Hot flashes, headaches and depression are typical symptoms of menopause that strike fear in many women who are nearing “the change.” Hormone replacement therapy — taking a combination of estrogen and progestin — is the treatment of choice for most physicians today because of its ability to relieve menopausal symptoms and provide other health benefits such as delaying osteoporosis and protecting against heart disease.
But what if you have breast cancer? Hormone replacement therapy is not recommended because it may increase the risk of breast cancer, although studies are inconclusive. Or what if you just don’t want to take hormones because of the possible side effects like bloating, blood clots and depression?
Treating menopausal symptoms is an individual process, says Judy Lane, NP, MS, director of women’s medicine at the Preventive Medical Center, San Rafael, Calif. “As the degree and severity of menopausal symptoms varies enormously, so does response to therapy, whether it be herbal or hormonal. Consequently, herbal therapy has been of great help to some women, and totally ineffective with others.”
Black Cohosh: Another Option
There may be another option in the fight against hot flashes — the herb black cohosh. Black cohosh is found predominately in the eastern United States and was traditionally used by Native Americans to treat women’s health issues from irregular menstruation, to cramping and menopausal symptoms. Packaged herbal supplements contain Remifemin, the standardized extract of black cohosh, which has a low toxicity with few side effects — except in pregnant women who should consult a physician before taking any herbal supplements.
A randomized trial was completed recently on the effectiveness of black cohosh in treating menopausal symptoms in women who have breast cancer. The study’s lead author, Judith S. Jacobson, DrPH, in the division of epidemiology at the Mailman School of Public Health, Columbia University, N.Y., discusses the team’s motivation. “We knew that cancer patients were using many kinds of complementary and alternative medicine (CAM), and we believe that it is important to study the efficacy and safety of CAM. Joel Evans, M.D., a co-author of the study, is an obstetrician/gynecologist who has been encouraging his patients who did not want to take hormone replacement therapy to try black cohosh. He decided that a formal trial was needed and came to us.”
The study offers some insight into the herb’s effectiveness and possible dangers. Women who have survived breast cancer often take the drug tamoxifen to treat or prevent any recurrence of the cancer. Unfortunately, tamoxifen magnifies the symptoms of menopause — particularly hot flashes. Because hormone replacement therapies are often off-limits to women with breast cancer, they are turning to alternative medicine for help in ever-increasing numbers. Out of 305 breast cancer patients polled at Columbia-Presbyterian Medical Center, 37 percent reported they were using medications not prescribed by their doctors.
These findings prompted researchers at Columbia to do a clinical trial comparing the effect of black cohosh on women who have breast cancer, have completed the first phase of treatment and who suffer from frequent hot flashes. They tested 85 women for two months — 42 took black cohosh, 43 took a placebo. The results were mixed: Both groups reported reductions in their symptoms.
Does this mean that black cohosh is all hype? Not necessarily. The study did find that the group taking black cohosh noted a significant decline in excess sweating — a symptom obviously related to heat — and the placebo group did not.
Christiane Northrup, M.D., obstetrician/gynecologist and author of the book The Wisdom of Menopause, which follows her New York Timesbestseller, Women’s Bodies, Women’s Wisdom, comments, “It is well-documented that placebos often work for many menopausal symptoms. That is because stress of all kinds exacerbates menopausal symptoms. When a woman is given a remedy that both she and her doctor believe in, it is far more likely to work. And that is not ‘all in her head’ — there are direct physical effects that result from positive expectations, such as the decrease in the stress hormones cortisol and adrenaline.”
Jacobson admits that the study is far from cut and dry. “Although these findings do not tell us everything we might want to know about the potential phytoestrogenic activity of Remifmin, they represent more information than is currently available on other herbal agents for menopausal symptoms. I believe that quality of life is important, and that a woman who is suffering from hot flashes and wishes or is advised by her physician not to use hormone replacement therapy might reasonably consider trying black cohosh.”
