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Case Study: Herbal Medicine for Menopausal Issues

by Carol Rogers(more info)

listed in women's health, originally published in issue 176 - November 2010

Women have traditionally consulted a herbalist during their menopause. In the last ten years however there has been quite a resurgence of interest, perhaps due to concerns about treatment with modern drugs.

Carol_in_dispensary
The author in her dispensary


My approach to treatment is to consider how menopause is affecting the individual woman. We have a look at how herbs can help, but I advise that they are not a replacement for conventional hormone replacement drugs. Although herbs may contain plant steroids or hormone, they do not work in the body as female hormones do. Herbs are still administered in the traditional way, following knowledge gathered after generations of observation and use, but with a eye to modern research.

Having a natural menopause means working with it, and cultivating a healthy lifestyle is part of this. Usually then the transition is much easier. As a herbalist I am treating primarily the symptoms of menopause, the commonest ones being hot flushes, insomnia, fatigue and emotional upset. As women are affected differently, there may be other symptoms too. Understanding how to ease individual symptoms is the key, and the resulting prescription is unique to the individual.

Jenny was aged 45 when menopause was diagnosed.  She was happily married but had no children, as she had a hysterectomy fifteen years previously, following an ectopic pregnancy. Jenny consulted me a couple of years ago as she had started having hot flushes very suddenly four months before. She was on the young side for the climacteric at forty-five, and coming to terms with the menopause starting early with no warning was difficult. She felt her moods were adversely affected and it caused her to find her work more stressful. She had a challenging job working in films, on the production side.  There were big demands on her energy, as she often worked long and anti-social hours, and travelled abroad as well.  As she was under considerable work stress, I observed  that hers was one of those cases where stress and exhaustion are often responsible for worsening symptoms of menopause. She had always coped well with work demands before. She was having hot flushes often during the day, and some during the night which were awakening her. She was feeling tired out by it. Tension headaches at work had become a problem, together with an irritable mood.

She was very definite that she did not want to take hormone replacement therapy, and the reason she gave was she had read about a possible link with breast cancer, and her mother had it. She felt women had got through the change without hormonal drugs in the past, so it was clearly possible.

She was sociable, enjoyed life, and liked going out to eat with friends. She was in the habit of having several cups of coffee a day to 'keep going', and had a couple of glasses of wine occasionally in the evening to unwind. She had given up smoking four months before. I explained that all of these caused worsening of hot flushes, due to the subsequent stimulation of small blood vessels.
 
Otherwise she was in good health, and was previously always energetic. Her diet was basically quite healthy but I suggested she include some soya rich foods, as isoflavones from these help reduce flushing in menopause. In addition, she could add some flax seed oil for beneficial omega 6. I advised drinking more water as well, up to a litre and a half daily. I also recommended a good daily vitamin and mineral health supplement. We discussed the prevention of osteoporosis with appropriate mineral supplements, as an important consideration when a woman is not taking HRT

My approach to her treatment was individual and I used up to eight herbs in a single prescription, some in  larger quantity, some quite small.   My therapy was synergistic, using herbs with a similar action that I find enhances the healing effect.  My treatment plan was to bring the acute vasomotor symptoms under control and lessen the physical impact of stress.  At the same time, I encouraged her to improve her own lifestyle in order to cope.

Several herbs were prescribed which would help the hot flushes: Chasteberry (Vitex agnus castus) - a small dose was used to stimulate production of progesterone from the ovary, which falls low in early menopause; Black Cohosh (Cimicifuga racemosa), affecting the body's oestrogen receptors positively, and which has been clinically proven to reduce hot flushes; Red Clover (Trifolium pratense), also a phyto-oestrogen, has a traditional history of use for hormonal problems; Sage (Salvia officinalis), a cooling herb with long use, is helpful for profuse perspiration. In addition, from China, Dang Gui (Angelica sinensis) - used as a 'blood tonic' herb for older women to boost health and well being. I added three other herbs for her particular case, which were Astralagus, Borage and Scullcap. Astragalus (Astragalus membranaceus) known in China as Huang Qi, promotes strength and energy. In Western terms it is seen as supporting the adrenal glands which have to work hard during menopause; and this herb guards against the harmful effects of stress. Borage (Borago officinalis) is an old English remedy that 'gladdens the heart', raising the spirits, according to Culpeper. In modern Western terminology it supports adrenal function. Skullcap (Scutellaria laterifolia) is a north American herb beloved by Native American peoples, for its calming and restorative properties on the nervous system. I hoped this would ease Jenny's stress, and help her sleep better.

I suggested that we meet again after three weeks to discuss how it was helping, and to make any changes to the prescription as needed. Jenny was busy, but told me all her symptoms were greatly relieved, and she requested another prescription. She collected a further two months treatment until I saw her again. She reported that she ran out of medicine and she found that within a week the hot flushes had increased. Now they were mild and reduced to a few a day, her sleep was much better and her energy quite good. She felt she was coping well and felt her stress levels were lower. She had just returned from a ten day holiday abroad. This visit I found her blood pressure was raised a little from before, at 133/87 which was within acceptable levels. As she was doing well, I only made one change, a small amount of False Unicorn root which has a re-balancing action on ovaries.

