Being a woman has certain advantages. Compared to men, we have more range — that is, society tolerates a greater range of emotional, stylistic, recreational and vocational expressions. We feel freer to express joy, anger, love, sadness, jealousy and full-throttle hysteria (hystera is, after all, Greek for “womb”). We dress in denim, taffeta, corduroy, lace, leather and silk. We hold dominion over the color pink, polka dots, floral prints and rhinestones. We wear work boots, heels, clogs, running shoes and slippers. We carry briefcases, tool belts and evening bags. We style our hair (dyed or not) in braids, crew cuts, pageboys, French twists and pigtails.
Compared to men, our reproductive processes are also more complex, more cyclical. When we’re young, our hormones wax and wane each month. Ovaries release eggs, breasts periodically swell, the uterus cramps and bleeds, ballooning with pregnancy and contracting with childbirth. Moods shift — one moment we’re humming “I enjoy being a girl” from The Flower Drum Song; the next, we’re fantasizing acts that make Steven King’s character Carrie look like a lamb.
In middle life, as ovaries head into retirement, cycles go erratic. We open windows, turn down thermostats, dress in layers for the inevitable flash of body heat. We awaken tangled in damp sheets, while our male partners slumber on comfortably beside us.
Over the ages, women have learned how to enlist herbs to ease cycles and changes. Recently, scientific research has validated many of these remedies.
Premenstrual syndrome (PMS), if you include mild forms, troubles more than 40 percent of the menstruating population during the last week or two of each cycle. Some women experience primarily physical symptoms: headaches, bloating, water retention, breast tenderness, acne and craving for sweets. Some women are bothered more by intense emotional responses: irritability, anger, sadness and nervousness. More severe monthly mood symptoms that significantly disrupt a woman’s life are known as premenstrual dysphoric disorder. The exact cause of PMS is unclear but may involve imbalances of female hormones, adrenal hormones, brain chemicals and deficiencies in various nutrients.
A thoroughly researched article published in the May 2003 issue of the American Journal of Obstetrics and Gynecology reviewed an integrative approach to PMS. One of the three authors is Roberta Lee, M.D., the medical director of the Continuum Center for Health and Healing in New York. For her patients with PMS, Lee first encourages healthy lifestyle habits — diet, exercise and sufficient sleep. Based upon the available research and her clinical experience, she counsels women to emphasize dietary intake of legumes, vegetables, whole grains and cold-water fish (which contain inflammation-lowering omega-3 fatty acids) and to limit intake of red meat, sugar, salt and caffeine. Another lifestyle habit — regular exercise — is cheap and has been shown to improve all symptoms of PMS. “These basic lifestyle changes can help significantly change symptoms of PMS,” Lee says. If these changes aren’t effective, she turns to vitamins and herbs.
Low levels of calcium, magnesium and vitamin B6 have been implicated in PMS. Research published in The Annals of Pharmacotherapy in 1999 suggests that supplementation may help. Lee recommends 1,200 mg of calcium, 400 to 800 mg of magnesium, and 50 to 100 mg B6 a day.
Best PMS Herbs
Vitex (Vitex agnus-castus), also known as chaste tree berry because of a historical misbegotten belief that the dried fruit promoted chastity, helps balance female hormones. Specifically, it acts on the pituitary gland to promote luteinizing hormone (which stimulates the ovaries to produce progesterone) and reduce prolactin (which interferes with estrogen and progesterone).
“Chaste tree is the quintessential women’s herb,” says Kari Radoff, clinical herbalist at Apothecary Tinctura, a Denver herb store that specializes in women’s health. “It’s excellent for cyclical changes — acne, spotting, breast tenderness, PMS and irregular cycles.”
Indeed, nine studies have shown that extracts of this herb can reduce PMS symptoms, according to The ABC Clinical Guide to Herbs (American Botanical Council, 2003). It also helps relieve breast tenderness and control acne. Extracts also may help restore regular menstruation in women whose menses have become irregular or stopped due to hormonal imbalances.
Vitex does not have immediate effects. Radoff recommends a minimum of three months of continuous use. Although this herb can be taken once each morning at a dose of 6 droppersful of tincture (6 ml, or just more than a teaspoon), Radoff prefers taking two to three droppersful two to three times a day. Sometimes she combines vitex with another hormonal herb, such as dong quai (Angelica sinensis), nerve tonics such as oat straw (Avena sativa) and lemon balm (Melissa officinalis), and liver tonics such as dandelion root (Taraxacum officinale).
According to Lee, anti-inflammatory herbs such as ginger (Zingiber officinale), turmeric (Curcuma longa) and boswellia (Boswellia serrata) can reduce premenstrual breast tenderness and cramping. Radoff says other traditional cramp-relieving herbs include black haw (Viburnum prunifolium,) cramp bark (V. opulus), catnip (Nepeta cataria) and wild yam (Dioscorea villosa).