China’s Remedy: Dong Quai
There are many other herbs that are frequently used to treat the long list of menopausal ailments. But women must be patient, says Northrup. “Herbs do not work as fast as hormones and may not be appropriate for a woman who is suffering from something like severe insomnia from hot flashes, or severe vaginal dryness.”
Dong quai is one of the most popular. A Chinese herb, dong quai is used for menopausal complaints, irregular menstruation and abdominal pain. Janet Zand, LAc, OMD, a naturopathic physician in Austin, Texas, and author ofSmart Medicine for Healthier Living, explains, “Dong quai, also spelled tang kuei or angelica sinensis has been used for over 2,000 years throughout Asia in the treatment of many gynecological problems. As for menopause, it is known to treat hot flashes as well as painful and abnormal menstruation. It is believed that the efficacy of dong quai is due to its phytoestrogens as well as its ability to help stabilize blood vessels.”
However, a study was conducted on 71 postmenopausal women using dong quai and a placebo. Dong quai failed to live up to its reputation as a menopausal cure-all — both the placebo group and the group taking the herb reported the same results.
However, Lane reports that there is more than one way of interpreting studies. “The most widely accepted study on dong quai in Western medicine was published in Fertility and Sterility and was a double-blind, placebo controlled trial that showed no benefit to using the herb. However, in Chinese medicine, dong quai is generally never given as a single herb, but in combination, and this was one of the criticisms of the study.”
Using natural hormones is another option. Cynthia M. Watson, M.D., family practitioner in private practice in Santa Monica, Calif., recommends a combination of maca root and natural progesterone. “Maca root is probably one of the number one things I use for women with perimenopausal and menopausal symptoms who don’t want to go on estrogen, and I use it with natural progesterone. I have very good results with symptoms like hot flashes and vaginal dryness. I think natural progesterone is far underutilized in conventional medicine. I have been on natural progesterone myself for almost 10 years. It has saved me many times and has prolonged my menstruating years.”
Zand is a proponent of plant estrogen. “Natural plant estrogens, orphytoestrogens, provide a useful form of estrogenic like supplementation for women who are unable or who choose not take conventional estrogen replacement therapy. There are over 300 different plants that contain estrogenic-like substances.”
However, there are potential drawbacks to natural hormones. Watson explains, “The issue is, do herbs and natural hormonal treatment protect the bones, the heart and the brain? We don’t know the answer to that question yet. Synthetic hormone replacement does that. I believe the power is in the individual and in her own ability to educate herself and to be a part of her own healthcare, but you do need to be careful because it would be a shame for a woman to be on plant estrogen for 15 years and find out that she’s developed osteoporosis.”
Northrup says, ”My favorite alternative menopause remedy is high dose whole soy food, either as soy food itself, e.g. soy milk, edemame, etc, or as a powdered drink. Usually 100-180mg of soy isoflavones per day will improve hot flashes, vaginal dryness, skin dryness, and mood swings. Research has shown that soy tends to enhance the effects of estrogen, giving better results at lower doses. It is also very useful in those women who cannot take estrogen because of a history of breast cancer, uterine cancer, or ovarian cancer.”
Frustrated? Without a multitude of in-depth research projects, randomized trials, and clinical studies to scientifically back up the benefits of herb and natural hormone use in treating menopausal symptoms, it is difficult to make any grandiose claims or sweeping criticisms.
Jacobson offers some hope. “Many studies of herbal agents are in progress. Dr. Fredi Kronenberg at Columbia’s Rosenthal Center is currently conducting a clinical trail of black cohosh in a different formulation, at a different dose, over one year of use in healthy women with hot flashes. That trial should give us much more detailed information about efficacy and safety than we now have.”
On the positive side, black cohosh, dong quai and maca root have few or no adverse side effects, so trying them may be an option for many women. Your physician can advise you on any possible interactions if you are taking other medications. Also ask about hormone replacement therapy and natural hormones — one may be the right choice for you. As Lane says, “The only given about treating menopausal symptoms is there is no ‘one size fits all.”
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