Hormone Replacement Alternatives for Women
By Ward Dean, M.D.
Plants and herbs have been used since the earliest times for a variety of medicinal purposes by all cultures and civilizations. In fact, even today, many of our prescription and over-the-counter drugs have been derived from plants. Modern scientific research has identified many of the active constituents in these herbs, along with the metabolic pathways by which they exert their health-supporting effects. This has led to the manufacturing of standardized extracts of these herbs, insuring the same level of activity and purity from batch to batch.
Among the various historical uses of herbs, many have proved especially beneficial for a wide range of ailments and patterns of ill-health. Such herbs are considered tonic herbs. Rather than having a harsh, overt, direct action, like many prescription medications, tonic herbs work to gently rebalance the body and restore homeostasis without harmful side effects.
Adult womens lives can be divided into three distinct phases. First, are the childbearing years. This period is characterized by cyclic ovulation and menstruation. The second phase called perimenopause is a time when women still experience menstrual periods, but also exhibit menopausal signs and ovulation problems. The third phase, is that of the climacteric, also known as menopause. This is characterized by the cessation of ovulation and menstruation.1 These three phases also have distinct patterns of hormone balance and endocrine gland activity as well as distinct physical, mental and emotional patterns.
Vitex (Chaste Berry)
Neuroendocrine Regulator of the Reproductive System
Chaste Berry (Vitex agnus castus) is an herb native to Greece and Italy. As long ago as 450 B.C., Hippocrates recommended vitex for the relief of inflammation and injuries. Modern interest in vitex began in Germany in 1930 when Dr. Gerhard Madus first researched its effect on the female reproductive system. Studies in the 60s and 70s further clarified its actions.
Menstrual Cycle Normalizer
When used for extended periods of time, vitex can normalize menstrual cycle regularity. Vitex has been successfully used to alleviate conditions that cause hypermenorrhea (excessive uterine bleeding), polymenorrhea (abnormally frequent menstruation), PMS, and even acne and constipation that often result from excessive levels of estrogen. Physicians in Europe commonly prescribe vitex for conditions that include breast inflammation, fluid retention, migraines, and other problems associated with the menstrual cycle.
Black Cohosh (Cimicifuga racemosa) was first introduced to medicine by American Indians, who called it Squaw Root, and recommended it for the treatment of uterine disorders. Black cohosh is a vascular and neurologic antispasmodic agent that also has a spasmolytic and anti-inflammatory effect on the uterus. Black Cohosh contains the anti-inflammatory substance salicylic acid (the same substance in aspirin), making it useful for counteracting menstrual pain, swelling and other gynecological complaints. Black Cohosh has also been used historically to treat numerous musculoskeletal problems, ranging from trauma to rheumatism. It has also been used to treat hypertension, and to prevent miscarriage and premature labor.
An Alternative to Hormone Replacement
Since 1956, a standardized extract of Black Cohosh (called Remifemin) has been used by over 1.5 million European women for menopausal problems. Relief of symptoms with this substance is documented to be comparable to the relief obtained from Hormone Replacement Therapy (HRT), but without harmful side effects. Clinical research on the benefits of cimicifuga in relieving menopausal symptoms is impressive. For example, in one study of 629 women suffering from severe menopausal symptoms, over 80% obtained relief within eight weeks of treatment with black cohosh. Many women showed improvement within four weeks. Table I shows the effects that cimicifuga has on eliminating and improving menopausal symptoms.
Phytoestrogens are a diverse group of plant-derived substances which have estrogenic activity. The structures of these compounds are similar to estrogens, but their actions are less powerful (about 1/1000 as potent). Consequently, when estrogen levels are high, phytoestrogens compete for estrogen receptors, reducing the effects of excess estrogen. The excess estrogens, in this case, are safely metabolized (broken down) by the liver. When estrogen levels are low as in peri- and post-menopause phytoestrogens act as an estrogen supplement. Thus, phytoestrogens balance both excess and insufficient estrogen by acting as an anti-estrogen as well as a weak estrogen.
