Menopause

4.5. Herbal remedies and dietary supplements

Some plants include substances that might work in the body in a similar way to oestrogen [27], [28], [29]. These are called phyto-oestrogens. This group includes, for example, soya and red clover (trivlium pratense). Dietary supplements manufactured out of these plants are often recommended to women for symptoms of the menopause. If you are taking a herbal medicine, it is important for your doctor to know so that he or she can explain if there are possible contraindications or a drug interaction problem with something else you are using.

Soya - Isoflavone

Soya-based products are the best studied herbal medicine for menopausal symptoms. They include so-called isoflavones, and they belong to the phyto-oestrogen group. But the results of over 20 trials testing soya preparations and a soy-rich diet are contradictory [11], [23]. Women's hot flashes improved in some of the trials, but not in others.

Taking these products for longer and at higher doses means that adverse effects need to be taken into account. Some women who took high-dose soya-isoflavone for five years in a study developed a condition called endometrial hyperplasia [11]. Women who have this condition are at higher risk of developing endometrial cancer. However, taking isoflavones for a short time is not believed to cause health problems [30].

Red clover

The evidence base on red clover (trivlium pratense) is patchy. Red clover has isoflavones, but they are different to the kind in soya. This means the evidence about soya does not necessarily apply to red clover. There is no conclusive evidence that red clover products can help with menopause symptoms like hot flashes [11], [23], [31]. There has also not been enough study on whether or not red clover has adverse effects.

Black cohosh

Some herbal medicines containing black cohosh (cimicifuga racemosa or acteaea racemosa) are licensed for use in Germany. However there is no strong evidence that black cohosh can relieve menopausal symptoms [11],[31]. About 5 out of 100 women (5%) of women who take black cohosh report adverse effects [32], such as stomach or gut problems, headaches, dizziness, nausea and allergies [31]. These usually go away when the medicine is no longer used.

Some people have experienced serious liver damage after using black cohosh. The European drug authority therefore recommends that people stop taking these preparations if they develop signs of possible liver damage such as tiredness, loss of appetite, yellowing of the skin or eyes, darker urine or severe upper stomach pain with nausea and vomiting [33].

Other herbal options

A variety of other herbal substances are used to try to relieve the symptoms of the menopause, including rhubarb (rheum rhaponticum), ginseng, dong quai (angelica sinensis), evening primrose oil (oenothera biennis), monk's pepper (vitex agnes castus) and kava (piper methysticum). There is not good evidence that any of these can relieve symptoms like hot flashes [11], [31]. Some of these preparations can have adverse effects, or they cause problems if they are taken with other medicines. For example it is possible that taking ginseng at the same time as an anti-clotting drug (like heparin or ASA - acetyl salicylic acid), or evening primrose oil, could cause bleeding. It is not possible, though, to give accurate and reliable information about how often adverse effects might happen with these products.

In Germany and several other countries, products containing kava have been taken off the market for safety reasons. Kava can cause allergic reactions and skin problems. Liver damage or an impact on the nervous system might be possible [31]. Again, there is not enough research to show how likely or common this might be.

Other complementary therapies

Acupuncture is a part of traditional Chinese medical treatment. It is based on the theory of life energy circulating through the body, with imbalances leading to illness or pain. This energy is sometimes thought of as a kind of electricity in the body. Needles inserted at specific points of the body aim to affect this flow of energy.

There have been some trials of acupuncture to try to relieve menopausal symptoms, but this is really in the early stages and the quality of the research is not high [11]. It is therefore not possible to say whether or not acupuncture can help reduce hot flashes or other problems.

Chiropractic is a form of manual therapy that seeks to adjust imbalances in the spine and neck. This is thought to reduce stresses on the nerves and other problems than can lead to pain or ill health. There is not enough evidence to enable a judgment to be made on whether or not it can help with menopausal symptoms, and the adverse effects are not well studied either [11].

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