Herbs for Health: Remedies for Menstrual Problems

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Black cohosh
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Hawthorn (Crataegus monogyna)
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Chinese hawthorn (C. pinnatifida)
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Dried Chinese hawthorn
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Saw palmetto berries
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Women’s use of herbs dates to the roots of herbalism. By tradition, the keepers of herbal knowledge have always been women, and they have probably been taking herbs to relieve menstrual disorders since humans first nibbled on leaves and fruits.

The menstrual cycle, the time from the onset of one menstrual flow to the beginning of the next, is a cascade of hormonal events controlled by the hypothalamus, pituitary gland, and ovaries. At the beginning of a normal cycle, the hypothalamus, a cluster of nerve cells in the center of the brain, releases a hormone that triggers the anterior pituitary to manufacture and release luteinizing hormone (LH) and follicle-stimulating hormone (FSH) into the circulatory system.

These initiate the enlargement of several ovarian follicles (structures containing the developing egg). As they grow, they secrete estrogens (female hormones), which stimulate the lining of the uterus (endo­me­trium) to begin rebuilding itself after menstruation. High estrogen levels in the blood produced by the enlarging follicles stimulate a sudden surge in the release of LH, which stimulates the maturation of the egg in a single follicle and its subsequent release from the ovary on about the fourteenth day.

The ruptured follicle is transformed into the corpus luteum, a glandular mass that begins producing progesterone and estrogen. These hormones signal the anterior pituitary to stop releasing FSH and LH, thereby stopping development of additional follicles. Progesterone also signals the endometrium to prepare for implantation of a fertilized egg. If no fertilized egg arrives, however, the corpus luteum stops secreting hormones, and the drop in progesterone causes the endometrial cells to die and slough off on about the twenty-eighth day, marking the beginning of a new cycle. Normally, these events occur every month for thirty-five or forty years (unless a women becomes pregnant), but stress, illness, or hormonal imbalances can interrupt them.

Menstrual disorders

Among the most common of menstrual disorders are amenorrhea, dysmenorrhea, and premenstrual syndrome (PMS). Amenorrhea, an absence or abnormal cessation of menstruation, may be caused by emotional stress, strenuous physical activity, binge dieting, obesity, diabetes, heart disease, or anatomical, hormo­nal, or chromosomal abnormal­ities. Drugs such as corticosteroids and barbiturates can also disrupt the menstrual cycle. The low estrogen levels accompanying this condition lead to loss of bone mass.

Dysmenorrhea (painful menstruation) is characterized by cramps in the lower abdomen and sometimes the back and thighs. It is most common during the first day of menstruation.

PMS, which affects from 5 to 30 percent of women, is charac­ter­ized by irritability, emotional upset, nervousness, headaches, breast tenderness, and weight gain due to fluid retention. These symptoms generally occur a week to ten days before the onset of bleeding and usually disappear shortly after the period begins. They have been associated with an imbalance of estrogen and progesterone. Phy­si­cians sometimes prescribe steroid hormones if symptoms are debilitating.

The herbs that people throughout the world have used to treat menstrual disorders must number in the hundreds. Those used by Western herbalists include blue cohosh (Caulophyllum thalictroides), crampbark (Viburnum opulus), false unicorn root (Chamaelirium luteum), feverfew (Tanacetum parthenium), lady’s-mantle (Alchemilla mollis), motherwort (Leonurus cardiaca), wild yam (Dioscorea villosa), and yarrow (Achillea millefolium). Several others have been the subject of recent studies testing their effectiveness in relieving various menstrual disorders.

Chaste tree

For more than 2,500 years, chaste tree has been used to treat menstrual disorders. Hippocrates (460-377 b.c.) wrote, “If blood flows from the womb, let the woman drink dark wine in which the leaves of the chaste tree have been steeped.”

In the first century a.d., Pliny noted its applications for the opposite problem: “The trees furnish medicines that promote urine and menstruation.”

Chaste tree and its fruits (seeds) were widely used for gynecological applications until the eighteenth century. Largely neglected during the next two centuries, chaste tree found favor in the 1930s and 1940s with German physicians, who recommended taking it to stimulate milk flow.