Recently, there has been a great deal of interest in the benefits of dietary phytoestrogens in hormone-dependent processes, such as menstrual cycle regulation; breast, prostate, and uterine cancer; cardiovascular disease; and osteoporosis. Epidemiological studies have shown that the incidence of hormone-dependent diseases are lowest in populations whose diets are highest in phytoestrogens.
Alfalfa, soybeans, and the Chinese herb Angelica sinensis (Dong Quai) contain high amounts of some of the most widely studied phytoestrogens. These phytoestrogens include coumestans and the isoflavonoids, genistein and daidzein.
Genistein is the most extensively studied isoflavone phytoestrogen. Studies have shown that genistein may reduce the symptoms of menopause, prevent bone loss, and possibly provide a safe alternative for prescription estrogens.
Dong Quai – The Female Ginseng
Next to ginseng, Angelica sinensis (Dong Quai) is the most honored Chinese herb for female conditions. Angelica has been used in Chinese medicine for at least 2000 years. It is primarily regarded as a female remedy and is the most widely used tonic herb for female reproductive problems. The actions of angelica are a result of its coumarin, phytosterol, flavonoid and polysaccharide constituents.
Numerous studies have demonstrated Angelicas usefulness in gynecological problems, including uterine cramping, ovarian functional disorders, infertility, PMS, dysmenorrhea (painful menses), metrorrhagia (excessive bleeding), amenorrhea (absence of menses), chronic miscarriage, and menopausal complaints.
Angelica is considered a uterine tonic. It increases ovarian and uterine metabolism, as well as improves glucose utilization and DNA synthesis in these organs. Angelicas overall calming action is the reason it is often used to treat dysmenorrhea, uterine spasms and cramps.
Cardio and Immune Tonic
Studies have shown that angelica is a hypotensive (blood pressure lowering) agent, primarily due to the vasodilator actions of its coumarin constituents. Coumarins dilate coronary arteries and prevent spasms by acting as calcium channel antagonists. They also relax smooth muscles of visceral organs, explaining why angelica has been historically used in the treatment of intestinal spasms and uterine cramps. Coumarin compounds have also shown immune-enhancing actions since they promote the production of macrophages and stimulate phagocytosis.
Menopause and Pain Relief
Angelica also contains ferulic acid, the active component in gamma oryzanol. In conjunction with other components of angelica, ferulic acid produces an analgesic effect and has mild tranquilizing actions. These substances have been proven to be effective in the relief of menopausal symptoms, including hot flashes. A primary action of gamma oryzanol is to promote the release of endorphins, the bodys natural pain-relievers. One study showed that the analgesic effect of angelica was 1.7 times greater than that of aspirin.
Blue Cohosh (Caullophyllum thaluctroides) has an extensive historical usage as a uterine stimulant. From 1882-1905, the US Pharmacopoeia listed blue cohosh for antispasmodic, emmenagogueic (assisting menstrual flow) and diuretic purposes.
Overcoming Uterine Spasms and Preparing for Labor
Blue cohosh is specifically indicated for uterine spasms, oligommenorrhea (scanty or infrequent menstrual flow) and infertility. Blue Cohosh has also been recommended for breast tenderness and abdominal pain as a result of fluid retention. It may also be used for menstrual cramps – particularly when there is poor pelvic and uterine tone. Some practitioners have found blue cohosh to be valuable in preparing a woman for labor when the uterus has been weakened by multiple childbirths, or other reasons.
Research has shown that blue cohosh normalizes the overall tone of the uterus. It stimulates contractions of the myometrium (smooth muscles of the uterus). This is an important effect – especially when there is a lack of uterine muscle tone. Paradoxically, blue cohosh has antispasmodic actions when the uterus has hypertonic spasms. Blue cohosh contains several alkaloids that appear to be responsible for these actions. Methylcystisine is thought responsible for blue cohoshs antispasmodic actions, and saponins, which contain hederagenin, are thought to increase uterine tone.
