The Wisdom of Menopause

by Christiane Northrup

  Alternatively, you can have a formulary pharmacy make up a combination of estrogen and progesterone, and/or testosterone (if necessary), such as the formulations I’ve mentioned above.

  Remember that formulations that work well for one woman do not necessarily provide optimal results for another. You may want to try a different formulation, a different delivery system, or a different dosage, or switch from hormone supplementation to nonhormonal herbal support or vice versa. Be calm and at peace about this decision process—you can always change your mind if what you’ve chosen falls short of your expectations.

  6

  Foods and Supplements to

  Support the Change

  For thousands of years, long before our culture placed its trust in pharmaceuticals, women relied upon their intuition and Mother Nature to keep themselves and their families healthy. Guided by their inner wisdom, our ancestors plucked healing plants from nature’s colorful pharmacy—fragrant chamomile for calming teas, fresh ginger to prevent nausea and calm the stomach, and foxglove to regulate the heartbeat.

  It is remarkable that our herbalist ancestors, though separated by thousands of miles, often drew upon the same herbs to treat the same conditions. American Indian women and their Chinese counterparts, for example, both used angelica (dong quai) to treat menopausal symptoms.

  Today this ancient, intuitive wisdom is being augmented by objective scientific studies confirming what wise women have always known: plants contain a wide range of ingredients, such as essential fatty acids, phytoestrogens, and antioxidants, that can heal and help keep us healthy at all stages of our lives, including perimenopause.

  To use herbs and foods optimally requires an adjustment in thinking. Plant medicine and food do not work in the body the way drugs, or even bioidentical hormones, do. Modern pharmaceuticals and hormones usually consist of one purified active ingredient (often derived from a plant source and then altered biochemically) that is carefully standardized and measured for its biological effect.

  Whole herbs and foods, on the other hand, contain many different active ingredients that act synergistically in the body. There is good reason to believe that to get the full range of benefits, you need to consume the whole plant—or a product made from part of the whole plant, such as leaves or roots—rather than a single ingredient. This is why some studies show that whole soy foods give better results than capsules or pills containing isolated soy isoflavones.

  In allopathic Western medicine, we try to target a symptom or illness with a single drug—we give birth control pills, for example, to stop heavy bleeding or to regulate irregular periods. Birth control pills control symptoms, but they do nothing to treat the underlying imbalance.

  Herbs and foods, on the other hand, with their exquisite combinations of interactive ingredients, work to balance the body at a number of different levels simultaneously. Accordingly, there are many different herbs or foods that one might use to regulate the menstrual cycle or as overall perimenopausal tonics, including soy foods, ground flaxseed, dong quai, Pueraria mirifica, or chasteberry, to name just a few. All contain substances that help balance the endocrine system in slightly different but synergistic ways.1

  Herbs also work best when considered as part of an overall plan that includes a good diet, exercise, and improved relationships. In other words, we need to approach herbs and foods with a holistic mindset that asks, “What foods or herbs will best help me balance my body so that it can heal itself?” rather than the more dualistic “What pill do I need to take to remove this symptom?”

  WHO SHOULD CONSIDER HERBS?

  ~ Your symptoms are mild but you’d like a little support.

  ~ You believe that herbs are simply more natural and beneficial than prescribed hormones.

  ~ You’d like to avoid hormone therapy because of fear of breast cancer or another health concern.

  ~ You’re on HT of some sort but would like the added benefits of herbs.

  ~ You cannot tolerate HT.

  BASIC PRINCIPLES OF HERBAL THERAPY

  AT MENOPAUSE

  In order to use menopausal herbs well and wisely, you need to understand the following basic principles.

  ~ All plant foods contain what are known as phytonutrients. (Phyto- means “plant.”) These are unique substances produced during the natural course of growth and are specific to a particular plant’s genes and environment. In addition to providing taste and nutritional value, phytonutrients can play therapeutic roles by modifying physiological processes in our bodies. This is the basis for botanical medicine. An example of this is the phytochemical indole-3-carbinol, found in cruciferous vegetables such as broccoli. This substance appears to convert the most potent estrogens in the body into weaker, less carcinogenic forms. High consumption of cruciferous vegetables is associated with a decreased risk for breast cancer, breast tenderness, and bloating, all of which are related to estrogen levels that are too high.

