their intake of important essential fatty acids.

There are a few other plant-based supplements that have demonstrated some ability to alleviate menopausal ailments, although their efficacy is not well documented. For instance, chaste berry (Vitex agnus castus), which has been approved by Germany's Commission E for treating hot flashes, night sweats, headaches, heart palpitations and vaginal dryness, appears to be a much more effective treatment for the complaints associated with PMS. "Chaste berry reduces levels of the hormone prolactin in the body," says Lellman. "I have found tinctures of this herb to be very effective in easing breast tenderness, fatigue and anxiety." It should be noted, however, that chaste berry has also been found to reduce libido.

Rest assured that customers who are treating their symptoms with a daily dose of ginseng (Panax ginseng) will not lower their sex drive, as this herb is a confirmed stimulant. "I am not sure where the idea came from to use ginseng as a menopausal treatment," admits Bratman. Nevertheless, due to its stimulatory nature, many women have found ginseng effective in combating the fatigue and depression that often accompany menopause. In addition, some doctors believe that 200 mg a day of this herb may also exert some estrogen-like effects, such as easing vaginal dryness and hot flashes.

For centuries, many menopausal women have combated the pain of hot flashes by taking the ancient Chinese herb dong quai (Angelica sinesis). While recent clinical studies have suggested that this herb is no more effective than a placebo at relieving menopausal symptoms, many physicians, including Lellman and Bratman, question such findings.

"This herb's ability to thin the blood and calm the blood vessels, whose spasms cause hot flashes, clearly make it useful in the treatment of menopausal symptoms," Lellman says. "It is also important to remember," Bratman says, "that in traditional Chinese medicine, dong quai is never used in isolation as it was in the recent scientific studies; so its well-known powerful effects might be due to herbal synergism."

Finding the perfect synergistic combination of menopausal supplements to bring about results can be a delicate process, even if they are all plant-based. "Using any kind of hormone therapy is not natural, so it should be done with caution, and only when an individual is suffering from symptoms that are troubling," advises Lellman.

Perhaps, then, the best advice a retailer can offer a customer is to try individual products and monitor their results before buying a prepackaged blend of herbal supplements. Once it is clear which mixture of these plant-based products will effectively relieve her specific symptoms, you can dazzle her with the many natural menopausal combinations now gracing your shelves.

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Linda Knittel is a nutritional anthropologist and freelance writer living in Boulder, Colo.

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