Tribulus terrestris (Puncture vine) is a plant that is most commonly found in the Indian sub-continent and Africa. It has been used since ancient times in India as a treatment for both male and female sexual problems. An active preparation is obtained from the above-ground part of the plant that contains steroid saponins of the furostanol type, with a predominant quantity of protodioscin (not less than 45%).5 Experimental and clinical studies in eastern Europe have been conducted on the effects of this extract on the endocrine functions of pre- and postmenopausal women.6
It is clear that a careful selection of tonic herbs and natural substances can be very effective in alleviating a number of hormonally-related symptoms, and can even improve the functioning of womens reproductive systems.
A Libido Enhancer that Relieves Menopausal Symptoms
Tribulus has been found to improve libido and alleviate the vasomotor and neuropsychic symptoms of menopause (hot flashes, depression and emotional instability). The regular use of tribulus for several months often significantly decreases the intensity and occurrences of hot flashes, insomnia, general tenseness, sweating, insomnia, irritability, depression, apathy and loss of sexual interest. Two thirds of the women tested reported increased sex drive after treatment with tribulus.
Comparison of endocrinological functions prior to and after tribulus therapy showed that gonadotropic hormones (FSH, LH, and Prolactin) decreased, while the ovarian hormones (estrogen and progesterone) did not. These actions indicate the hypothalamic-resensitizing effect of tribulus and probably account for the positive influence on menopausal symptoms and the increase of sexual drive.
The effect of a 45% extract of tribulus was found to be equivalent and in some cases, even better in relieving many menopausal symptoms than an estrogen-testosterone hormonal preparation. Tribulus did not cause the adverse side effects of the estrogen/testosterone preparation, which included virilization (masculinization) and weight gain.6, 8
Practical Use of Phytonutrients for relief of hormone-related symptoms
It is clear that a careful selection of tonic herbs and natural substances can be very effective in alleviating a number of hormonally-related symptoms, and can even improve the functioning of womens reproductive systems. These phytonutrients can prevent and remedy a wide range of ailments and complaints. Table II summarizes some of the actions and effects of these botanicals on the female reproductive system.
Each of the phytonutrients described in this article produces distinct primary and secondary effects on the female reproductive system. Some agents such as agnus vitex castus, gamma oryzanol, black cohosh and tribulus terrestris act to restore hypothalamic and pituitary sensitivity to feedback inhibition, and thereby normalize the output and balance of gonadotropic secretions (FSH, LH) that control the organs of the reproductive system. Other agents such as blue cohosh exert direct (but non-hormonal) actions on the uterus.
Therefore, it is best to utilize a combination of different phytonutrients with actions that (1) normalize homeostatic balance by restoring hypothalamic sensitivity to feedback; (2) optimize estrogenic effects by counteracting excessive estrogen or supporting estrogen deficiency; and (3) enhance uterine metabolism and function.
Above are some basic guidelines for utilizing combinations of phytonutrients for relieving disturbances and helping restore homeostasis throughout all phases of a womans life – premenopausal, perimenopausal, and postmenopausal.
1. Principles and Practice of Clinical Gynecology (Kase NG & Weingold, eds). John Wiley & Sons, New York, 1983.
2. Brown DJ: Vitex Agnus Castus, clinical monograph. Quart Rev Nat Med Summer, 1994.
3. Propping D, Bohnert KJ, et al: Vitex agnus-castus: Treatment of gynecological syndromes. Therapeutikon 5 (11): 581-5, 1991.
5. Tomova, M., Gyulemetova R: Steroid saponin and steroidsapogenine VI. Furastanol bisglykosid aus tribulus ferrestris L. Planta Medica, 1978. 34, 188-191.
6. Tabakova P, Dimitrov M, Tashkov B 1st Obstetrical and Gynecological Hospital T. Kirkoua-Sofia, Clinical Studies on the Preparation Tribestan in Women with Endocrine Infertility or Menopausal Syndrome (1984-1987) cited on web site at: http://www.tribestan.com/clinic1.htm
7. Milanov S, E. Maleeva E and Taskov M: Tribestan effect on the concentration of some hormones in serum of healthy subjects.
8. Nikolov R: Neuropharmacological Study on Tribestan. Scientific-technical Report, 981.Hypothyroidism