  ~ The line between using herbs as foods and using them as drugs can be blurry. For example, ephedra (ma huang) can be an effective treatment for asthma and sinusitis, but it should be avoided as a daily supplement. (It was even taken off the market for a while because people were using it addictively to lose weight and suffered severe side effects from overdosing.) In general, the greater your intake of an herb, the greater the potential for druglike effects. For safety, keep doses moderately low, and follow the directions on the package or an herbalist’s recommendation. It is also best to let your health care provider know what herbs you take regularly, because some herbs interact with some drugs in a way that either decreases the drug’s potency or changes its effect. This is because both use the same metabolic pathways in the liver.

  ~ Recent advances in the standardization of herbal supplements have led to more consistent quality and potency. The most effective products are those that combine the whole plant (or plant part, such as the root) with a standardized percentage of the primary active ingredient.

  ~ The common menopausal herbs mentioned in this chapter have been used safely and effectively for thousands of years and rarely have side effects. However, a few people may react to some of them, some of the time—just as with any food or drug. There are also many herbs with known toxicity that shouldn’t be used except under the care of an experienced herbalist. Examples include belladonna, blue cohosh, lobelia, and poke root.

  ~ Phytoestrogens, the natural hormones found in plants, are not the same as the hormones found in the female body, although they may have somewhat similar beneficial effects. Phytoestrogens are found in more than 300 plants, including some that we routinely eat in the United States, such as apples, carrots, oats, plums, olives, potatoes, tea, coffee, and sunflower seeds. Soy and flaxseed are particularly rich in these substances.2 Phytoestrogens can be divided into two main families: the isoflavones, which include substances such as genistein, daidzein, equol, and coumestrol, and the lignans, which include matairesinol, enterolactone, and enterodiol.

  The estrogenic activity of phytoestrogens is lower than that of human estrogens—in the range of a hundredth to a thousandth that of estradiol. They also have antioxidant and antiproliferative activity that is still being elucidated. This means that they have the ability to prevent free-radical damage to cells, the number-one cause of premature aging of tissue, and they also help prevent abnormal cell growth.

  Like other estrogens, phytoestrogens bind to estrogen receptors throughout our systems. (Research has shown that estrogen receptors are found on the surface of nearly every cell of our bodies, not just those of the vagina, uterus, and breast tissue.) When they bind, they exert a balancing, or “adaptogenic,” effect.3 This means that if your estrogen levels are low, the herbs will have an estrogenic effect, but if your estrogen levels are too high, they will block the stronger estrogens. That’s why the same herb—dong quai, for example—can be used both for conditions in which there is too much estrogen (such as PMS) and for those in which there is too little (hot flashes).

/>   Phytoestrogens do not stimulate the growth of estrogensensitive tissue such as in the breast and uterus; in fact, they have been shown to inhibit breast tumors in some animal studies, probably because they occupy estrogen receptor sites and prevent overstimulation of the cells.4 Menopausal herbs have never been implicated in promoting cancer in humans, either, and indeed, some herbs are noted for their anticancer properties.5 For this reason, menopausal herbs are an excellent choice for those who are concerned about cancer.

  ~ Many plant extracts exert a tonic effect on the female pelvic organs, and other organs as well. What this means is that they stimulate blood flow and sometimes even increase the weight of these organs.6 Herbs such as black cohosh and chasteberry have also been shown to reduce menopausal symptoms by acting on the pituitary gland.

  ~ In general, herbs exert their influence in a much slower, more gradual way than drugs or even the bioidentical hormones that I often recommend. So be prepared to wait three or four weeks before noticing an effect from an herbal supplement.

  ~ Finally, menopausal herbs are often given in combination, since experienced herbalists have found that their actions are synergistic and produce better results when used this way. Chinese herbal formulations set the standard for this synergy.

