The menopause - a review of botanical supplements

The Menopause, like pregnancy or childbirth, is a natural phase in a woman's life. As with pregnancy and childbirth some sail through with no significant issues, while others struggle and find it hard to cope. The added problem with the menopause is that, unlike pregnancy and childbirth, this phase of a woman's life can span a 10 year period. Making it a particularly difficult challenge if symptoms are significant and persistent.

The 20th century  saw the rise and some might say fall of hormone replacement therapy (HRT). Following the million woman study  -  that demonstrated the links between the onset of breast cancer and taking HRT - shock waves were sent around the world. The methodology of this  major study has since been criticised in some scientific quarters. However, understandably, some women are reticent about taking HRT.

The knock on effect to all of this has been a growing interest in alternative approaches to the management of symptoms and specifically botanical and other herbal products have grown in popularity. There's a lot of conflicting evidence out there, which can leave some women unsure. I do recall that, at the time when all of this was an issue for me,  I felt both unsure and confused. I recently read a review -  that appeared in the American Journal of Medicine, that succinctly evaluated some of the most popular over the counter remedies - which I found to be useful and informative. If you could do with some reliable guidance in this area, I hope this is helpful. Here's a precis of the main findings:

The remedies studied were  -

Black Cohosh
Soy Isoflavone Extracts
Red Clover Isoflavone
Domg Quai (Angelica Sinesis)
Evening Primrose oil

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Summary of findings - 

Black Cohosh - in the review the majority of studies showed that black cohosh improved menopausal symptoms. Often taken to control hot flushes it appeared to be well tolerated with relatively low toxicity if used appropriately.

Glycine Isoflavone Extracts - the results for this are mixed as, due to the composition and dose of soy supplements, comparisons and definitive conclusions are difficult. Also, one study challenged the long term safety of high dose isoflavone extract (150md/day for 5 years) on the uterine endometrium.

Red Clover -  often taken to reduce hot flushes,  the evidence supporting the efficacy of semi-purified isoflavone red clover is contradictory; although no significant adverse effects have been noted. The largest study into it's efficacy - as compared to a placebo - showed no benefit in symptom reduction.

Single clinical trials do not support the use of dong quai, ginseng or evening primrose oil for improving menopausal symptoms at the dosage and in the preparations used in the studies.

Overall, the study concludes that black cohosh does appear to ease menopausal symptoms. Soy isoflavone extracts appear to show little to minimal benefits and specifically semi - purified red clover leaf has minimal to no effect in reducing menopausal symptoms; although, given the wide variety of product composition and dose,  definitive conclusions are difficult. Also, long term safety of soy isoflavone at higher doses is uncertain. .
Finally a word about St John's Wort and it's effectiveness when treating mild/moderate depression during the menopause. Although this remedy was not reviewed in the study, it is an important botanical alternative to standard prescription medication and so it's worth looking at separately. St John's Wort is a herbal remedy that has been used to treat a variety of ailments for hundreds of years. More recently it seems to have gained popularity as an alternative treatment for mild/moderate depression. There have been a number of studies. However, the conclusions are contradictory. Overall, it's effectiveness appears to be more notable when treating mild depression and it appears to be well tolerated with little to no side effects noted at the standard dose - 300 mg x3/day.

So, where does all of this leave women faced with the issue of coping with menopausal symptoms? As with so much else in life sometimes it's a matter of trial and error. Just remember though, as with a lot of prescription medication, any benefits will not occur instantly. To get a good idea about effectiveness it's best to give any remedy a 3 month trial period. However, if it's not working, don't be tempted to up the dosage, as this could be harmful.  If no benefits have been noticed at the end of 3 months, then it's probably not worth continuing. On a personal note I actually found St John's Wort to be very helpful in the menopause. At the time when I took it  I had 3 children still at school and combined this with with an active full time professional career. So I really needed to keep going and St John's Wort helped me to do this. I took it for 2 years with no ill effects and I can say that, for me,   it was a bit of a life saver in a difficult time.

It's important to note, however,  that St John's Wort can adversely interact with some prescription medication -  particularly anti-coagulants, anti cancer drugs and anti-hypertensives. It also goes without saying that - whether you're taking prescription medication or not - if you have issues with low mood and anxiety always discuss this with your GP first to ensure that the most appropriate therapeutic intervention is being chosen. Unfortunately,  most GPs don't know much about complementary therapies and can sometimes be scathing about their usage. So, if you do discuss botanical approaches with them, their response might not be as helpful as you  might wish. Hopefully, this won't happen to you. However, if it does and you are left floundering wondering what to do, then maybe what I've written may enable you to make an informed choice about how you want to effectively work with what is a natural process in your life.

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