Herbal Medicines for Menopausal Symptoms?

Discussion in 'Fibromyalgia Main Forum' started by gapsych, Aug 6, 2009.

  1. gapsych

    gapsych New Member

    I also posted this on the health board but some people may not go over there and I know some people on the FM/CFS board take the following herbs.

    This is from "Worse Pills Best Pills" newsletter which I g.et


    Herbal Medicines for Menopausal Symptoms? Hang Onto Your Wallet and Your Health

    Worst Pills Best Pills Newsletter article August, 2009

    Want to use red clover or ginseng to alleviate some of your menopausal symptoms? A highly respected British medical journal advises otherwise.

    The January 2009 Drug and Therapeutics Bulletin reviewed these and other herbal and dietary supplements that are used to treat the symptoms of menopause. The journal found that women should not use these supplements to ease the symptoms of menopause because the products are not effective and many can cause dangerous side effects. The products also have the potential to interact dangerously with other drugs or herbal supplements.

    In recent years, the tendency for women to use these dietary and herbal supplements has greatly accelerated with the evidence that more "traditional" hormone replacement therapies — estrogens or estrogens plus progestagens (such as PREMARIN or PREMPRO) — have been found, with longer term use, to increase the risk of breast cancer, ovarian cancer, venous thromboembolism (blood clots in the legs that can break off and go to the lungs), heart attacks and strokes, as well as other diseases.

    In Britain, one survey suggested that about 40 percent of women who are going through menopause have used herbal or other alternative treatments for relieving menopausal symptoms such as hot flashes and night sweats.

    The herbal products are easily available on the Internet and in a wide variety of stores; many women who use them do not even think to tell their doctors that they’re using the supplements because they don’t think of them as "real drugs". And the fact that they are "natural" leads many to believe the products are safe. But these products can have serious health consequences.

    The following is based on the DTB article and reviews from Worst Pills, Best Pills (Black Cohosh and ginseng). In our previous reviews and in examining the results in the DTB article, we have only reported the results of efficacy studies in which just one herb, rather than combinations, were used so as to make the results more interpretable. We have also limited our review to randomized, placebo-controlled clinical trials.

    The Drug and Therapeutics Bulletin reviewed the following commonly used products for menopausal symptoms for effectiveness and safety:

    • Black cohosh

    • Red clover

    • Dong quai/dang gui

    • Evening primrose oil

    • Ginseng

    Black Cohosh

    Black cohosh is a North American plant. The root and rootstalk are used for medical purposes.


    The bulletin reviewed seven randomized, placebo-controlled trials of black cohosh and found that, in four of those, there was no evidence that the herb was superior to a placebo.

    Public Citizen has previously described the results of the largest and apparently most well-conducted of these studies (Worst Pills, Best Pills News, March 2007). Those authors concluded that "black cohosh used in isolation, or as part of a multibotanical regimen, shows little potential as an important therapy for relief of vasomotor symptoms [change of the size of blood vessels responsible for hot flashes]."

    In two other randomized trials, black cohosh was found to be similarly effective to estrogen drugs in relieving menopausal symptoms and, in another placebo-controlled study, it was found more effective than the placebo. However, in all of the three latter trials, there were serious methodological problems that cast doubt on the results.

    Safety Concerns

    Short-term post-marketing studies of black cohosh have revealed that mild, short-lasting side effects such as headache, dizziness and gastrointestinal complaints have been reported, although the rates of unwanted side effects with black cohosh in randomized controlled trials were similar to those with a placebo.

    Worst Pills, Best Pills News previously has noted (Worst Pills, Best Pills News, August 2006) that the Australian equivalent of the U.S. Food and Drug Administration (FDA) reported 49 cases of liver toxicity worldwide associated with the use of black cohosh. Of these 49 suspected cases of liver toxicity, five patients experienced liver failure, and four of those cases required a liver transplant.

    Serious cases of liver toxicity have occurred when patients have used the supplement for less than a month. Because of this, patients should stop using the product and consult their doctor if they develop symptoms and signs suggestive of liver toxicity. This includes symptoms such as yellowing of the skin and eyes, severe upper stomach pain with nausea and vomiting and loss of appetite.

    Red Clover

    Red clover contains isoflavones, a class of phytoestrogens which have estrogen-like activity.


    A meta-analysis of five randomized trials lasting at least 12 weeks examined the efficacy of foods and supplements including high levels of phytoestrogens (red clover extracts) for reducing hot flashes and night sweats in menopausal women; however, this analysis found no difference in the frequency of hot flashes between women using red clover extract and those using a placebo.

