Management of Perimenopause and Menopause Symptoms through Herbal Drugs
Corresponding author: [email protected]
Abstract
The menopausal transition brings vasomotor symptoms, sleep disturbance, mood change, genitourinary atrophy and accelerated bone loss, and in many women these persist for several years. Menopausal hormone therapy remains the most effective treatment, but concern about breast cancer and thromboembolic risk, contraindications in some women, and personal preference lead many to seek herbal alternatives. This chapter reviews the herbal drugs most widely used for perimenopausal and postmenopausal symptoms and grades the clinical evidence for each. Isoflavone preparations from soy and red clover are the most extensively studied; meta-analyses show a modest reduction in hot flush frequency and severity, of roughly one fifth to one quarter beyond placebo, with more consistent effects for genistein-rich preparations and in women who produce equol. Black cohosh (Actaea racemosa) has been evaluated in many trials, but the Cochrane review found insufficient evidence of benefit over placebo, and rare cases of hepatotoxicity require label warnings. Hop extract standardised to 8-prenylnaringenin, St John's wort combined with black cohosh for mood-dominant symptoms, ashwagandha, maca, valerian for sleep and sea buckthorn oil for vaginal dryness have smaller evidence bases with some positive trials. Dong quai, flaxseed and evening primrose oil have not shown consistent benefit for hot flushes. Safety considerations centre on hepatotoxicity, cytochrome P450 induction by St John's wort, anticoagulant interactions and use in women with oestrogen-sensitive cancers. The chapter concludes with a symptom-oriented framework for selecting a herbal agent, setting realistic expectations of benefit given the large placebo response in menopause trials, and deciding when referral for hormonal or non-hormonal prescription therapy is needed.
Author Affiliations
- 1 Principal, Department of Pharmaceutical Chemistry, Ravindra Vidya Prasarak Mandal Institute of Pharmacy, Dwarka, Nashik, Maharashtra, India.
- 2 Lecturer, Department of Pharmacognosy, Ravindra Vidya Prasarak Mandal Institute of Pharmacy, Dwarka, Nashik, Maharashtra, India.