  Key Menopausal Herbs

  The following are some of the best-studied herbs used for menopausal symptoms. They can be used singly or in combination. Please note that this list is far from comprehensive. Many others, such as peony, hops, motherwort, and false unicorn root, are also effective.

  DONG QUAI (Angelica sinensis): Dong quai (also known as angelica, dang gui, and tang kuei) has excellent phytoestrogen activity and has been called female ginseng because of its ability to enhance energy and a sense of well-being. It is used for amenorrhea, irregular periods, and excessive uterine bleeding. My acupuncturist, who is from Taiwan, tells me that dong quai is one of the most widely used herbs in China and that many women take it throughout their reproductive and perimenopausal years.

  Dong quai also has analgesic and antiallergy effects, is antibacterial, is a smooth-muscle relaxant, and can stabilize blood vessels.7

  Dong quai is widely available over the counter. It is the foundation of almost all menopausal formulations and can be taken indefinitely. In Asia, women simmer the raw dried herb with chicken to make a soup or stew. Angelica root can be found in many herb shops or health food stores. It is also processed into capsules, tablets, and tinctures. (It is best to avoid alcohol-based tinctures.) The recommended dosages for most over-the-counter dong quai preparations are probably too low to be helpful (the usual dose is 4.5 g per day). Increasing the dosage on your own is unlikely to cause any problems, but it’s always best to be under the supervision of a certified herbalist or practitioner of Traditional Chinese Medicine.

  Note: Do not take dong quai if there’s a chance you’re pregnant.

  CHASTEBERRY (Vitex agnus-castus): Chasteberry comes from the chaste tree, which is native to the Mediterranean. It is widely available at natural food stores, often under the name vitex. It has been shown to have a profound effect on pituitary function, increasing the secretion of LH (luteinizing hormone) and decreasing the production of FSH (follicle-stimulating hormone), which in turn shifts the production of hormones toward more progesterone and less estrogen.8 This is thought to be the main reason why it helps balance the irregular periods that result from the hormonal swings of perimenopause. It also acts somewhat like the neurotransmitter dopamine. Chasteberry is particularly beneficial for women who are having PMS-like symptoms or are experiencing scanty, irregular periods. It has been shown to suppress appetite, relieve depression, and improve sleep. It can take several months to work.

  The usual dose is 1 tsp of crushed fruit per cup of water one to four times per day, or 20–75 drops of the 1:3 liquid extract one to four times per day (or as directed on the bottle).

  Note: Chasteberry can cause rashes in susceptible individuals. Don’t take it with neuroleptic medicines such as haloperidol (Haldol) or thioridazine (Mellaril), or when pregnant or nursing.

  BLACK COHOSH (Cimicifuga racemosa): Black cohosh has been used in this country for hundreds of years. Native Americans called it cramp bark. It is also a popular Chinese herb and is often used in formulations for perimenopausal symptoms. It binds to estrogen receptors, where it selectively represses the elevation of LH that occurs at menopause.9 It decreases hot flashes, night sweats, irritability, and mood swings (although recent studies show black cohosh improves hot flashes in only about a third of those women taking it—far less than placebo).10 It is also helpful for PMS symptoms. Although this herb was originally considered a phytoestrogen, studies show that it actually works by affecting the neurotransmitters dopamine and serotonin.

  A standardized extract of black cohosh sold under the trade name Remifemin is one of the most widely used herbs in Europe, where it is a well-documented alternative to HT. Many women take Remifemin alone for relief of menopausal symptoms. Clinical studies show that it relieves depression, vaginal dryness, and menstrual cramps. While Denmark recently banned this herb because of concerns that it might cause serious liver damage, such cases of liver toxicity are rare and the evidence isn’t definitive. (The culprit may actually be a related but different herb that was misidentified on product labels as black cohosh.)

  The usual starting dose for Remifemin is 1–2 tablets (20 mg per tablet) twice per day. Or take black cohosh in any of the following forms, three times per day: powdered root or as a tea, 1–2 g; solid, dry 4:1 powdered extract, 250–500 mg; fluid extract, 1:1 tincture, 4 mg (1 tsp, or about 5 ml).