    The reviewers concluded that there was no evidence that phytoestrogens treatments helped to relieve menopausal symptoms.

    Safety Concerns

    Red clover appears to be well-tolerated with few, if any, serious side effects found in clinical studies.

    But because red clover contains isoflavones, the question of safety in hormone-sensitive tissue such as breast and uterus is important. However, its safety in women with a history of hormone-sensitive cancers or other hormone-sensitive conditions is currently unknown.

    There is some evidence that phytoestrogen supplements can interfere with drugs that affect estrogen receptors (such as tamoxifen, brand name NOLVADEX) and may reduce the effects of aromatize inhibitor drugs such as letrozole (FEMARA).

    Dong Quai/Dang Gui

    The root of this plant, sometimes in combination with other herbs, has been used for hundreds of years as part of traditional Chinese medicine to treat many medical problems, including menopausal symptoms.


    In a 24-week double-blind randomized trial involving 71 women with frequent and troublesome night sweats or hot flashes, researchers found no difference between those on dong quai and those on placebo.

    Safety Concerns

    Sensitivity to the sun and skin side effects (photosensitivity) have been observed in some people using dong quai who have also been exposed to the sun.

    Even more serious is the evidence that dong quai can increase the risk of bleeding in people who are also using the blood thinner warfarin (COUMADIN) by accentuating the blood-thinning effects of warfarin. Because of this, it is too dangerous to use this herb if you are using warfarin.

    Evening Primrose Oil

    Evening primrose oil is extracted from the seeds of the evening primrose plant, a native American wildflower. Although the oil is rich in the fatty acids linoleic acid and gamma linolenic acid, there is no biologically plausible reason why these components should improve menopausal symptoms.


    In one randomized placebo-controlled trial involving 56 menopausal women, researchers found that the reduction in hot flashes was no different with evening primrose oil than it was in women using a placebo. In addition, no other benefits were seen.

    Safety Concerns

    According to the Drug and Therapeutics Bulletin review, when given with drugs that can cause seizures, such as some anti-psychotic medicines, evening primrose oil may further increase the risk of seizures.



    One 16-week double-blind randomized placebo-controlled trial involving 384 postmenopausal women compared ginseng with a placebo and found that the Psychological General Well-Being Index scores (the primary outcome measure) did not differ between the treatment groups.

    Safety Concerns

    In our WorstPills.org review of ginseng, we state that "ginseng has been associated with hypertension, nervousness, insomnia, vomiting, headache, skin rashes and nosebleeds. A ginseng abuse syndrome, involving the simultaneous use of caffeine, has also been described. Its features are hypertension, nervousness, and sleeplessness.

    Other reports describe estrogen-like effects for ginseng: changes in the lining of the vagina and vaginal bleeding."

    According to the FDA, ginseng "can interfere with the bleeding effects of COUMADIN [warfarin]. In addition, ginseng can enhance the bleeding effects of heparin, aspirin, and nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen, and ketoprofen. Combining ginseng with MAO inhibitors such as NARDIL [phenelzine] or PARNATE [tranylcypromine] may cause headache, trouble sleeping, nervousness, and hyperactivity."

    What You Can Do

    There is no convincing evidence that any of the herbal supplements promoted for relief of menopausal symptoms is beneficial. In addition, as discussed above, many of them have serious safety problems. Given the lack of benefit, why would a woman want to risk her health for a product — usually an expensive one — that jeopardizes her health?

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  2. lynncats

    lynncats New Member

    thank you for posting this. I called my sister right after reading about black cohosh. She was taking this for hot flashes, and she has Hep C. She told me that she actually quit taking it cuz one of the pills smelled really, really bad. But she did thank me for telling her about how it can cause liver problems. And as you know Hep C, is a liver disease. So thank you from the bottom of my heart.


  3. gapsych

    gapsych New Member

    I am glad this helped you out.

    With Hep. C you do have to be really careful. I remember getting a shot for Hep. B but do they have one for Hep. C? I will have to look that one up.

    Information = Power.

    You take care.

  4. gapsych

    gapsych New Member

    You post brings to mind a question I have been curious about. If it is recommended to not take HRT's because of the risks, wouldn't the bio identical hormones carry the same risk? No I do not want to debate this subject but am curious about it.

    I was on hormone replacement therapy for about six months after a hysterectomy, when the study came out. I did not have any apparent side effects nor any menopausal symptoms when I went off the med. In fact I never went into perimenopause, but that is another story.

