Dr M Rajen
B Pharm(Hons), MBA, MD
CEO, Tropical Botanics Sdn Bhd
MD, Alterni (M) Sdn Bhd

Study after study the world over has repeatedly shown that women not only personally favor traditional and complementary medicine but also promote them for their families.

So it should come as no surprise that they would opt for it for themselves for a condition that is unique to them as in the case of menopause.

Thus even when HRT was being promoted as the” option of choice” for menopause and long before doubts about both its safety and efficacy, many women choose not to undertake HRT as a treatment of first choice. They preferred instead to try what appears 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.

Indeed, menopause is traditionally not viewed as a disease. It is seen as a phase of the life of a woman like menarche or pregnancy.

As such, traditional medicine practitioners do not prescribe 'natural' HRT. Instead they 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 can be safely recommended to women as a starting point. 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).

Over the last decade or so, some new clinical validation of these European herbs has happened.

St John's Wort 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. To date no significant side effects have been observed.

Black cohosh has been shown to have demonstrable oestrogenic effect. A preparation of dried aqueous ethanolic extract, was shown to significantly lower LH without affecting FSH, implying an oestrogenic effect.

While no serious side effects have been observed, the British Herbal Compendium suggests that treatment not exceed six months.

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.

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 these up.

In Ayurveda and Chinese Traditional medicine, herbs are also the mainstay of treatment of menopause related symptoms. Indeed, the use of herbs in more prevalent in Asia and more historic in nature than when compared to North America and Europe.

Sadly, herbs of Asia like Ashwaganda (Withania somnifera) Satavari (Asparagus racemosus)and Dong Quai ( Angelica sinensis) have not been vigorously researched by western based scientific methods but this is soon to change as the herbs of China and India are getting a lot of buzz in the western world both in the scientific and lay communities.

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.

Other elements of traditional medicine like panca karma and acupuncture have a long history and safe as well as effective use. Still, they need scientific validation.
 

Footnotes

• 1. Ernst E St John's Wort, an anti-depressant? A systematic, criteria-based review. Phytomedicine 2 (1) 67-71, 1995
• 2. Duker E et al Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal woman and ovariectomized rats. Planta Medica 57 420-424, 1991
• 3. Bradley PR (ed) British Herbal Compendium Vol 1 British Herbal Medicine Association Dorset 1992, 34-36