If a low mood predominates the days before menstruation, you might want to consider St. John’s wort (Hypericum perforatum). More than 20 studies show this herb improves mild depression. Preliminary reports, including one published in the
International Journal of Psychiatry in Medicine in 2003, suggest it can help premenstrual mood problems. One small study found benefits from only 300 mg of standardized extract a day — one-third of the average dose used in depression studies. Another study, published in Advances in Therapy in 1999, found St. John’s wort (one 300-mg tablet of standardized extract three times daily) reduced psychological and physical symptoms of perimenopause. Caution: St. John’s wort lowers blood levels of several drugs, including oral contraceptives. Check with your health-care provider before taking the herb.
A PREGNANT PAUSE
Pregnancy is a time when women must be very careful about what they consume, as many substances cross to the fetus’s circulation. Most of the herbs discussed in this article influence reproductive hormones, so if you’re pregnant, don’t take them, nor any other herb with strong medicinal effects.
Most herbalists give their blessing to nutritive herbs when they’re taken as teas in moderate amounts. Nutritive herbs are rich in vitamins and minerals, and include red raspberry leaf (Rubus idaeus), nettles (Urtica dioica), alfalfa (Medicago sativa) and dandelion. Rosemary Gladstar, author of Herbal Healing for Women, and founder of Sage Mountain Retreat Center and Native Plant Preserve in East Barre, Vermont, stresses that women should use the whole plant. That means eating the herb as a vegetable (dandelion and nettle leaf can be steamed) or brewing it into a tea.
About 75 percent of pregnant women experience some degree of nausea and vomiting, according to a 2004 study published in Complementary Therapies in Nursing and Midwifery. Eating small, frequent meals helps, as does getting plenty of fresh air. Ginger (Zingiber officinale) has an excellent track record for alleviating motion sickness and nausea associated with pregnancy, chemotherapy and anesthesia. Six studies have shown that ginger reduces nausea of pregnancy, two of which judged the herb as effective as vitamin B6. Pregnant women should only use ginger for short periods of time and not exceed 1 gram a day. Take whatever form seems most palatable — syrup, tea, capsule or ale made from real ginger.
Spearmint tea (Mentha spicata), while yet to be researched, brings relief to many women, according to a 2004 survey published in Complementary Therapies in Nursing and Midwifery. Some experts discourage peppermint tea (M. ¥piperita), which is stronger medicinally than spearmint.
Two trials found that vitamin B6 lessened nausea, and 10 of 14 studies found that stimulating a particular acupuncture point decreased nausea and vomiting. Boulder, Colorado, herbalist Brigitte Mars, author of Rawsome! (Basic Health Publications, 2004) and Sex, Love and Health (Basic Health Publications, 2002), says you can find acupressure wrist bands in health-food stores and pharmacies. She adds that liver tonics can quell nausea by helping the liver clear hormones (see “Love Your Liver” at left).
Some pregnant women take advantage of their heightened sense of smell and use appealing aromas to quell nausea. Examples include essential oils of lavender, lemon or spearmint. According to Mindy Green, clinical aromatherapist and coauthor of Aromatherapy: A Complete Guide to the Healing Art (The Crossing Press, 1995), essential oils derived from flowers — such as chamomile, ylang ylang, lavender, jasmine, rose and neroli — are generally mild enough for pregnant women. If you use them in massage oil, Green advises you keep the concentration weak — 0.5 to 1 percent, or not more than 5 drops essential oil per ounce carrier oil. Do not take these highly concentrated plant oils by mouth or apply them directly to your skin. And avoid altogether the strong essential oils of peppermint and culinary herbs such as oregano, thyme, sage, savory, tarragon and basil.
Menopause is the point at which, for want of estrogen and progesterone, your monthly periods cease. Perimenopause — the warm-up period to that point — is long and, for many women, uncomfortable. Progesterone often wanes before estrogen, the consequence of which is more frequent menstruation with heavier bleeding. Some women also notice mood swings and more frequent headaches. Vitex, which you’ll remember promotes progesterone, comes in handy in this situation.
As estrogen levels fall, women begin to believe in global warming or suspect coworkers and family members of flipping up the thermostat. Episodes of hot flashes and sweating occur during the day and night. Frequent sweat-soaked awakenings disrupt sleep. Vaginal tissues become thinner and drier (making sex less pleasurable). Concentration fizzles and moods go south.
Hormone replacement therapy (HRT) alleviates many of the symptoms and helps keep bones strong but often produces such side effects as bloating, breast tenderness, depression and vaginal bleeding — and worse, can increase the risk of blood clots and cancers of the uterus, breasts and ovaries.