    I have had hot flashes since my teens. Actually more like being hot all the time. My mother was the same way. Some ADs can make this worse but I weighed the pros and cons. Humid heat makes me especially ill. I have noticed that since this DD, this symptom is more pronounced.

    You gave me a chuckle about your libido.

    Maybe too much info. but I just had to respond to your statement. :D

    [This Message was Edited on 08/06/2009]
  5. gapsych

    gapsych New Member

    I forgot we have a hormone board. I will post it there.

    I just looked up DHEA as I was not sure what it is. It looks like it may have many side effects. I will post this article later.

  6. gapsych

    gapsych New Member

    This article is from issue of HealthNews, a newsletter from the publishers of The New England Journal of Medicine.

    What Is DHEA?

    Dehydroepiandrosterone, or DHEA, is a steroid hormone, a chemical cousin of testosterone and estrogen. It is made from cholesterol by the adrenal glands, which sit atop each kidney. For the first few years of life, the adrenals make very little DHEA. Around age six or seven, they begin churning it out. Production peaks in the mid-20s, when DHEA is the most abundant hormone in circulation. From one's early '30s on, there's a steady decline in DHEA production, so the average 75-year-old has only 20% of the DHEA in circulation that he or she had 50 years earlier. At all ages, men tend to have higher DHEA levels than women.

    By definition, hormones are chemical messengers made in a gland or tissue that start, stop, or otherwise orchestrate activity in some other issue. That makes DHEA a hormone in name only, since no one knows exactly what it does in the body. For years it was thought to be a kind of chemical trash left over from making other hormones. Today, "we still haven't been able to identify any mechanism of action," says Dr. Casson.

    In fact, about the only thing that researchers can agree on is that DHEA is easily converted into other hormones, especially estrogen and testosterone.

    The Food and Drug Administration isn't sure what to do with DHEA supplements. Ten years ago the agency told companies to stop selling DHEA, which was marketed at the time for weight loss, and classified it as an unapproved new drug, obtainable only by prescription. Then in 1994, DHEA was reclassified as a dietary supplement, allowing sales over the counter.

    The Evidence
    Much of DHEA's reputation as a wonder hormone comes from experiments in which mice or rats were fed daily doses. Such studies have shown that DHEA can prevent or delay the onset of cancer, "hardening" of the arteries, lethal viral infections, lowered immunity, obesity, and diabetes. But what works in rodents doesn't necessarily work in humans. That may be especially true in this case, because rats and mice produce only about 1/10,000 the DHEA we do.

    An early human study that pointed to possible benefits for DHEA came from Dr. Barrett-Connor's group. They measured DHEA levels in blood samples taken from almost 2,000 men and women between 1972 and 1974 and looked at how many died from heart disease. In 1986, they reported that men with high DHEA levels were far less likely to have died of heart disease, while women with high DHEA levels were at greater risk. A more detailed analysis published late last year, however, showed that men with above-average DHEA levels back in the early 1970s were only 15% less likely to have died of heart disease, while there was no association between DHEA levels and heart disease in women.

    The longest and perhaps most carefully conducted work in humans comes from Dr. Yen and his associates. In their latest study, published last year in a special issue of the Annals of the New York Academy of Sciences devoted to DHEA and aging, eight men and eight women aged 50 to 65 took either 100 milligrams of DHEA or an identical placebo pill each night for three months. For three months after that, they took the opposite pill.

    Within two weeks of starting DHEA, circulating levels of the hormone were a bit higher than normally found in young adults. Lean body mass increased slightly in both sexes, as did muscle strength, which also improved with the placebo. Fat body mass decreased in men but increased a bit in women. There was also a rise in some chemical markers that suggested improvement in immune function, though the number of colds and other illnesses was not measured.

    An earlier study from Dr. Yen's group showed that three months of daily 50-milligram doses of DHEA significantly improved the sense of "well-being," it did not improve sex drive, as advertisements for DHEA often claim..

    Another study in which volunteers took DHEA suggests that this hormone may help treat the autoimmune disease lupus. Trials looking at DHEA's ability to boost the immune system and maintain mental function in older adults are in progress.

    Experiments on a few dozen people over six months hardly constitute proof that a treatment works. "What we really need at this point are some long-term clinical trials to identify clear benefits and risks," says Dr. Nestler.

    One reason why such trials are crucial is that DHEA has side effects, some of which may be irreversible. Since DHEA is converted into testosterone, some women who take it grow body or facial hair and, if they are under age 50 or so, can stop menstruating. DHEA has also been shown to decrease levels of HDL ("good") cholesterol in women, and could increase the risk of heart disease, the leading killer of older women. "We have no idea what DHEA might do to the risk of breast cancer," says Dr. Nestler.