Today, European gynecologists prescribe chaste-tree preparations to treat PMS symptoms, heavy, too frequent, delayed, or irregular periods and infertility. In Germany, women going off birth-control pills are given fruit extracts to establish a normal menstrual cycle. One study showed that they may stimulate progesterone production and regulate estrogen levels. Chaste-tree preparations have also been shown to block the formation of FSH and increase the secretions of LH and luteotropic hormone, which would also normalize ­hormone balance and menstruation. These actions cannot be attributed to a single chemical ingredient, though flavonoids are believed to play a major role.

Chaste-tree preparations usually must be taken for four to eighteen months before an improvement in symptoms can be expected. A typical daily dose is the equivalent of 30 to 40 mg of the dried fruits divided into two or three doses, 40 drops of a standardized tincture, or one capsule.

Most of the clinical literature on chaste tree consists of anecdotal reports by practicing ­gynecologists rather than controlled clinical trials. A 1992 ­survey of German gynecologists evaluated the effect of a chaste-tree preparation on 1,542 women diagnosed with PMS. Ninety percent of both physicians and patients reported ­relief of symptoms after treatment averaging 25.3 days. In Germany, chaste tree is a safe, effective, and low-priced remedy for gynecological complaints; it is available in the U.S. as a dietary supplement.


Dong-quai (Angelica sinensis) is the best-known Chinese herb for gynecological problems. It is closely related to the European herb angelica (A. archangelica) and to the American A. atropurpurea, both of which have also been used by herbal practitioners to treat menstrual disorders on their respective continents.

In China, dong-quai is generally used in combination with other herbs. It is believed to harmonize vital energy (qi) and nourish blood, returning both to their proper destination or proper order. It is mentioned in the first-century Chinese herbal Shen Nong Ben Cao Jing as a treatment for vaginal infections, discharges, and infertility. In traditional Chinese medicine, dong-quai is used in prescriptions for abnormal, suppressed, or painful menstruation and anemia, as well as for various conditions characterized as “blood deficiency”.

Few Chinese herbs have been as extensively studied in recent decades as dong-quai. Laboratory experiments have shown that extracts with volatile constituents can raise blood pressure and relax uterine muscles, whereas those with nonvolatile constituents reduce blood pressure and stimulate uterine contraction. In cases of amenorrhea, in which stimulation of uterine muscles is desired, the root would be prepared by simmering it in water, which evaporates the volatile constituents. In cases of dysmenorrhea, in which uterine spasm is the cause of pain, the root can be steeped in hot water, which captures the volatile constituents.

Dong-quai’s actions are not believed to result from estrogenic activity, as it does not produce changes in the ovaries or vaginal tissue. It decreases blood pressure by increasing blood flow in the peripheral vessels and reducing resistance in the vessels. It also decreases inflammation and increases the number of red blood cells and platelets.

In China, the root is made into a tea or decoction. The usual daily dose is 4.5-12 g of dried root in infusions. The powdered root in capsules is available as a dietary supplement. Follow label instructions or consult a knowledgeable practitioner such as an acupuncturist or doctor of Oriental medicine.

Black cohosh

The root of black cohosh (Cimicifuga racemosa) was used by Native Americans and early white settlers to treat menstrual irregularity and ease childbirth. It was widely prescribed by physicians in nineteenth-century America and was listed in the U.S. Pharmacopoeia for stimulating menstruation and treating dysmenorrhea.

In Germany, black cohosh is approved for use in the treatment of PMS, dysmenorrhea, and menopausal symptoms, especially hot flashes, which occur when estrogen production decreases and LH increases. An isoflavone in the root has exhibited estrogenlike activity, and three as yet unidentified chemical components have been found to reduce the production of LH. Black cohosh was deemed comparable to conventional estrogen treatment in relieving the symptoms of surgically induced menopause in sixty women below the age of forty. A number of studies also has confirmed that black cohosh is a mild sedative and reduces inflammation, but more clinical studies are needed to fully understand its benefits for women.

