Herbs and Supplements Used to Treat Menopause
Black Cohosh (Cimicifuga Racemosa). Black cohosh is widely used for the relief of menopausal symptoms (e.g., hot flashes, insomnia, sweating, and mood changes) Black cohos is also used to trat PMS and dysmenorrhea, however, there are no randomized controlled trial (RTC’s) to support its use for the treatment of either PMS or dysmenorrhea. The most commonly studied preparation, Remifemin, is formulated as an isopropanolic aqueous extract and as a tablet in the United States. This product is standardized by its content of triterpene glycosides, specifically 27-deoxyactein. Each 20-mg tablet contains 1 mg of 27-deoxyactein; the product is typically dosed twice daily.[4]
The mechanism of action of black cohosh is poorly understood. It has been suggested that black cohosh reduced leutinizing hormone (LH) levels, which have been linked to hot flashes. Some suggest that black cohosh had estrogenic properties. Research has failed to show an effect on LH, follicle-stimulating hormone, prolactin, estradiol. Effects on serotonin and dopamine receptors might suggest a possible central role. Mice when fed the daily equivalent of 40 mg of black cohosh were more likely to develop breast cancer which metastasized to the lung. Women with a history of estrogen-dependent cancers should avoid this product until risks of use are better defined.
A number of studies demonstrated that black cohosh did alleviate menopausal symptoms (hot flashes, vaginal atrophy, and psychological symptoms, depressive mood, nervousness, and irritability). In comparative trials, the efficacy of black cohosh was similar to 0.625 mg conjugated estrogens (Premarin) and 25 mcg of transdermal estradiol (Estraderm) in alleviating menopausal symptoms over a 3-month period.
Side effects of black cohosh appear to be rare but can include stomach upset, and possible liver injury. Recent studies failed to show an effect of black cohosh 40 mg/day on liver enzymes over a 3-month duration. Women using this herbal medication should have regular gynecologic checkups, and women with estrogen-dependent cancers should avoid its use. Some studies recommend limiting use of this herb to 6 months because of a lack of long-term safety data. Black cohosh has no reported drug interactions.
Phytoestrogens are plant-based compounds that have an increased affinity for certain estrogen receptors. They are weak estrogens when compared to estradiol. Phytoestrogens are grouped into four main categories: isoflavones, coumestans, lignans, and flavonoids. The most studied group is the isoflavones, consisting of genistein, daidzein, and glycitein. Soybeans are a rich source of isoflavones, and flaxseed is a source of lignans. Flaxseed should not be confused with flaxseed oil, which is a source of omega-3 fatty acids, not phytoestrogens. Red clover (Trifolium pretense) contains compounds that are metabolized to create genistein and daidzein after ingestion. The most widely studied red clover product is Promensil. Although studies suggest that soy products may reduce the incidence of menopausal symptoms, a recent review of the literature concluded no clear benefit of soy foods, soy extracts, or red clover extracts on hot flashes and other menopausal symptoms. Women who want to consume phytoestrogens should use food products versus supplements and take no more than 100 mg of isoflavones per day, which is equivalent to 25 g of soy protein. The long-term use of large amounts of phytoestrogens is not recommended. One study demonstrated a significant increase in the risk of endometrial hyperplasia in women who consumed more than150 mg/day of isoflavones for 5 years. The safety of phytoestrogen use in women with a history of estrogen-dependent cancers is unknown.
St. John's Wort and Kava Kava may be beneficial in relieving some of the psychological symptoms associated with menopause. However, evening primrose oil (Oenothera biennis), dong quai (Angelica sinensis), Panax ginseng, wild yam (Dioscorea villosa), and vitamin E have been recommended for reducing menopausal symptoms. Studies have failed to show any clear benefit for these products. Vitamin E was associated with a small but significant reduction in hot flashes in breast cancer survivors taking 800 IU/day for 1 month.
St. John's wort reduces symptoms of mild to moderate depression, whereas kava kava may benefit symptoms of mild to moderate anxiety. St. John's wort has the potential to induce the metabolism of many medications and should be used cautiously in women taking prescription medications. St. John's wort is also known for causing photosensitivity reactions and may contribute to oxidation of lens proteins in the eye, causing cataracts. Persons using St. John's wort should be monitored for symptoms of agitation, insomnia, hypomania, and mania, which have occurred in rare instances, and should wear sunglasses and sunscreen when outdoors. St. John's wort should not be used in conjunction with antidepressants and other medications, which have the potential to increase norepinephrine, dopamine, or serotonin levels, as additive adverse effects, such as serotonin syndrome, may occur.
Although kava kava has shown benefits in alleviating anxiety associated with menopause, it may also have a damaging effect on the liver. It was removed from the market of many European countries because of this side effect. Use of this product is not recommended in women with preexisting liver disease or who consume acetaminophen, alcohol or other chemicals or medications that can damage the liver. Recommendations are suggested to limit the use of kava kava to no more than 3 months without medical supervision and approval. Women using kava should have liver function tests performed regularly. Kava kava should never be used in conjunction with other medications that can impair coordination or cause central nervous system sedation, because ataxia and motor impairment have been observed. Finally, kava has been associated with case reports of extrapyramidal reactions and should be avoided in persons with a history of Parkinson's disease.
Summary
Ideally, herbs and supplements should be evaluated for proof of efficacy in randomized clinical trials prior to use in a clinical setting. Unfortunately, Food and Drug Administration regulation under the Dietary Supplement Health and Education Act does not currently require this level of support before products are marketed to consumers. Herbs and dietary supplements have demonstrated value in treating certain gynecologic conditions. Some herbs and supplements, include black cohosh for menopause; vitamins B1 and E for dysmenorrhea; magnesium, calcium, vitamin B6, and chasteberry for PMS; and chasteberry for cyclic mastalgia have show significant value. There were too few randomized clinical trials involving herbs and dietary supplements in infertility to warrant a solid recommendation, but chasteberry, antioxidants, and Fertility Blend have some preliminary support.
To read Section 1:Herbs-Supplements In Gynecology (PMS and Dysmenorrhea)-1 click here.
To read Section 2: Herbs-Supplements In Infertility-2, click here.
Related Articles:
More articles by this author
|
Women's Health Issues 
