Do herbal remedies for menopause really work?

Natural remedies for menopause

Menopause is a big transitional phase for any woman. It signals the end of her menstrual cycles, and a decline in the production of reproductive hormones such as oestrogen and progesterone.

Menopause is defined as the time of your last period, which is usually between an average age range of 45 to 55 years. However, perimenopausal and premenopausal symptoms - symptoms traditionally associated with the menopause, but seen before or after your last period - can last several months to several years. That means it's not at all uncommon for symptoms to start in your early 40s, or even your late 30s.

What happens during menopause?

Many women find they experience the following symptoms:

Hormone replacement therapy (HRT)

Every woman will experience symptoms differently. Some may be able to ease their symptoms through lifestyle adjustments alone, while others may turn to hormone replacement therapy (HRT).

HRT is a medical treatment that has been shown to treat symptoms effectively. However, concerns regarding the possibility of increased breast cancer and heart attack rates rose after two major studies identified a link in 2002. The data behind these studies have since been questioned and in some cases debunked. But the perception of HRT's health advantages and drawbacks remains distorted².

Complementary and alternative therapies

Around 40-50% of women³ in western countries choose to use complementary and alternative therapies⁴, including mind and body practices such as hypnosis. Herbal (plant-based) remedies are another popular natural treatment option. There are several on the market, but is their effectiveness backed by science?

Do natural menopause treatments really work?

The evidence that natural remedies for menopause work is mixed, and scientific research is limited. According to the charity Women's Health Concern, herbal remedies may provide some symptom relief, but are unlikely to improve bone health or heart function.

Effectiveness

Research is still ongoing to determine how effective herbal remedies for menopause are at easing symptoms. A review of 62 studies³ found modest reductions in the occurrences of hot flushes and vaginal dryness, although the need for further evidence was also identified. The quality of current evidence is a big limitation - as many as 74% of these studies had a high likelihood of bias that may influence their results.

Adverse effects of herbal remedies

While reports of side effects for herbal remedies are relatively rare, there are some mild symptoms that may occur. For example, black cohosh⁵ can cause stomach upset, skin rashes, headache, vaginal bleeding, and weight gain. Some herbal remedies may also interact with drugs and cause side effects.

One such example is St John's wort, which can increase the chance of side effects in people also taking certain antidepressants. Always consult your pharmacist, who will be able to advise on the safe natural and drug therapy combinations.

Regulation

Safety concerns regarding the lack of regulation are another important factor. The National Institute for Health and Care Excellence (NICE) cautions that herbal remedies which are not regulated by a medicine authority shouldn't be considered safe. This is because different products have different ingredients and concentrations, which may increase the odds of more serious side effects.

There have been reports of contamination in certain natural remedies for menopause. For example, some commercial black cohosh supplements contain the wrong herb or other herbs not listed on the label⁵ which has led to adverse reactions⁶.

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Should you be worried about postmenopausal bleeding?

You've endured the hot flushes and the mood swings. You've survived the heavy, irregular bleeding. Once you come out the other side, maybe the menopause isn't so bad - after all, you don't have to put up with periods every month. But then you start bleeding again, and you're not sure if it's normal.

by Dr Sarah Jarvis MBE, FRCGP

Women's health

Perimenopause

Perimenopause refers to the transitional phase that occurs before menopause. It typically begins several years before menopause, although the exact duration can vary from woman to woman. During perimenopause, a woman's body undergoes hormonal changes as the ovaries start producing less oestrogen. Symptoms include hot flushes, night sweating, mood changes, vaginal dryness, and changes in libido.

by Dr Hayley Willacy, FRCGP

Herbal remedies for menopause relief

There are many herbal remedies for menopause on the market and most are used to treat a wide range of menopause symptoms. The following are some of the most popular plant-based products.

Black cohosh for menopause

What: A species of buttercup native to North America.

Benefits: Some studies have found that black cohosh can help to ease menopause symptoms when compared to a placebo. It also has a low chance of interacting with other medicines.

Considerations: Like all herbal remedies, it's not as effective as HRT at reducing symptoms such as hot flush frequency. There is also conflicting evidence about whether black cohosh is more effective than a placebo⁹. While adverse reactions are relatively rare, occasional instances of serious side effects with unlicensed versions include liver damage and low blood pressure. Black cohosh shouldn’t be taken by people who have liver and kidney problems.

Red clover for menopause

What: A flowering plant in the legume family, native to Europe, Western Asia and Northwest Africa.

Benefits: This remedy appears to have natural oestrogen-like properties that can help with hot flushes¹⁰. There are currently no identified safety concerns for its use.

Considerations: Nonetheless, as with all herbal remedies the scientific evidence is relatively weak, and there's little data on long-term use.

St John's wort for menopause

What: A flowering plant native to Europe, North Africa and West Asia.

Benefits: Some studies¹¹ suggest that St John’s wort may ease symptoms better than a placebo, although there's not enough evidence to know for certain. In particular, some studies suggest it may be as good as prescribed antidepressants at relieving low mood¹².

Considerations: It has a high chance⁸ of adverse effects from interactions with other drugs, and checking with a healthcare professional before use is advisable. St John's wort should not be taken by women on hormone therapy for breast cancer, as it makes treatment less effective.

Ginseng for menopause

What: A plant root originating in China and used in traditional Chinese medicine.

Benefits: Studies show mixed evidence for the use of ginseng to treat menopausal symptoms in comparison to placebo drugs. A review of research concluded that most have a high chance of bias.

Considerations: Ginseng has been shown to decrease the effectiveness of certain medications - including chemotherapeutic drugs, HIV drugs, and antidepressants. There is also some evidence that ginseng might affect blood sugar levels.

Evening primrose oil for menopause

What: The seeds of evening primrose, native to North America.

Benefits: There is some limited evidence¹⁴ for the effectiveness of primrose oil, although it should be noted that most studies conclude it is no more effective than a placebo. It is generally considered safe¹⁵ and is well tolerated by most people.

Considerations: Although it's widely used, there's insufficient scientific evidence¹⁵ to support its use for menopause treatment. Primrose oil may also interact negatively with certain HIV drugs and, as with all supplements, it's worth checking with a professional if you're on other medications.

Further reading

1. Palacios et al: Hormone therapy for first-line management of menopausal symptoms: Practical recommendations

2. Langer et al: Hormone replacement therapy - where are we now?

3. Franco et al: Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis

4. Johnson et al: Complementary and Alternative Medicine for Menopause

5. NCCIH: Herb-Drug Interactions: What the Science Says

6. NIH: Black Cohosh

7. Sarri et al: Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause

8. Asher at al: Common Herbal Dietary Supplement–Drug Interactions

9. Leach et al: Black cohosh (Cimicifuga spp.) for menopausal symptoms

10. Ghazanfarpour et al: Red clover for treatment of hot flashes and menopausal symptoms: A systematic review and meta-analysis

11. Grube et al: St. John's Wort extract: efficacy for menopausal symptoms of psychological origin

12. Linde et al: St John's wort for major depression

13. Kim et al: Ginseng for managing menopause symptoms: a systematic review of randomized clinical trials

14. Farzaneh et al: The effect of oral evening primrose oil on menopausal hot flashes: a randomized clinical trial