In the West, menopause seems to signal the end of your sexual health and wellness. However, in many traditional cultures, menopause is celebrated menopause as a rite of passage, a coming into wisdom. Similarly, such cultures have their own remedies for tackling the symptoms of menopause, but how do you know if they will work for your wellbeing? We asked Dr. Mary Hardy, head of the Integrative Medicine Group at Cedars Sinai Medical Group in Los Angeles, to explain how herbal therapies can ease the transition of menopause.
1. Why choose herbs? According to Dr. Hardy, ‘Many women choose herbs either because HRT is not recommended for them because of the increased risk of breast cancer, or because they just don’t feel comfortable using HRT.’
2. Which herbs are available for treating menopausal symptoms? ‘Eating soy can be very helpful for relief of menopausal symptoms.’ Dr. Hardy notes. ‘Among herbal remedies, black cohosh is an herb we learned about from the Native Americans and is now widely used in Europe. We don’t know exactly why, but it’s good at relieving some symptoms like hot flashes and mood swings. Study has started on red clover for its effects on hot flashes as well. This herb contains some of the same chemicals as soybeans, called isoflavones, often referred to as plant estrogens or phytoestrogens.’
3. Can you combine herbs with HRT? Dr. Hardy allows, ‘Combining herbs like black cohosh or red clover, or soy with conventional hormone replacement therapy is mostly okay. But HRTs are powerful drugs, so your physician needs to be involved in your decision.’
4. Is it safe to replace your HRT with herbs? This is ‘a question that every woman should ask her doctor,’ says Dr. Hardy. ‘As the answer depends on the individual’s indication for oestrogen. If you’ve been using HRT for symptom control, and not for significant medical issues that require oestrogen replacement, herbal treatments can be used safely. But if you are taking HRT for heart disease, severe osteoporosis, intractable hot flashing, or chronic vaginal infections, it may not be advisable. The more significant your medical issues, the more you need to involve your physician in this discussion.’
5. Can you take phytoestrogens, like soy, if you have breast cancer? Dr. Hardy admits, ‘It’s a very controversial issue right now, and you’ll find more than one opinion without definitive answers. If you want to take phytoestrogens, do so under doctor’s supervision. I also feel that eating soy foods is safer than taking high-dose soy extractions. Generally, most of the safety data comes from observing Japanese women and their diets, so we should try to approximate what they do.’ When it comes to taking black cohosh when you have breast cancer, Dr. Hardy is a bit more confident: ‘While the results are far from conclusive, researchers in a couple of in-vitro studies found black cohosh inhibited the growth of cancer cells. They also tested for interactions between black cohosh and Tamoxifen (an estrogen-blocking drug used in the treatment of breast cancer) and found the black cohosh did not weaken the Tamoxifen. There’s a far jump from a test tube to a person, but in low doses, we feel it’s safe.’
6. What about dong quai? Not all herbs are beneficial on their own, Dr. Hardy comments. ‘Customarily in Chinese medicine, dong quai is never used alone but rather as part of a formula,’ she explains. ‘And depending on the specific symptoms, may not be at all appropriate. Unless it’s part of a formula recommended by a certified practitioner of Chinese medicine, I’d say skip it.’