    In men, the increased levels of testosterone seen with daily DHEA pills could stimulate the growth of a tiny prostate tumor that would otherwise have remained dormant. Excess testosterone could also cause the prostate to enlarge, making urination difficult.

    [This Message was Edited on 08/06/2009]
  7. mbofov

    mbofov Active Member

    The landmark Women’s Health Initiative studies released in 2002 on the risks of HRT were based on synthetic/equine-based hormones - Premarin (conjugated horse estrogens) and Prempro (synthetic progesterone). Bio-identical hormones were not included in the study.,

    I read many years ago that bio-identical progesterone may actually protect against breast cancer as opposed to the synthetic progesterone.

    Here’s a link to a report published at Pubmed about a French study, which showed no increase in breast cancer risk for women using bio-identical hormones:

    I’m not saying bio-identical hormones are necessarily 100% safe, but it is really is too bad that bio-identical hormones were not studied by the WHI. They weren’t studied because most women were using the horse/synthetic hormones - I won’t go into the politics of why that happened.

  8. gapsych

    gapsych New Member

    I believe the general consensus is that the 2002 studies are what medical Doctor's use to make decisions on HRTs. If anyone has any medical updates on this, from REAL science, I would like to hear it.

    I find it confusing that people are more than willing to take a thyroid hormone made from dessicated pig glands but then use just the opposite reasoning to justify taking BIH.

    Hmmm, fitting the facts to prove a theory. This is not critical thinking. Nor are conspiracy theories.

    I am just giving out information I think is important. No hidden agendas. No debates. Just information to help people decide what choices to make.

    If people believe want to discuss the pros and cons of HRTs,whatever,I would suggest making another post as this has been debated to the point of boredom.

    Don't kill the messenger, LOL!!


    ETA I believe the women's health initiative has not done studies on bio identical hormones because they are not considered as a legitimate medical scientific alternative.

    [This Message was Edited on 08/06/2009]
  9. gapsych

    gapsych New Member

    I am confused. Are we talking about the same study? The one I read did not mention bio identical hormones. It is saying that for this group of women, taking other forms of estrogen and progestin, like in birth control pills may not have the same increase of breast cancer as taking only progesterone.

    "this conclusion MAY (caps. mine) not apply to women taking other estrogen and progestin formulations.

    I am not sure where this study fits in with other studies or if it was replicated.

    Did I misread the study or find the wrong one?


  10. jasminetee

    jasminetee Member

    My understanding is that BHRT are better for some women and HRT is better for others and natural herbs are better for others and sometimes nothing works at all. I visit the Powersurge message board all the time. You may want to go there. I only read there but boy, have I learned a lot!

    BHRT is not considered safe for women who have a risk of breast cancer in their family.

    I've tried DHEA but it made me break out with a new kind of zit and it didn't help me. I have CFS and that makes me react badly to most things.

    I drink Black Cohash Tea during my follicular stage of the month, that's after your period up to ovulation. I think it helps, I drink it with many other herbs as well, probably most of the ones listed above.

    Ginsing tea made my breasts very sore so I stay away from that.

    I'm now drinking Motherwort tincture and it seems to be helping me too. It really calms me down and helps with stomach/digestion issues too. It seemed to help with hot flashes a lot but I've just started trying it.

  11. TigerLilea

    TigerLilea Active Member

    DHEA in Canada is a controlled substance. My understanding is that only an endochronologist can prescribe DHEA. Even then, the doctor as to contact Health Canada's "Special Access Programme".

    I read somewhere recently that trying to bring DHEA into Canada would be treated no differently than trying to bring heroin or cocaine into Canada. Definitely would not be worth the risk for someone trying to sneak it across the border.
  12. gapsych

    gapsych New Member

    Wow, I did know that. The article did say it was once a prescription.

    Makes sense.


  13. mbofov

    mbofov Active Member

    To my knowledge, bio-identical thyroid hormones are not available for sale. If they were, I'd say take 'em. The reason many doctors prefer Armour thyroid to Synthroid, as I'm sure you know, is because Synthroid only contains T4. Many people have trouble converting T4 to T3, so many do much better when taking Armour thyroid. It's that simple. I'm not fitting facts to prove a theory. I hope this clears up your confusion about why people take thyroid from pigs' glands, while at the same time they often prefer to take bio-identical "female" hormones. It may seem contradictory but there are very good reasons why.

    Whereas with "female" hormones, there are bio-identical hormones available. So it seems obvious that if one is going to use HRT, it's better to use something identical to what our bodies make.