Jenny visited after another month, as she was feeling very stressed again due to new deadlines. At the same time her flushes had become acute again, with profuse perspiration in the daytime. She had noticed how heat was brought on by certain triggers, such as eating hot food, and even slight exertion. In the last two months she had been drinking only decaffeinated coffee and herbal teas, and cut down her units of alcohol. She felt very irritable, overly emotional, weepy at times and her concentration was poor at work. I suggested some tranquilizing herbs such as valerian - but she was not keen in case it made her sleepy or affected her performance.. We decided instead on a night time mixture, which would help her sleep, as well as flood her system with soothing herbs. I gave her Valerian and Passionflower, well known for sedative effect, and Californian poppy, a much more gentle version of its sister, the opium poppy, and perfectly legal! To this was added a small dose of Belladonna to ease the heat and perspiration at night.

My assessment was that it was not only demands at work, but that she had moved further into menopause and her hormone levels were falling. I suggested she increase the dose of herbal tincture she was taking for a short while.

Jenny rang to speak to me on the phone a month later to say briefly that although there was a general improvement, she was still suffering hot flushes. I made some changes to her prescription, including the addition of Shatavari (Asparagus racemosus), used traditionally on the Indian subcontinent by women in the change of life. It is nourishing and reputedly enhances and soothes the spirit, or 'Shen'. It can be very settling for some women. I replaced Chinese Angelica with Schizandra chinensis, or Wu Wei Zi, which encourages in TCM terms the 'Yin' or female essence, with its ability to ease irritability, heat and perspiration, encouraging sleep. Ginkgo was added for improving mental concentration. I added a very small quantity of Belladonna to the day time prescription.

I did not hear from Jenny again for three months but she collected the repeat prescriptions she requested every month, so I assumed it was working.

Seven months after her first visit Jenny reported she was "very able to cope" with the hot flushes, as they were much fewer. She was sleeping well at night and had stopped taking the night mixture two months earlier. An osteopath had 'sorted out' her tension headaches with several vertebral adjustments. She was feeling a bit emotionally unstable, either weepy or irritable, with swings between the two. We discussed how unresolved emotional issues from the past tend to come up again during menopause, to be sorted out before moving on to another phase of life. In her case she felt it was more due to her physical symptoms. She was working on a different project by this time and felt Valerian would not interfere too much. I replaced Schizandra with Hawthorn, as I was a little concerned about her blood pressure. Hawthorn is used for hypertension, and a tonic for the heart and whole blood circulation; it to has a gentle sedative effect. I thought this might also help to settle her reactivity to hot rooms and hot food.

Jenny repeated the prescription several more times, ordering less frequently, then I did not hear from her for a good while. She returned to consult me on another matter, and told me her menopause was over in a couple of years from when it started. The symptoms had became less and less troublesome. Then she had run out of medicine at one point and waited to see what would happen; the hot flushes did not return, she said, and she knew it was over. She felt overall quite happy with the way it had gone.

Bibliography and Further Reading

Blumenthal M, Brusse W, Goldberg A, Gruenwald J, Hall T, Riggins C and Rister R.
The Complete German Commission E Monographs. American Botanical Council. Boston, Massachusetts. 1998.
Crockett L. Healing Our Hormones, Healing Our Lives. O Books. Winchester, U.K. 2009.
Culpeper T. Culpepers Complete Herbal and English Physician. J. Gleve and Son. London. 1826.
Kenton L. Passage To Power - Natural Menopause Revolution. Vermilion. London. 1996.
Menzies-Trull C. Herbal Medicine. Faculty of Physiomedical Herbal Medicine. Staffs, UK. 2003.
McIntyre A. The Complete Woman's Herbal. Gaia Books Ltd. London. 1994.
Northrup C. The Wisdom of Menopause. Piatkus. London. 2001.
Rogers C. The Women's Guide to Herbal Medicine. Hamish Hamilton. London. 1995.
Scientific Committee. British Herbal Pharmacopoeia 1983. The British Herbal Medicine Association. Keighley, Yorks. U.K . 1983.
Tierra M. Planetary Herbology. Lotus Press. New Mexico. 1988.
Trickey R. Women, Hormones and The Menstrual Cycle. Allen and Unwin. N.S.W. Australia. 2003.
Weiss R. Herbal Medicine. Beaconsfield Publishers Ltd. Beaconsfield, Bucks.1988.

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About Carol Rogers

Carol Rogers BSc MNIMH is a retired member of the National Institute of Medical Herbalists; she had been a herbal practitioner since 1988. She has a life long interest in women's issues and ran a busy menopause clinic from 2001-2009 in Glasgow. She is the author of The Women's Guide to Herbal Medicine, published in 1995, now available as a free download from her website: www.womensherbalguide.com She may be contacted via carol@womensherbalguide.com

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