By Cathy Perlmutter, The New York Times Special Features
Will herbal products really take away the hot flashes, vaginal
dryness, night sweats, mood swings or other symptoms that can make
menopause seem like such a hassle?
Many leaders in the fields of menopause and natural therapies
say there are sound reasons to believe that a number of
health-food-store products might safely alleviate some discomforts
of menopause. And there are sound reasons to believe that others
won't. It's smartest to look at these remedies in terms of
individual ingredients.
BLACK COHOSH
The best documented of all the herbal remedies, evidence
suggests it can relieve hot flashes, night sweats, headaches, heart
palpitations and vaginal drying and thinning.
Some studies suggest that black cohosh can reduce
menopause-related headaches, depression, anxiety and decreased
libido, points out Varro Tyler, professor emeritus of
pharmacognosy, Purdue University, Lafayette, Ind.
One double-blind European study of 80 women found that black
cohosh reduced menopausal symptoms better than the conjugated
estrogens. It has been approved for the treatment of menopausal
symptoms by German Commission E, Germany's leading authority
entrusted with evaluating the safety and efficacy of herb remedies.
Black cohosh is available in capsules, tablets, drops and
powders. (Capsules or drops are the most practical way to take
black cohosh; the dose is too small to take as a tea.)
There is one brand in particular that is most trusted by leading
experts: Remifemin. The brand has been around for decades in
Europe, and became available in the United States in 1996. Its
quality and dose are controlled by a reputable manufacturer, and
many European studies have been done on Remifemin.
Forty milligrams a day is the therapeutic dose approved by
Commission E. Many products contain more -- sometimes hundreds of
milligrams more -- but larger doses are unnecessary and may even be
unsafe. Be sure to read the label to know how much of a product you
need to take to get the equivalent of 40 milligrams of black
cohosh.
Black-cohosh therapy can be more expensive than prescription
estrogen. Premarin, the most widely dispensed brand of estrogen,
costs less than 40 cents a day, while the recommended Remifemin
dose of two 20-milligram tablets daily runs about 50 cents to 60
cents a day.
Unlike estrogen-replacement therapy, black cohosh doesn't help
prevent osteoporosis and hasn't been linked to the prevention of
cardiovascular disease.
Because its long-term toxicity has not been studied, Tyler
agrees with the commission's recommendation that women use black
cohosh for no longer than six consecutive months. Tyler also
suggests allowing several weeks between uses.
CHASTEBERRY
This herb might relieve hot flashes, night sweats, headaches,
heart palpitations and vaginal drying and thinning.
Even though the commission has approved chasteberry for treating
symptoms of menopause, Tyler has a hunch that it's not so helpful
for this time of life. Based on the herb's pharmacology, it is
believed to reduce levels of prolactin, a hormone associated with
premenstrual symptoms.
The commission has approved chasteberry for treating symptoms of
menopause. In clinical experience, our experts' reviews of its
effectiveness have been mixed.
Chasteberry is available in pills, tea and drops, alone or in
various combinations. The commission's recommended therapeutic dose
for menopause is 20 milligrams a day.
While its side effects and long-term toxicity aren't well
documented, chasteberry can trigger a rash in some people. The
herbal literature also reports that it reduces libido.
GINSENG.
It might erase some of the fatigue and possibly even slight
depression that can accompany menopause. Ginseng is a proven
stimulant, Tyler says. In menopause, it may give a boost to your
general feelings of well-being.
Some doctors believe that it might have an estrogenlike effect
on the body, easing menopausal symptoms such as vaginal dryness and
hot flashes and possibly stimulating endometrial growth and
bleeding.
Some women who take ginseng experience uterine bleeding long
after they have gone through menopause, says Dr. Brian Walsh,
director of the menopause clinic at Brigham and Women's Hospital in
Boston.
With such a lack of research, the unanswered question is whether
such bleeding can be attributed to the herb itself or to the use of
an inferior product.
If any type of ginseng could be effective for menopause, it
would be Panax ginseng. This is the variety on which most studies
have been done.
Ginseng can be found in capsules, drops, tea bags and dried
herb, alone or in combination.
No one knows the therapeutic dose for menopause, since this
remedy is unproven. But for other uses, the recommended dose of a
typical product containing 4 percent ginsenosides is two
100-milligram capsules daily.
TOFU AND OTHER SOY PRODUCTS
It's not an herb, but, ``tofu and other soy products may be more
promising for menopause than any herbs,'' Tyler says. Soy may be
effective for soothing hot flashes, eliminating vaginal dryness,
slowing bone loss and protecting the heart. No one can say for sure
how much you need, but many experts think that taking in soy
products containing 30 to 50 milligrams isoflavones a day may be
enough. That's about 1 1/2 cups of low-fat soy milk, 1/2 cup of
tofu or 2 tablespoons of roasted soy nuts.
LICORICE ROOT
It might reduce hot flashes, irregular bleeding, mood swings and
vaginal dryness.
Licorice root contains high levels of estrogenlike compounds,
called phytoestrogens, that act like weak estrogens in some parts
of the body. That means phytoestrogens might have the ability to
act like hormone-replacement therapy, quashing hot flashes and
other symptoms that are believed to result from the reduction in
estrogen levels that comes with menopause.
However, unlike soy, another food high in phytoestrogens,
licorice root has the potential for side effects, and can't be
recommended, as soy can be.
``There are simply no studies that show licorice root can affect
symptoms of menopause in human beings,'' Tyler says. While this is
similar to what we know for remedies such as vitamin E, we put
licorice root in the ``approach cautiously'' category because of
its potential for sometimes serious side effects. It contains
compounds that affect the adrenal hormones in potentially harmful
ways.
``It can raise blood pressure and lower potassium, and there's
even a reported case of a cardiac arrest,'' says Dr. Adriane
Fugh-Berman, chair of the National Women's Health Network and
nationally recognized authority on alternative medicine.
While the trouble in these cases was caused by people addicted
to licorice laxatives or imported licorice candy (black licorice in
this country is flavored with anise, not real licorice), ``That
doesn't negate the fact that high doses of licorice can be
harmful,'' she adds. The point is, it shouldn't be used without
consulting a doctor or other health-care practitioner knowledgeable
about herbs
If you're still determined to try this and have your doctor's
OK, at least use a safe dose. According to the commission, that's
no more than 15 grams a day, for no longer than four weeks.
It can be found in pills, drops, tea bags and in bulk, alone or
in combination.
