Menopause and Phytotherapy

Posted: August 2023

Author: Katie Donnelly, Adv Dip HSc Naturopathy

Menopause and Phytotherapy

Herbal support for menopausal changes

Around 85% of women experiencing perimenopause and menopause, face uncomfortable and challenging symptoms. These include hot flashes and night sweats, with subsequent sleep disturbance and mood alterations also prevalent.¹ Phytotherapy can play an important role in helping to regulate the symptoms, with herbal combinations, and also single herbs, providing an effective course of action.  

Hot flashes

Hot flashes are a debilitating symptom and often continue for five to ten years after menopause commences. Waves of heat often occur sporadically, typically lasting from one to five minutes. Associated chills, sweating, flushing, and anxiety, can result in significant discomfort.²

The phyto-oestrogen effect of Vitex agnus-castus (chaste tree) has been identified in regulating the vasomotor response, in a dose-dependent manner. This is correlated to the dopamine receptor binding interfering with the release of prolactin. The flavonoid casticin is of perceived significance, along with diterpenoids.³ Salvia officinalis (sage) can also reduce hot flashes.  This has been demonstrated in studies showing decreased incidence by 50% within four weeks. Both herbs additionally act as anxiolytics.⁴

While specific herbal constituents are correlated with improved outcomes, the exact mechanism of herbal actions is often not clearly understood.³ Reduced symptoms may occur relative to multiple processes working congruently from herbal combinations.

This is evident with Angelica sinensis (dong quai). Often used for hormone regulation, dong quai showed minimal symptomatic improvements for hot flashes when used as a simple herb. However, it was an effective adjuvant when combined with other herbs. This included a blend of Actaea racemosa (black cohosh), Trifolium pratense (red clover), chaste tree, and Panax quinquefolium (American ginseng).¹ 

Similarly, separate random control studies combining dong quai with Matricaria recutita (chamomile) reduced hot flashes by 90-96% compared to a placebo.¹ 

Sleep disturbance

Sleep disturbance is a concern for up to 60% of menopausal women. Melatonin decline is a contributing factor, with hormonal shifts also interfering with rapid eye movement sleep and thermoregulation.⁵

Zizyphus spinosa (zizyphus) is commonly used for its actions in supporting sleep through saponins, primarily jujubosides, and flavonoid glycosides. Active compounds such as spinosyn, are noted in regulating gamma-aminobutyric acid (GABA) and serotonergic pathways. Also, zizyphus regulates temperatures and sweating, beneficial for night sweats and hot flashes.⁶  

Foeniculum vulgare (fennel) in combination with Melissa officinalis (lemon balm) has also been studied to aid menopausal sleep concerns. Each herb was supplemented at 300mg per day, and improved sleep onset, maintenance, and quality compared to citalopram. It is suggested that many of these effects are the result of improvements in anxiety and depression levels on supplementation.⁷

Mood regulation

Oestrogen influences the regulation of 5-hydroxytryptophan (5-HT, serotonin), which decreases 50% post-menopause. This is noted as a key factor in mood changes associated with menopause.²

Paeoniflorin, an active constituent of Paeonia lactiflora (paeony), has shown to regulate 5-HT in animal model studies.  Paeony altered the presence of oestrogen receptor β (Erβ) and tryptophan hydroxylase-2 (TPH2), resulting in reduced incidence of anxiety and depression.⁸ Glycyrrhiza glabra (liquorice), regularly paired with paeony for improved bioavailability of primary constituents, has also shown benefits for menopausal changes. Liquorice demonstrated notable reduction in hot flashes compared to placebo, and improved vaginal atrophy symptoms when applied topically.^{9, 10} 

Further studies on Leonurus cardiaca (motherwort) also showed reduced mood disorders, relative to GABA-A interaction. Traditionally, this herb was also used for night sweats and for mild sedative actions. Cardioprotective actions then reduced the incidence of increased blood pressure, cholesterol, and triglycerides commonly associated with menopause.³

Dioscorea villosa (wild yam) is another herb traditionally used for menopause.  It is shown to balance oestrogen, a follicle-stimulating hormone, and luteinising hormone levels.¹⁰ This has demonstrated marked symptomatic relief when used internally, primarily attributed to steroidal saponins. However, despite often being used topically as a cream, separate studies have shown no perceived or measured benefits.¹

This also emphasises the role of symptomatic relief on mood regulation. Irregular menstrual bleeding associated with menopausal changes is experienced by 90% of women and is simultaneous with reduced quality of life.¹¹ Astringent actions of Alchemilla vulgaris (lady’s mantle) and New Zealand native Phyllocladus trichomanoides (tanekaha), can support regulated menstruation, subsequently improving mood.

