Herbal Therapies for Perimenopausal and Menopausal complaints

by Debra Israel, Pharma.D. and Ellis Wuinn Youngkin, Ph.D., R.N.C.

Consumer use of alternative medicines in the United States is growing rapidly. Included in this phenomenon are herbal therapies instead of or as adjuncts with traditional medicine for perimenopausal and menopausal complaints. Of significant concern is the safety of these herbs. Since many women are using herbal therapies, clinicians must be knowledgeable about their use, quality, and safety. There are currently no government standards on the quality of herbal products in the United States and some products are either unsafe or little is known scientifically about them. Selected herbal therapies touted in the lay press for common perimenopausal complaint are examined with advice on their use and safety based on scientific sources. (Pharmacotherapy 1997; 17(5): 970-984)

Outline

General Concepts Related on Herbal Therapies Safety Concerns

Common Complaints and Selected Herbal Therapies

Hot Flushes, Flashes and Sweats

Menstrual Irregularities

Dyspareunia and Vaginal and Urinary Complaints

Insomnia, Mood Alterations and Memory and Concentration Difficulties

Decreased or Increased Libido

Review of Herbal Therapies

Conclusions

Significant numbers of women approaching or in menopause have complaints serious enough to warrant seeking medical attention. The most common are menstrual irregularities; hot flashes, flushes and sweats; atrophic vaginitis and urethritis; stress incontinence; mood alterations including irritability, depression and anxiety; sleep disorders; concentration and memory changes; and diminished libido.^1,2 The current trend is to treat is to treat climacteric women with some form of hormone replacement therapy (HRT), but many women prefer not to or cannot take HRT². Instead some may take herbs to alleviate symptoms and others may use herbs together with prescribed agents.

Commonly women seeking these remedies are under the misconceptions that herbal remedies are "natural" and not medicinal and therefore safe. With the burgeoning number of herbal products available to the consumer and the conflicting data regarding their efficacy, making appropriate choices among them can be bewildering.

General Concepts Related to Herbal Therapies

Entire books are available that provide some real and some misleading concepts for herbal management of various complaints. Two, for instance, give the impression that all the remedies are natural and outside the realm of traditional medicine^3,4. Many of the suggested therapies are, in fact, lifestyle changes, vitamins, diet changes and other remedies that do not require a prescription. However, many are herbs that are known to have medicinal effects and as such must be considered drugs, albeit not prescription or over the counter (OTC) ones indicating Food and Drug Administration (FDA) approval.

Several issues are of extreme importance for the provider in managing women with menopausal or other complaints. First and foremost, providers must always understand that herbs are drugs. In the evolution of traditional medicine, the first agents, used by healers were herbs. Over the millennia, some of these evolved to products that ware prepared and sold by strict standards as prescription or OTC compounds. Second, consumers often believe that herbs are not medicines and are safe, especially since they are sold in places such as health food stores and grocery stores. Thus purchasers may conclude that if the herbs were not safe, they would not be available, and this is not always the case.

Third, herbs that are sold today make no (claims) of preventing or treating disease, otherwise they could not be sold as food products. Fourth, consumers are going to use herbs regardless of safety issues if the believe they have certain medicinal effects. Finally herbs cannot be ignored as important sources of therapy; to do so would be to ignore "about 25 percent of our current materia medica that is derived from such sources." ⁵

The various definitions of herbs gives rise to related problems. Horticulturalists see them as "non-woody seed-producing plants." Chefs see them as enhancing foods' flavors and aromas. However, medicine defines them as crude drugs of vegetable origin utilized for the treatment of disease states, often of a chronic nature, or to attain or maintain a condition of improved health." ⁵ This includes tinctures, extracts, and similar preparations that, as such, are called phytomedicinals (plant medicines).

The amount of drug in herbal preparations varies widely from product to product. In addition, other compounds may increase, decrease, or other components may increase, decrease, or change the effects of an herb. The quality of herbs varies since there are no standards; the plants may be gathered or purveyed by people with no knowledge of these variations, which are often subtle but have an impact on effect. Finally, consumers should be aware of the possibility of products having been adulterated or containing substitutes or other ingredients. One study analyzed 54 ginseng products and concluded that 60% of them were without worth.⁵ In addition, poisonings have been caused by adulterants or by substitutes; for example, phenylbutasone, (termcinolone, desamethasone, prednisolone, indomethacin, and acetaminophen.⁶ Users have suffered serious adverse effects from these ingredients.