The recommended daily dose is 0.4 to 2 ml (about 1/4 teaspoon or 10 drops) of a 40 to 60 percent alcohol tincture or 40 to 200 mg of the dried root in capsule or decoction form. Conservatively, the German government limits use of black cohosh to six months because long-term toxicity studies have not been conducted.

Evening primrose oil

Evening primrose oil, obtained from the seeds of Oenothera biennis, is used as a die­tary supplement to provide essential fatty acids, especially gamma-linolenic acid. PMS symptoms are believed to be associated with deficiencies in essential fatty acids.

More than 120 studies in fifteen countries have reported on the use of the seed oil in treating imbalances and abnormalities of essential fatty acids. Conflicting results point to the need for further well-designed scientific studies. For example, double-blind, placebo-controlled clinical studies have shown that evening primrose oil significantly reduced symptoms associated with PMS, such as breast pain and tenderness, irritability, and mood swings. Another clinical study showed improvement in PMS symptoms, though they were deemed statistically insignificant when compared to the placebo. Herbalists usually recommend three to six capsules per day with meals as a dietary supplement.

Further reading

Brown, D. Herbal Prescriptions for Better Health. Rocklin, California: Prima, 1996.
“Vitex agnus-castus Clinical Monograph” Quarterly Review of Natural Medicine. Summer 1994: 111-112.
Chang, H. M., and P.P.H. But. Pharmacology and Applications of Chinese Materia Medica. Vol. 1. Singapore: World Scientific, 1986.
Foster, S. Herbs for Your Health. Loveland, Colorado: Interweave Press, 1996.
Hobbs, C. Vitex: The Women’s Herb. Capitola, California: Botanica Press, 1990.
Khoo, S. K., et al. “Evening Primrose Oil and Treatment of Premenstrual Syndrome”. Medical Journal of Australia 1990, 153:189-192.
Milewicz, A. E., et al. “Vitex agnus-castus Extract in the Treatment of Luteal Phase Defects Due to Hyperprolactinemia”. Arzneimittel-Forschung- Drug Research 1993, 43(7): 752-756.
Shimp, L. A., and C. M. Fleming. “Vaginal and Menstrual Products”. Handbook of Nonprescription Drugs. 11th ed. Washington, D C.: American Pharmaceutical Association, 1996.
Tyler, V. Herbs of Choice. Binghamton, New York: Pharmaceutical Products Press, 1994.

“Herbs for Health” is offered bimonthly by the American Botanical Council and the Herb Research Foundation as a supplement to ­The Herb Companion.Editor, Steven Foster

American Botanical Council
PO Box 201660 Austin, TX 78720
Herb Research Foundation
1007 Pearl St., Ste. 200 Boulder, CO 80302

“Herbs for Health” is intended as an educational service, not a source of medical advice or a guide for self-medication. Please consult a qualified health-care professional for treatment of any serious health problems. For further information on any of the topics in “Herbs for Health”, write the American Botanical Council or the Herb Research Foundation.

Hawthorn: Plants of strength


Few plant groups have perplexed botanists as thoroughly as the hawthorns (Crataegus), a genus of shrubs and small trees in the rose family native to temperate North America, Europe, and northern Asia. Unrestrained interbreeding and a lack of isolating mechanisms have produced hundreds of hybrids and other variants. During the late nineteenth century, botanists felt compelled to describe nearly every one of these as a species and named almost 1,000 species native to North America alone. Today’s botanists recognize a total of 100 to 200 variable species.

The generic name Crataegus is derived from the Greek kratos, “strength”, referring to the toughness of the wood. Plants range from 3-foot shrubs to 30-foot trees, most with dark brown scaly bark and stout or slender, straight or branched spines ranging in length from 1 to 8 inches. The leaves are usually 1 to 4 inches long, varying in shape from oval to deeply cut. In England, the nutty-tasting young leaves of one-seeded hawthorn (C. monogyna) were eaten in sandwiches. Clusters of delicate white (sometimes red, purple, or pink), usually foul-smelling, 1/2-inch, roselike flowers bloom in May and June. The fruits (haws) look like round, oblong, or pear-shaped rose hips. They may be 1/4 to 1 inch long and come in orange-yellow, scarlet, red, yellow, blue, and black. The flesh is mealy and dry like that of rose hips and contains one to several hard seeds. Some fruits are extremely astringent, but those of several species are reportedly quite tasty. The 1-inch, orange-yellow haws of the eastern Mediterranean azarole (C. azarolus) are apple-flavored and are used to make jams and liqueurs.