    I believe the reason the women's health initiative did not do studies on bio-identical hormones is that the vast majority of women were using the horse and synthetic hormones. They took these because that is what their doctors prescribed, and I don't think I'm being paranoid to reason that the doctors prescribe them because that's what the large pharmaceutical companies sold them. If the vast majority of women had been taking bio-identical hormones, then those would ahve been studied.

    The question remains: why did the pharmaceutical companies sell the horse/synthetic hormones in place of bio-identical? Well, probably because they make a lot more money that way. They can't patent the stuff our bodies make.

    I hope this answers your questions.

    [This Message was Edited on 08/07/2009]
  14. mbofov

    mbofov Active Member

    I agree, that sentence is confusing in the way it's worded, and actually is slightly inaccurate when it refers to "other .... progestin formulations". Progestins are synthetic. Progesterone is not. Below is the full text which I think clarifies things. If you look at what I highlighted in all caps, it is clear that the study involved the use of bio-identical hormones (estradiol and progesterone), as opposed to CEE (confugated equine estrogens) and MPA (medorxy-progesterone acetate).


    The largest-to-date randomized trial (Women's Health Initiative) comparing the effects of hormone replacement therapy (HRT) and a placebo concluded that the continuous use of an oral combination of conjugated equine estrogens (CEE) and medroxy-progesterone acetate (MPA) increases the risk of breast cancer. This conclusion may not apply to women taking other estrogen and progestin formulations, as suggested by discrepancies in the findings of in vitro studies, epidemiological surveys and, mostly, in vivo studies of human breast epithelial cell proliferation SHOWING OPPOSITE EFFECTS OF HRT COMBINING CEE PLUS MPA OR ESTRADIOL PLUS PROGESTERONE. TO EVALUATE THE RISK OF BREAST CANCER ASSOCIATED WITH THE USE OF THE LATTER [estradiol and progesterone] COMBINATION, commonly prescribed in France, a cohort including 3175 postmenopausal women was followed for a mean of 8.9 years (28 367 woman-years). In total, 1739 (55%) of these women were users of one type of estrogen replacement with systemic effect during at least 12 months, any time after the menopause, and were classified as HRT users. Among them, 83% were receiving exclusively or mostly a combination of a transdermal estradiol gel and a progestin other than MPA. Some 105 cases of breast cancer occurred during the follow-up period, corresponding to a mean of 37 new cases per 10 000 women/year. Using multivariate analysis adjusted for the calendar period of treatment, date of birth and age at menopause, we were unable to detect an increase in the relative risk (RR) of breast cancer (RR 0.98, 95% confidence interval (CI): 0.65-1.5) in the HRT users. The RR of breast cancer per year of use of HRT was 1.005 (95% CI 0.97-1.05). These results do not justify early interruption of such a type of HRT, which is beneficial for quality of life, prevention of bone loss and cardiovascular risk profile, without the activation of coagulation and inflammatory protein synthesis measured in users of oral estrogens.

  15. mbofov

    mbofov Active Member

    Here's a link to an article published in the Journal of American Physicians and Surgeons:

    I think this may clarify the pubmed blurb about the French study, which I agree was confusing. Here's an excerpt from the jpands article:

    Two recent studies point to a difference in breast cancer risk when comparing synthetic progestins to bioidentical progesterone for hormone replacement therapy (HRT). A French cohort study involving 3,175 postmenopausal women predominantly using natural HRT (83% using transdermal estradiol and progesterone and non-medroxyprogesterone progestins) found no increased risk. The French E3N-EPIC cohort study assessed the risk of breast cancer associated with HRT use in 54,548 postmenopausal women and found the risk was significantly greater ( <0.001) with HRT-containing synthetic progestins (RR=1.4) than with HRT containing micronized progesterone, which actually reduced the risk (RR=0.9).
  16. gapsych

    gapsych New Member

    I did come up with the same study but not the one with bioidentical hormones. In the other study I do not see this. Sometimes something can be right in front of me and I don't see it.

    Do you think HRT are bioidentical hormones. I thought it was just hormone replacement therapy. I don't think the reference to others is bioidentical?
    [This Message was Edited on 08/07/2009]

    ETA Are transdermal estradiol and progesterone and non-medroxyprogesterone progestins bioidentical hormones? If so, I am completly misread what study was saying.

    It still does not convince me of the validity of the study compared to other studies.

    I agree with KJM that either should be taken for the shortest amount of time.

    [This Message was Edited on 08/07/2009]