Pros & Cons of Alternatives
Phytoestrogens are estrogen-like substances found in cereals, vegetables, legumes (beans), and some herbs. They may work in the body like a weak form of estrogen. Some may lower cholesterol levels. Soy, wild yams and herbs such as black cohosh and dong quai, contain phytoestrogens and may relieve some symptoms of menopause. The government does not regulate phytoestrogens. Scientists are studying some of these plant estrogens to find out if they really work and are safe.
Black Cohosh
The herb, black cohosh, known by its Latin names Actaea racemosa and Cimicifuga racemosa, is a native-American herb with a long history of use for "female problems."
The product studied in most of the trials has been used in Germany since the mid 1950s and is currently marketed in the U.S. under the name RemiFemin Menopause. The German government has approved black cohosh as a nonprescription medicine for treatment of various symptoms associated with menopause.
Although some study results suggest that black cohosh may help relieve menopausal symptoms, other study results do not, in part because of lack of rigor in study design and short study duration (6 months or less). To provide more definitive evidence on the effects of black cohosh on menopausal symptoms, NCCAM is funding a 12-month, randomized, placebo-controlled study to determine whether treatment with black cohosh is effective in reducing the frequency and intensity of menopausal hot flashes. The study also will assess whether black cohosh reduces the frequency of other menopausal symptoms and improves quality of life.
In the U.S., black cohosh is sold as a dietary supplement, and dietary supplements are regulated as foods, not drugs. Manufacturers do not have to provide the Food and Drug Administration (FDA) with evidence that dietary supplements are effective or safe before marketing. Because dietary supplements are not always tested for manufacturing consistency, the composition may vary considerably from lot to lot.
Black cohosh can cause stomach discomfort, headaches, heaviness in the legs and weight problems. The safety of long-term use needs to be studied.
Dong Quai
In Chinese medicine, the root of the angelica sinesis plant is known as dong quai. In China, it is used for painful or difficult menstruation, anemia or abdominal pain and as a supportive herb for menopausal symptoms. But in traditional Chinese medicine, it is never used alone. It has gained an identity in the West as the "menopause herb," but this reputation is not supported by scientific evidence.
A recent double-blind study of 71 post-menopausal women with significant menopausal symptoms received either a placebo or 1500mg of dong quai extract three times a day. (During the course of a double-blind study, neither patients nor researchers know who is receiving a placebo of inactive ingredients or who is receiving the substance being tested.)
The study found no change in the proliferation of endometrial cells lining the uterus or hormone blood levels - both key menopausal measures. Dong quai contains coumarin derivatives, which slow blood clotting, particularly in patients taking the blood thinner coumadin. Dong quai also may cause sensitivity to the sun and skin rashes.
Red Clover
A member of the legume family, red clover (trifolium pratense) is rich in phytoestrogens, compounds that function like estrogen in the body. It is one of the few plants that contain all four types of isoflavones. It's also high in bioflavonoids. Because of all of these characteristics it is thought to help in alleviating a number of perimenopausal and menopausal symptoms like hot flashes, night sweats, and other symptoms linked to estrogen levels. Red clover has been made into a pill form with the brand name Promensil.
Two double-blind studies, both funded by the manufacturer of Promensil, found no difference between red clover and a placebo for treating menopausal symptoms such as hot flashes and vaginal dryness. The studies tested daily doses of 40mg or 60mg of red clover administered for 12 weeks.
However, another study found that red clover may increase blood flow in arteries, which diminishes with menopause. Patients were given 40mg of red clover for five weeks followed by 80mg for five weeks.
It's important for women to note that red clover may stimulate breast cancer cells. It also contains coumarin, natural blood thinners that may slow blood clotting. Women taking clover-based remedies along with aspirin or prescription anticoagulants might develop abnormal bleeding. Likewise, red clover's effect on breast and uterine tissue has not been tested.
Wild Yam (Progesterone Creams)
Progesterone creams contain diosgenin, which is synthetically derived from wild yams and is identical to human progesterone. There have been some reports that progesterone cream might increase bone mineral density (BMD) of the lumbar spine and provide a sense of well-being. A recent double-blind study of progesterone cream found improvement or resolution of hot flashes in 83% of women compared to 19% on placebo. Women in the study applied 1/4 teaspoon of the cream containing 20mg of progesterone once a day. However, there was no effect on BMD or depression scores. Of 102 post-menopausal women in the study, eight experienced vaginal spotting.
Remember to discuss alternatives with your doctor
The use of certain herbs and other natural substances can be toxic or, in rare cases, even deadly. Be sure to discuss the use of herbs and supplements with your physician.
Source: National Institutes of Health, Office of Dietary Supplements