Many kinds of hawthorns are grown as ornamentals in parks and residential plantings. The showy fruits lengthen their season of interest, and tolerance of heavy pruning make some forms suitable as hedges. Hawthorns are generally more resistant to disease than other ornamental fruit trees.

Traditional uses

Hawthorns have been used as medicine wherever they are native. They include the European one-seed hawthorn (C. monogyna) and English haw­thorn (C. laevigata), the Balkan (C. pentagyna), Mediterranean (C. azarolus), and eastern European black hawthorn (C. nigra). In China, C. pinnatifida and C. cuneata have been used.

The Greek and Roman herbal writers mention haw­thorn only in passing for its edible, though less than delicious fruit. English herbalists also paid it little attention. A few Western sources note it as a remedy for stomach ailments and diarrhea.

Native Americans including the Potawatomi, Ojibwa, Chip­pe­wa, Meskwaki, Cherokee, Omaha-Ponca, Winnebagos, and Kwakiutl used the fruit or decoctions of the root or bark to treat gastrointestinal disorders and as female and general tonics, heart stimulants, and poultices for wounds and sores.

In China, hawthorn was mentioned as a drug in the Tang-Ben-Cao, an herbal dating to a.d. 659. It was used to treat stomach disorders, heart disease, and scurvy.

Western medicine first acknowledged hawthorn’s utility in treating heart ailments in an 1896 article by J. C. Jennings, a Chicago physician. For the next fifty years, it was widely used in both Europe and the United States, but U.S. physicians have since forgotten it.

A modern phytomedicine

Today, European and Asian practitioners prescribe haw­thorn for treating early congestive heart failure, angina pectoris, and heart attacks, as well as sensations of pressure or anxiety in the heart, age-related heart problems not requiring digitalis, and mild arrhythmias. Pharmacological and clinical studies have shown that it increases the blood supply to the heart muscle and strengthens its contractions, enabling the heart to pump more blood to the rest of the body. Hawthorn extracts also improve circulation to the extremities by reducing resistance in the arteries.

Germany has approved prep­a­rations of the leaf with flowers of C. monogyna or C. laevigata but not drugs made solely from the fruits or the leaves. That’s because most clinical studies of hawthorn have used preparations that include both the leaf and the flower.

Active constituents

Studies have confirmed that sterols, triterpenes, flavonoids, catechins, proanthocyanidins, and amines isolated from the flowers, leaves, and fruits affect the cardiovascular system. A combination of these compounds appears to be responsible for these effects.

Commercial preparations are standardized to flavonoids, oligomeric procyanidins, chlor­ogenic acid, and other constituents. Potency varies with the plant part used as well as the time of harvest. For example, procyanidins are three times as concentrated in the fall leaves as in leaves harvested in the spring.

Preparations and cautions

The usual dose of a standardized product is 160 mg per day (divided into two doses); under a physician’s supervision, as much as 160 mg three times daily may be prescribed in Europe. A pleasant-tasting, slightly tart, astringent tea may be made by combining a teaspoon of the powdered fruits with a cup of boiling water.

Although no adverse effects from taking hawthorn have been reported, any heart condition is a serious matter. Don’t try to diagnose or treat yourself, but see a qualified health-care provider.

Further reading

Brown, D. Herbal Prescriptions for Better Health, Rocklin, California: Prima, 1996.

Foster, S. Herbal Renaissance. Layton, Utah: Gibbs Smith, 1993.

——. Herbs for Your Health. Loveland, Colorado: Interweave Press, 1996.

Hamon, N. W. “Herbal medicine: Hawthorns (Genus Crataegus)”. Canadian Pharmaceutical Journal 1988, 121:708-9, 724.

Tyler, V. Herbs of Choice: The Therapeutic Use of Phytomedicinals. Binghamton, New York: Pharmaceutical Products Press, 1994.