“The actual risk to any one woman is small,” points out Lisa Corbin, M.D., the medical director of The Center for Integrative Medicine at the University of Colorado Health Sciences Center in Aurora. Her approach is to find out what each woman wants. Many of her patients are willing to modify their diets, exercise more, learn relaxation training and try herbs — all of which can help. If symptoms persist, HRT can be added to the regimen but typically at doses much lower than standard treatment.
Savor Your Soy
Lee points out that Japanese women, who consume more soy and veggies and fewer meats than the average American woman, seem to have an easier transition into menopause and a lower risk of breast cancer — unassisted by HRT. Soy (Glycine max) and other legumes contain isoflavones, which act as phytoestrogens (weak plant estrogens) in the body.
Studies on soy’s effectiveness during perimenopause have been inconclusive. The type of soy preparation used includes soy foods (soy milk, soy flour or tofu), soy protein or isolated isoflavones. The isoflavone content in soy foods varies widely, and it’s possible that other soy constituents are important.
A report in the January 2004 issue of Maturitas reviewed the research. Out of 10 well-designed studies, four found that soy modestly improved perimenopausal symptoms. In the May 2004 Alternative Medicine Alert, Monica Stokes, M.D., an integrative ob-gyn doctor in San Francisco, writes that, despite the muddy research, “it is clear that regular consumption of soy during the menopausal period may be helpful for some of the typical symptoms encountered.”
In Corbin’s experience, soy helps control hot flashes and has additional benefits of preserving bone and lowering cholesterol. Lee believes the emphasis should shift from popping soy during perimenopause to regularly consuming that bean and other phytoestrogen-rich foods all our lives. She adds that incorporating soy into a healthy diet is safe and does not seem to raise the risk of breast cancer or interfere with thyroid hormones.
How much soy is enough has yet to be established. Doses in studies range from 20 to 125 mg of isoflavones a day. The more processed the product, the more likely the isoflavone depletion. According to the Soy Foods Association of America, 1/2 cup of cooked soybeans provides between 50 and 78 mg of isoflavones; 1/4 cup roasted soybeans, 78 mg; 1/2 cup tempeh, 53 mg isoflavones; 1/2 cup tofu, 25 mg; 1 cup soymilk, 10 mg (43 mg, if fortified). Other sources of phytoestrogens include red clover, legumes, alfalfa, hops, licorice (Glycyrrhiza glabra), sesame seeds, sunflower seeds, buckwheat, millet and other whole grains.
Women have long relied on herbs to get them through “The Change.” The list includes dong quai, Asian ginseng (Panax ginseng), licorice (Glycyrrhiza glabra), vitex, St. John’s wort (Hypericum perforatum), red clover (Trifolium pratense) and black cohosh (Cimicifuga racemosa). The best researched of these herbs is black cohosh.
Most of the research on black cohosh has used a proprietary isopropanolic extract called Remifemin, produced in Germany but marketed in the United States. A 1998 review of eight black cohosh studies published in the Journal of Women’s Health concluded, “It is apparent that it is a safe, effective alternative to estrogen replacement therapy for those patients in whom estrogen replacement therapy is either refused or contraindicated.”
Because black cohosh is at risk of becoming endangered in the wild, it’s best to look for a product that uses organically grown black cohosh, such as Herb Pharm’s black cohosh liquid extract (see Page 28 for more about endangered herbs).
In a German study published in Maturitas in 2003, women aged 40 to 60 randomly received either 40 mg of black cohosh extract, 0.6 mg conjugated estrogens or a placebo. The herb was equivalent to estrogen in controlling perimenopausal symptoms and protecting bones. While estrogen stimulated cell division in the uterus (raising the risk for cancer), black cohosh did not.
Scientists have yet to pinpoint how black cohosh works. Unlike HRT, it does not influence blood levels of reproductive hormones, nor does it stimulate cells in the uterus or breast. In fact, it can actually inhibit division of breast cancer cells and enhance the inhibitory effect of the cancer drug tamoxifen. The implication is that black cohosh doesn’t seem to pose a risk for uterine or breast cancer. A recent analysis in the Journal of the North American Menopause Society confirmed the safety of this herb.
You can take black cohosh as a standardized extract (40 mg a day) or tincture. Radoff finds that black cohosh taken frequently (1 to 2 droppersful five times a day) controls hot flashes and steadies emotions. Shelley Torgove, clinical herbalist and owner of Apothecary Tinctura in Denver, adds that women kept awake by night sweats can take 20 mg of encapsulated standardized extract in the morning and evening, then one to two droppersful of tincture two to three times a day. Because research has yet to establish safety, this herb is not recommended for pregnant or nursing women.
Linda B. White, M.D., is the coauthor of The Herbal Drugstore (see Bookshelf, Page 58) and an adjunct faculty member in the health professions department at Metropolitan State College in Denver.
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