  A new form of black cohosh known as BNO 1055, used in the preparations Klimadynon (now known as Menopret) and Menofem, was shown to suppress hot flashes in breast cancer survivors as well as conjugated estrogens did (completely eliminating the hot flashes in 47 percent of the women in the study).11

  Note: Black cohosh can interact with medicines for high blood pressure and may result in excessively low blood pressure in some women.

  MACA (Lepidium peruvianum Chacon): This herb is adaptogenic, which means that it helps modulate the body’s response to stress of all kinds. Peruvian maca (a dietary staple in that country) traditionally has been used to benefit the endocrine and reproductive systems of both men and women, and research shows that it increases the production of sex hormones, enhances sex drive, increases energy, and also results in mental improvement in many. Its properties make it particularly useful for perimenopausal and menopausal women.12 Femmenessence MacaPause, a formulation of maca that has guaranteed potency and excellent bioavailability, is made by Natural Health International (www.naturalhi.com). The standard dose is two 500 mg capsules twice daily (morning and evening), although if you haven’t noticed improvement in four to seven weeks, ask your health practitioner about taking slightly more or less until you find the optimal balance for you.

  Note: Women taking thyroid medication should monitor their thyroid levels when taking Femmenessence because often thyroid medication will need to be reduced. Also, women taking tamoxifen should not take Femmenessence.

  LICORICE ROOT (Glycyrrhiza glabra): Licorice is a perennial, temperate-zone herb that grows three to seven feet high. The parts used are the dried runners and roots. Licorice root is one of the most extensively used and scientifically investigated herbal medicines. The active constituents of licorice include both isoflavones and lignans. Licorice has many pharmacological actions, including estrogenic, anti-inflammatory, antiallergy, antibacterial, and anticancer effects. It helps regulate estrogen/progesterone ratios. It also helps replenish adrenal function, so it is very good for fatigue.

  The usual dose is ¼ tsp of solid extract once or twice per day.

  Note: Blood pressure should be monitored to be sure that it stays stable. The cortisol-like activity of this herb may cause a problem in those who are prone to hypertension. In those with low blood pressure, this herb can help correct and balance the problem.

/>   NUTRAFEM: This new and very promising natural phytoestrogenic supplement contains botanical extracts derived from the bark of Eucommia ulmoides (the Chinese rubber tree) and Vigna radiata or mung beans. This supplement works by helping the body use its own estrogen more effectively. A placebo-controlled study published in 2010 found that 43 percent of women taking Nutrafem cut the number of symptoms they experienced in half within seven days, with 90 percent experiencing a reduction in hot flashes.13 Although most women see improvements quickly, it takes about three months for your body to get the full effect. If you’re stopping HT, you may experience several weeks of fluctuating symptoms before your body rebalances itself on Nutrafem.

  Nutrafem also reduces fatigue and relieves body aches, and the phytoestrogens it contains maintain bone health and, as natural antioxidants, combat the damaging effects of free radicals. The recommended dose is two to four capsules per day for mild to moderate symptoms and up to six capsules per day for more severe symptoms. Women currently using HT may require up to six capsules per day. Nutrafem is available from Emerson Ecologics (800-654-4432 or 603-656-9778; www.emersonecologics.com). For additional information, see www.nutrafem.ca.

  Note: Don’t take this supplement if you have an overactive thyroid or if you’ve been diagnosed with cystic breast disease.

  AMBEREN: Another promising new supplement for menopausal symptoms, Amberen is manufactured by Lunada Biomedical. Amberen is a 100 percent natural over-the-counter preparation that combines calcium, magnesium, zinc, vitamin E, the neurotransmitter monosodium L-glutamate, and the amino acid glycine, which regulates brain cell activity. Basically, Amberen works by restoring communication between the brain and the endocrine system, maximizing the body’s ability to produce and balance its own hormones. A recent study showed that the supplement relieves hot flashes, weight gain, mood swings, fatigue, anxiety, and loss of libido without side effects.14 In some women, it works in less than one week. The normal dose is two capsules once a day for ninety days. If symptoms return, the course is repeated. (For more information on Amberen, including ordering instructions, call 800-993-6339 or visit www.amberenonline.com.)