Use of Herbal Medicine in Menopause
Almost one-third of a woman’s lifetime is composed of her post-menopausal years. However, to make it to that time, several rites of passage need to be crossed, like menopause which the levels of estrogen and progesterone decrease dramatically. During this transitional change, several symptoms may appear, such as sudden sweats, fatigue, dizziness, weight gain, depression, and intense hot flashes. Indeed, the consequences of menopause promote physiological and psychological conditions such as osteoporosis, loss of muscle mass, a higher risk of developing cardiovascular disease, and sometimes Alzheimer’s disease. Therefore, it is crucial to improve these patients’ quality of life in all ways possible. However, the use of alternative herbal medicine can improve serotonin release and estrogen-like effects that might improve drastically the quality of life of women going through menopause.
Black Cohosh and Valerian promoting neurotransmitter function:
Menopause is characterized by estrogen withdrawal that directly affects the function and release of norepinephrine and serotonin that affect the thermoregulation capacity of the hypothalamus. In turn, this mechanism is experienced as hot flashes and night sweats, overall a disturbed night sleep.
In the past, these disturbances have been treated with the prescription of antidepressants SSRIs. However, undesired secondary effects came along with this treatment. Furthermore, among these secondary effects, weight gain, sexual dysfunction, and nausea are what lead women to seek alternative herbal medicine.
ACTAEA/CIMICIFUGA RACEMOSA (BLACK COHOSH)
The use of Black Cohosh by Native Americans in the United States to modulate serotonergic due to its antidepressant effect has been widely studied. However, the use of the roots and rhizomes of black cohosh does not modulate estrogenic mechanisms, and up-to-date the bioactive components of this herb have not been identified.
The downside of black cohosh is that the research is inconsistent, with some papers reporting only adverse side effects with no symptom relief. On the other hand, a placebo-controlled trial reported a significant improvement in reducing menopause-related symptoms (95% interval), with beneficial effects lasting up to 12-weeks after the washout period.
VALERIANA OFFICINALIS (VALERIAN)
The use of the extracts of valerian roots results in sleep improvements which reflect in fewer night sweats, which also associate with valerian’s serotonergic benefits.
Furthermore, valerenic acid, an active valerian compound, acts as an agonist of the 5-HT. Valerian associates its overall benefits with a reduction in hot flashes frequency and intensity and improved sleeping patterns. Some of these studies used 530mg of valerian root capsules twice a day, without any observed adverse effects.
Estrogen mimicking botanicals:
Estrogenic activity can be modulated by specific botanical agents interacting with estrogen receptors (ERa and ERb). Indeed, particular herbs can mimic estrogen chemical compounds and interact with ER to activate transcription genes or estrogenic mechanisms that promote proper physiological function.
Furthermore, these botanicals are more likely to activate ERb, which is associated with counteracting the proliferative effects of ERa. This characteristic allows botanicals with ERb selectivity to be a safer alternative than HRT.
Soy gut-derived metabolites are associated with beneficial estrogenic effects, promoted by their capacity to bind to ERb. Indeed, soy active compounds genistein and daidzin are hydrolyzed in the intestine by β-glucosidases. These by themselves are ERb-selective compounds, but its microbiota-derived metabolite S-equol has higher estrogenic activity and ERb-affinity.
Nowadays, soy isoflavone supplementation is part of the recommendations to relieve menopausal symptoms, and The North American Menopause Society has expressed this statement. Furthermore, clinical trials have used dosages ranging from 50 to 100mg/day with a statistically significant reduction of hot flashes.
Other precursors of daidzein and genistein are the isoflavones found in red clover. However, these isoflavones are proestrogens biochanin A and formononetin. After being demethylated by cytochrome P450 in the intestine and liver, genistein and daidzein can directly interact with ERb.
Also, clinical applications show that isoflavones derived from red clover show more efficacy and higher bioavailability. Also, the supplementation of red clover is associated with a significant reduction of hot flashes with no increase in endometrial thickness or breast density.
Treating symptoms like hot flashes might seem too superficial for so many. Most people think that women should be used to that feeling by now, and these symptoms are a burden that they have to face. Other people might think that HRT is the only way to deal with these symptoms, and patients need to deal with the secondary effects. Nowadays, with the combination of traditional herbal medicine and modern research, we have extensive information about the application, efficacy, and secondary outcomes.
Furthermore, the use and efficacy of these herbals can improve estrogen levels, but these benefits will reflect in all the processes that depend on hormonal balance. Indeed, the connection between anthropometric measurements and hormonal balance can influence bone density and muscle mass. Consequently, all of these factors predict our patients’ overall quality of life. – Ana Paola Rodríguez Arciniega, MS.
Dietz, Birgit M et al. “Botanicals and Their Bioactive Phytochemicals for Women’s Health.” Pharmacological reviews vol. 68,4 (2016): 1026-1073. doi:10.1124/pr.115.010843
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