Summary

Phytotherapy can be used to ease the symptoms of menopause, with a combination of herbs working to successfully support women during this transitional phase.

References

1. Johnson A, Roberts L, Elkins G. Complementary and Alternative Medicine for Menopause. Journal of Evidence-Based Integrative Medicine. 2019;24. Available from: https://doi.org/10.1177/2515690X19829380
2.  Bansal R, Aggarwal N. Menopausal Hot Flashes: A Concise Review. J Midlife Health. 2019 Jan-Mar;10(1):6-13. Available from: https://doi.org/10.4103/jmh.JMH_7_19
3. Kenda M, Glavač NK, Nagy M, Sollner Dolenc M, On Behalf Of The Oemonom. Herbal Products Used in Menopause and for Gynecological Disorders. Molecules. 2021 Dec 8;26(24):7421. Available from: https://doi.org/10.3390/molecules26247421
4. Hechtman L. Clinical Naturopathic Medicine. 2^nd ed. Chatswood, NSW: Elsevier; 2016.
5. Tandon VR, Sharma S, Mahajan A, Mahajan A, Tandon A. Menopause and Sleep Disorders. J Midlife Health. 2022 Jan-Mar;13(1):26-33. Available from: https://doi.org/10.4103/jmh.jmh_18_22
6. Chen L, Chang X, Hu C, Zhang Y, Zhang L, Kan J, Li B, Du J. Regulation of GABAA and 5-HT Receptors Involved in Anxiolytic Mechanisms of Jujube Seed: A System Biology Study Assisted by UPLC-Q-TOF/MS and RT-qPCR. Method Frontiers in Pharmacology, Sec. Ethnopharmacology. 2020;11. Available from: https://doi.org/10.3389/fphar.2020.01320  
7. Khadivzadeh T, Najafi MN, Kargarfard L, Ghazanfarpour M, Dizavandi FR, Khorsand I. Effect of Fennel on the Health Status of Menopausal Women: A Systematic and Meta-analysis. Journal of Menopausal Medicine 2018 Apr;24(1):67-74. Available from: https://doi.org/10.6118/jmm.2018.24.1.67
8. Wang J, Song C, Gao D, Wei S, Sun W, Guo Y, Sun S, Tian X, Li H, Qiao M. Effects of Paeonia lactiflora Extract on Estrogen Receptor β, TPH2, and SERT in Rats with PMS Anxiety. Biomed Res Int. 2020 Mar 7;2020:4690504. Available from: https://doi.org/10.1155/2020/4690504
9. Nahidi F, Zare E, Mojab F, Alavi-Majd H. Effects of licorice on relief and recurrence of menopausal hot flashes. Iran Journal of Pharmaceutical Research. 2012 Spring;11(2):541-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832176/
10. Sadeghi M, Namjouyan F, Cheraghian B, Abbaspoor Z. Impact of Glycyrrhiza glabra (licorice) vaginal cream on vaginal signs and symptoms of vaginal atrophy in postmenopausal women: A randomized double blind controlled trial. Journal of Traditional and Complementary Medicine. March 2020;10(2):110-115.Available from: https://www.sciencedirect.com/science/article/pii/S2225411019302445
11. Obidiegwu JE, Lyons JB, Chilaka CA. The Dioscorea Genus (Yam)-An Appraisal of Nutritional and Therapeutic Potentials. Foods. 2020 Sep 16;9(9):1304. Available from: https://doi.org/10.3390/foods9091304
12. Vitale SG, Watrowski R, Barra F, D’Alterio MN, Carugno J, Sathyapalan T, et al. Abnormal Uterine Bleeding in Perimenopausal Women: The Role of Hysteroscopy and Its Impact on Quality of Life and Sexuality. Diagnostics 2022;12:1176. https://doi.org/10.3390/diagnostics12051176