Herbal Therapy: Natural Options for Menopause

Many traditional cultures celebrate menopause as a rite of passage, a coming into wisdom, but as ovaries stop producing eggs, and hormone levels drop, most Western women don't feel like celebrating.

Conventional medicine relies on hormone replacement therapy (HRT) to relieve hot flashes, mood swings, and sleep disorders, and to keep more major medical issues such as osteoporosis and heart disease in check. But since HRT often means increased breast cancer risks, not everyone can use or wants this treatment.

Dr. Mary Hardy, head of the Integrative Medicine Group at Cedars Sinai Medical Group in Los Angeles, has found some natural remedies to ease this transition:

Q: Why take herbs instead of a more conventional therapy?

A: Many women choose herbs either because HRT is not recommended for them because of the increased risk of breast cancer, or because they just don't feel comfortable using HRT.

Q: What are some alternative treatments for menopausal symptoms?

A: Eating soy can be very helpful for relief of menopausal symptoms. Among herbal remedies, black cohosh is an herb we learned about from the Native Americans and is now widely used in Europe.

We don't know exactly why, but it's good at relieving some symptoms like hot flashes and mood swings. Study has started on red clover for its effects on hot flashes as well. This herb contains some of the same chemicals as soybeans, called isoflavones, often referred to as plant estrogens or phytoestrogens.

Q: Is it okay to use herbs while still on HRT?

A: Combining herbs like black cohosh or red clover, or soy with conventional hormone replacement therapy is mostly okay. But HRTs are powerful drugs, so your physician needs to be involved in your decision.

Q: Is it safe to replace my HRT with herbs?

A: That's a question every woman should ask her doctor, as the answer depends on the individual's indication for estrogen. If you've been using HRT for symptom control, and not for significant medical issues that require estrogen replacement, herbal treatments can be used safely.

But if you are taking HRT for heart disease, severe osteoporosis, intractable hot flashing, or chronic vaginal infections, it may not be advisable. The more significant your medical issues, the more you need to involve your physician in this discussion.

Is It Right For You?

Q: Is it safe to take phytoestrogens, like soy, if I have breast cancer?

A: It's a very controversial issue right now, and you'll find more than one opinion without definitive answers. If you want to take phytoestrogens, do so under doctor's supervision. I also feel that eating soy foods is safer than taking high-dose soy extractions. Generally, most of the safety data comes from observing Japanese women and their diets, so we should try to approximate what they do.

Q: Is black cohosh safe to use if I have breast cancer?

A: While the results are far from conclusive, researchers in a couple of in-vitro studies found black cohosh inhibited the growth of cancer cells. They also tested for interactions between black cohosh and Tamoxifen (an estrogen-blocking drug used in the treatment of breast cancer) and found the black cohosh did not weaken the Tamoxifen. There's a far jump from a test tube to a person, but in low doses, we feel it's safe.

Q: What about dong quai?

A: Customarily in Chinese medicine, dong quai is never used alone but rather as part of a formula, and depending on the specific symptoms, may not be at all appropriate. Unless it's part of a formula recommended by a certified practitioner of Chinese medicine, I'd say skip it.

Q: Where can I find herbs and how much do they cost? Can I get insurance to cover them?

A: You need to identify a local source of good herbal products. You can start with your neighborhood natural food store. More and more pharmacies are stocking herbal products these days, so I'd look there too. Your herbalist or physician should also be able to make recommendations as well. Most herbs cost less than $100/month, but generally those costs are out of pocket.

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