Weiss, R. F. Herbal Medicine. Beaconsfield, England: Beaconsfield, 1988.



Numerous studies have shown that the fruit of schisandra (Schisandra chinensis) can lower serum levels of certain enzymes associated with liver disease, thus protecting the liver and promoting regeneration of liver tissue. A recent study in Argentina sought to determine whether the “five-flavor fruit” (wu-wei-zi in traditional Chinese medicine) would improve the performance of sluggish racehorses, which have high levels of these enzymes in their blood.

Two groups of twelve poorly performing racehorses of similar age, weight, temperament, and training at the San Isidro Sporting Club in Buenos Aires exhibited high levels of two liver enzymes and creatinine phosphokinase (CPK), an enzyme found in striated and heart muscles that is excreted during intense anaerobic exercise. High levels of this enzyme in association with high levels of serum lactic acid can lead to muscle damage.

One group of horses received a standardized schisandra extract while the other group received a placebo. After seven and fourteen days, levels of all three enzymes were significantly lower in the treated horses than in those in the placebo group. Fifty percent of the treated horses also performed better. Researchers attributed the improvement to a recovery from liver damage and lowered CPK levels due to decreased lactic acid.

The genus Schisandra, related to magnolias, comprises about twenty-five species of aromatic woody vines, all native to eastern Asia except S. coccinea, which grows in the southeastern United States. S. chinensis is grown as an ornamental in Europe for its showy, shiny red fruits, which have a combined sweet, sour, bitter, salty, and pungent flavor, but is rarely seen in this country.(1)


Dandelion (Taraxacum officinale), America’s most underappreciated weed, has been used in European traditional medicine to promote urination, stimulate the appetite and flow of bile, and in the treatment of diabetes mellitus (excess sugar in the blood). Now researchers at the Faculty of Pharmaceutical Sciences at Leuven, Belgium, are studying the effect of dandelion root extract on reducing the clumping of human blood platelets in blood vessels, a condition that is worsened in arteriosclerosis (hardening of the arteries), a common complication of diabetes.

A preliminary study showed that two chemical fractions extracted from dandelion root strongly inhibited platelet aggregation. Further studies are planned to isolate the active compounds and determine their mode of action.(2)


Researchers in Spain have suggested that the ability of saw palmetto (Serenoa repens) to decrease the symptoms of benign prostatic hyperplasia (BPH), ­especially the urge to urinate at night, may be related to its ­capacity to reduce spasms.

Clinical studies of more than 2,000 men showed that the fruit of this small palm found in the southeastern United States is an effective treatment for BPH but failed to reveal how it works. Theories that it inhibits androgens (substances such as the hormone testosterone that promote masculinization) or 5-alpha-reductase (an enzyme that affects testosterone levels) or ­reduces inflammation have been advanced, but all of these mechanisms should result in shrinkage of the prostate gland, which generally does not occur in men taking saw palmetto.

In laboratory experiments ­involving male rats given saw palmetto extract, the Spanish ­researchers observed a decrease in spasms associated with ­increased muscle tone and ­relaxed muscles in the prostate and urethra, which might decrease the urge to urinate without reducing prostate size. They attributed the muscle relaxation to increased calcium ion exchange between cells and theorized that sterols (compounds related to steroids) in the extract might induce protein synthesis in prostate cells, which would further relax smooth muscles.

German health authorities have approved the use of saw palmetto fruit preparations for urinary problems in early stages of BPH.(3)


(1) Hancke, J., et al. “Reduction of Serum Hepatic Transaminases and CPK in Sport Horses with Poor Performance Treated with a Standardized Schisandra chinensis Fruit Extract”. Phytomedicine 1996, 3(3): 237-240.

(2) Neef, H., et al. “Platelet Anti-aggregating Activity of Taraxacum officinale Weber”. Phytotherapy Research 1996, 10: S138-S140.

(3) M. Gutierrez. “Spasmolytic Activity of a Lipidic Extract from Sabal serrulata Fruits: Further Study of the Mechanisms Underlying This Activity”. Planta Medica 1996, 62:507-511.

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