By: Peter J. Wong, MD, FACOG

As you’ve probably heard on TV or read in the news, hormone replacement therapy (HRT) is associated with various side effects and complications. Over 30% of women experience some degree of abnormal bleeding during the first year, and many discontinue using it. Many women are afraid to try estrogen therapy be-cause they believe it may increase the risk of breast cancer.

Menopausal symptoms raise concern about wellness and motivate women to seek help in lowering health risks. If you’re menopausal, it’s only natural that you may have an interest in alternative medicine as another way to alleviate your symptoms. According to the North American Menopause Society, more than 30% of women use other options to find relief including acupuncture, natural estrogen, and herbal supplements. Alternative therapies to conventional hormone therapy include botanical (or plant) products, vitamins and minerals, unconventional hormones and steroids sold over-the-counter as nutritional supplements.

Up to one half of drugs commonly used today are either made from plants or are what we call “phytochemicals.” Phytochemicals are plant chemicals that have protective or disease preventive properties but no nutritional value. Herbs, oils, pills, teas, or tinctures are forms of plants used therapeutically. Currently used products include phytochemicals, synthetic derivatives, and even steroids like DHEA and androstenedione, which are classified as food supplements, because they are produced from plants.

Plants make sterol molecules, many of which act as weak estrogens in animals. These compounds, phytoestrogens, are classified into three groups: (1) Isoflavones, which can be found in soy, garbanzo beans, and other legumes. (2) Lignins, which are available as a result of intestinal bacteria in grains. You can find the highest amounts of lignins in the husk of seeds, especially flaxseed. (3) Coumestans—found in high concentrations in red clover, sunflower seeds, and bean sprouts—have steroid-like activity but not a significant source.

The Federal Dietary Supplement Health and Education Act of 1994 (DSHEA) defined dietary supplements and limited the claims that can be made. Manufacturers are responsible for ensuring the safety of their products. Supplements are neither foods nor drugs, so manufacturers do not have to provide any evidence to support the supposed benefits before marketing their products. While the FDA oversees the industry, it’s the Federal Trade Commission that is responsible for identifying inappropriate or unsubstantiated claims and enforcing DSHEA regulations.

You should be aware that botanicals and herbs vary to a high degree in production. The amount of active ingredients is affected by where the plants are grown and what facilities produce them. The botanical industry itself has set up voluntary guidelines, which some manufacturers have agreed to follow. However, without mandatory regulation, there will continue to be problems with dose standardizations, contamination, and adulteration (when a company exchanges valued for less valued ingredients before sale).

Commonly used botanicals for menopausal symptoms include soy products, Black Cohosh, Evening Primrose, and Don Quai. Not all soybean products work to relieve menopausal symptoms. The processing often used in making tofu or soy milk often destroys the active ingredients needed for symptom relief.

Black Cohosh, once the principle ingredient in Lydia Pinkham’s vegetable compound sold in the U.S. and Europe, is one of the leading botanicals sold in Germany and is the country’s top-selling menopausal herbal remedy. Black Cohosh is suggested for hot flashes, sleep disorders, anxiety, and depression and for painful menstruation and PMS. A dozen studies show an apparent reduction in symptoms with Black Cohosh, but these studies are not well designed. The results also conflict on how the plant works in the body.

Evening primrose is commonly recommended for breast swelling and pain, mood disturbance, menopausal symptoms and bladder symptoms. This plant produces seeds rich in (GLA) gamma linolenic acid—a fatty acid found in the placenta and breast milk. Clinical trials show mixed results.

Dong Quai is the most commonly prescribed Chinese herbal medicine for “female problems”. It supposedly regulates and balances the menstrual cycle. It also is said to act somewhat like estrogen in the body. One large study shows both dong quai and placebo reported a 25% reduction in hot flashes, but doctors don’t agree on the dosage or whether certain botanicals should be taken together.

For mood disturbance, St. John’s Wort and Valerian Root are recommended. Ex-tracts of the flower hypericum perforatum, known as St. John’s Wort, have been used for centuries to treat mild to moderate depression. It’s unconfirmed whether the effects of the herb involve brain chemical alteration. Side effects include dry mouth, dizziness, and constipation, which are similar to, but far less than, standard antidepressants. Fifteen studies involved 1,700+ cases found that St. John’s Wort produced a 61% to 75% improvement in mild to moderate depression dependent on the dosage.

Valerian root has been used traditionally as a tranquilizer and soporific (sleep aid). The active compound has never been identified but is thought to be a GABA-derivative, a brain chemical. A similar GABA compound has been found in chamomile, an herb suggested as a sleep aid. Valerian has been reported for dystonic reactions (adverse reactions involving muscle contractions) and visual disturbances, perhaps because other drugs were taken at the same time.

For decreased libido and vaginal dryness, chasteberry and ginseng have been used. Chasteberry or vitex has been recommended by some for vaginal dryness at menopause. It is often recommended to reduce libido in males, because of its proposed value as an anti-aphrodisiac. Thus, it is used by some to enhance libido in menopausal women. Studies are limited, but results show improvement in mood alteration, anger, headache, and breast fullness.

There are many types of ginseng. All are promoted as the botanical that supposedly boosts immunity and helps one cope with stress. Ginseng also is reputed to be an aphrodisiac, a medically unproven claim. Fifty-four ginseng products examined by the American Botanical Council proved to have little or no ginseng, and many were adulterated with caffeine.

Wild Yam has been used for menstrual disorders and heavy menses. Yam ex-tracts claim to be progesterone (hormone) substitutes. Claims are made that a form of the plant is converted into progesterone in the body and alleviates “estrogen dominance”. Mexican yam extract contains more estrogen-like substance and is more likely to work as estrogen. But one has to consume large quantities of raw yam to notice a change. There is nothing published that tells about the effectiveness of wild yam cream.

Because there are no standards set for the biological/herb industry, few recommendations can be made on which product to use. Soy and isoflavones, St. John’s Wort and Black Cohosh may be helpful in the short term. But, before trying any herbs or botanicals, make sure you check first with your doctor.

For more information or to schedule an appointment, please contact Dedicated to Women at their Dover location by calling 302-674-0223 or at their Middletown location by calling 302-389-4009.