HRT and Natural Alternatives

The menopause, although a normal phase in a woman’s life, may for some be an uncomfortable and stressful experience.  The symptoms that can arise include hot flushes, mood disturbances, joint pain, insomnia, sore breasts, vaginal dryness, depression, headaches and palpitations.  These symptoms arise as the body readjusts to changes in the production of hormones.  The release of oestrogen by the ovaries gradually reduces leading to irregular periods and finally the cessation of periods altogether.  The reduction in activity of the ovaries is compensated for by an increase in the activity of other glands, in particular the adrenal glands.  This time of readjustment and the associated symptoms, is usually completed within about five years.

Many women will be offered Hormone Replacement Therapy for the relief of their symptoms.  HRT has been promoted in the past as offering women a degree of protection against heart disease whilst at the same time warning of possible increased risk of breast cancer.  Many women have chosen this treatment  in the light of this information.  However, recently new evidence has been published which has altered the picture and caused concern amongst those taking HRT.  A recent study published in the Lancet cast doubt over the idea the HRT protects women against heart attacks.  HRT is not suitable for everyone: if you have osteoporosis, breast cancer or heart disease or are at increased risk of these conditions, it is not advised that you take HRT.

For those women who are looking for an alternative to HRT, either because they have been advised against it, or because they seek a more natural alternative, herbal medicine can provide a safe and effective treatment to promote optimum health and reduce unwanted side-effects.

 Useful Herbs

 Black Cohosh (Cimicifuga racemosa)

Often thought of as one of the most useful herbs for menopausal difficulties with its anti-inflammatory and gentle sedative properties making it suitable for the relief of hot flushes, insomnia, anxiety, headache and joint pain.

 St John’s Wort (Hypericum perforatum)

This is a herb which has long been valued for its healing properties for both the mind and body.  It is very effective in supporting the nervous system and helping to relieve low spirits, depression and insomnia.

 Sage (Salvia officinalis)

Sage has an oestrogenic effect and is excellent in relieving menopausal symptoms, in particular hot flushes and night sweats.  It is a useful tonic herb and can support the body during times of stress, anxiety and debility.

Chaste Tree, Agnus Castus (Vitex agnus-castus)

This herb is useful in the earlier stages of the menopause to bring hormonal balance to the menstrual cycle.  It can help with menstrual irregularity and heavy bleeding as well as other menstrually-related problems such as breast-tenderness, headaches and period pains.  It is not advisable to take this at the same time as HRT or the oral contraceptive pill.

 Wild Yam (Dioscorea villosa)

Wild Yam contains compounds which have an oestrogenic effect making it useful in the relief of menopausal symptoms.  It is particularly effective in reducing joint pain.

Fenugreek (Trigonella foenum-graecum)

The seeds of this herb help to support oestrogen levels during the menopause.  It can be useful in helping to reduce vaginal dryness and hot flushing and may have a role in preventing cardio-vascular disease.

 Lady’s Mantle (Alchemilla vulgaris)

This herb is has astringent and possibly hormonal properties which make it useful for the reduction of heavy menstrual bleeding and flooding.  It will also help with irregular periods.

 Valerian (Valeriana officinalis)

This herb acts as a gentle sedative making is helpful in reducing stress, anxiety and insomnia.  Its general tonic properties are useful in supporting the body during depression, exhaustion and debility.

 Phytoestrogens

The word phytoestrogen is used for any plant compound which has oestrogenic properties.   Although they have the ability to act on the body to mimic the effects of human oestrogen, their effects are comparably weak.  However, they can still be useful in helping with hormonal balance during all stages of the menopause acting to increase the levels of oestrogen when they are low and helping to relieve unwanted side-effects. Phytoestrogens may also have the added advantage of lowering cholesterol and helping to prevent osteoporosis. Plants which are particularly rich in phytoestrogens include Red Clover (Trifolium pratense), Linseed (Linum usitatissimum) and Soya.

Although herbal medicines may be bought over the counter, certain safety issues must be considered (See Safety Issues).  More effective treatment can be offered to you by a qualified medical herbalist.

During the menopause, as at any time of life, it is important to remember the benefits of a good diet, regular exercise and relaxation.  In doing so,  your body will cope better with the changes taking place and will help to protect against heart disease and osteoporosis.  For further advice on nutrition see the Women’s Nutritional Advisory Service (www.wnas.org.uk) and the National Osteoporosis Society (www.nos.org.uk).

The Kava Kava Controversy

Kava Kava (Piper methysticum) is a plant indigenous to the islands in the South Pacific where it is commonly used to prepare a traditional beverage. Supplements containing the herbal ingredient kava are promoted for relaxation (e.g., to relieve stress, anxiety, and tension), sleeplessness, menopausal symptoms and other uses.

 Recently the press has reported cases of adverse effects from taking supplements containing constituents of the Kava Kava. This followed concern about a number of cases in Germany and Switzerland, where the use of Kava Kava was believed to be linked to liver damage.  As a result the Medicines Control Agency called for a voluntary withdrawal of Kava Kava products in the summer 2002. The UK herbal industry complied. The National Institute of Medical Herbalists (NIMH) agreed to the voluntary withdrawal of Kava Kava (and the temporary cessation of using Kava Kava in traditional herbal medicine) pending the outcome of the MCA investigation.  On 20th December 2002 the Department of Health announced its decision to ban the use of Kava Kava.  No special provision was included in this announcement to protect the traditional use of Kava Kava in the UK. 

 NIMH object strongly to the ban on this useful herb.  They point out that previous cases of liver toxicity reportedly linked to the use of Kava Kava in Germany and Switzerland are both very rare and have referred to the use of concentrated extracts rather than the safe traditional use of the herb.  Medical herbalists use the whole plant in a specially formulated tincture and only prescribe Kava Kava after a thorough consultation.

 Although at present Kava Kava continues to be a banned product in the UK, NIMH are lobbying for qualified medical herbalist to be allowed to prescribe it once again.