Do herbal remedies for menopause really work?

The best remedy for menopause

Menopause is a big transitional phase for any woman as she gradually produces less of the sex hormone oestrogen, her egg stores and ovaries decrease and her ability to conceive children diminishes.

Menopause is defined as the time of your last period, which is usually between an average age range of 45 to 55 years. However, perimenopausal and premenopausal symptoms - symptoms traditionally associated with the menopause but seen before or after your last period - can last several months to several years. That means it's not at all uncommon for symptoms to start in your early 40s or even your late 30s.

What happens during menopause?

These uncomfortable and inconvenient symptoms may include:

• Night sweats.

• Hot flushes.

• Vaginal dryness.

• Chills.

• Problems sleeping.

• Mood problems.

• Weight gain.

• Hair or skin changes.

Hormone replacement therapy (HRT)

Every woman will experience symptoms differently; some may be able to ease their symptoms adequately through lifestyle adjustments alone, while others may turn to hormone replacement therapy (HRT).

HRT is a medical treatment that has been shown to treat symptoms effectively. However, fears of increased risk for breast cancer and heart attacks rose after two major studies identified a link in 2002. The data behind these studies have since been questioned and many of the risks debunked, but the perception of the benefits/risks remains largely distorted.

Complementary and alternative therapies

Around 40-50% of women in western countries choose to use complementary and alternative therapies, including mind and body practices such as hypnosis. Herbal (plant-based) remedies are another popular natural treatment option. There are several on the market, but is their efficacy backed by science?

Does natural menopause relief work?

Put simply, the evidence that natural remedies for menopause work is mixed, and scientific research is somewhat limited. According to the charity Women's Health Concern, herbal remedies "may sometimes help with troublesome symptoms, but they are unlikely to have a significant impact on bone strength, the heart or blood vessels".

Effectiveness

Research is still ongoing to determine how effective herbal remedies for menopause are at easing symptoms. A review of 62 studies found modest reductions in the occurrences of hot flushes and vaginal dryness, although the need for further evidence was also identified. The quality of current evidence is a big limitation - as many as 74% of these studies had a high risk of bias that may influence their results.

Adverse effects of herbal remedies

While reports of side effects for herbal remedies are relatively rare, there are some mild symptoms that may occur. For example, black cohoshcan cause stomach upset, skin rashes, headache, vaginal bleeding, and weight gain. Some herbal remedies may also interact with drugs and cause side effects: one such example is St John's wort, which can increase the risk of side effects in people also taking certain antidepressants. Always consult your pharmacist, who will be able to advise on the safe natural and drug therapy combinations.

Regulation

Safety concerns regarding the lack of regulation are another important factor. The National Institute for Health and Care Excellence (NICE) cautions that herbal remedies which are not regulated by a medicine authority shouldn't be considered safe. This is because different products have different ingredients and concentrations, which may increase the risk of more serious side effects.

There have been reports of contamination in certain natural remedies for menopause. For example, some commercial black cohosh supplements contain the wrong herb or other herbs not listed on the label which has led to adverse reactions.

Patient picks for Menopause and HRT

Women's health

What's the link between menopause and cholesterol?

After the menopause, you're at higher risk of heart (cardiovascular) disease, and it's the leading cause of death for women. Your cholesterol levels play an important role here, and this is why it's important to attend your NHS Health Checks.

by Dr Sarah Jarvis MBE, FRCGP

Women's health

Perimenopause

Perimenopause refers to the transitional phase that occurs before menopause. It typically begins several years before menopause, although the exact duration can vary from woman to woman. During perimenopause, a woman's body undergoes hormonal changes as the ovaries start producing less oestrogen. Symptoms include hot flushes, night sweating, mood changes, vaginal dryness, and changes in libido.

by Dr Hayley Willacy, FRCGP

Five herbal remedies for menopause relief

There are many herbal remedies for menopause on the market and most are used to treat a wide range of menopause symptoms. The following are some of the most popular plant-based products.

Black cohosh for menopause

What: A species of buttercup native to North America.

Benefits: Some studies have found that black cohosh can help to ease menopause symptoms when compared to a placebo. It also has a low risk when it comes to interactions with other drugs.

Considerations: Like all herbal remedies, it's not as effective as HRT at reducing symptoms such as hot flush frequency. There is also conflicting evidence about whether black cohosh is more effective than a placebo. While adverse reactions are relatively rare, occasional instances of serious side effects with unlicensed versions include liver damage and low blood pressure. Black cohosh shouldn’t be taken by people who have liver and kidney problems.

Red clover for menopause

What: A flowering plant in the legume family, native to Europe, Western Asia and Northwest Africa.

Benefits: This remedy appears to have natural oestrogen-like properties that can help with hot flushes. There are currently no identified safety concerns for its use.

Considerations: Nonetheless, as with all herbal remedies the scientific evidence is relatively weak, and there are little data on long-term use.

St John's wort for menopause

What: A flowering plant native to Europe, North Africa and West Asia.

Benefits: Some studies suggest that St John’s wort may ease symptoms better than a placebo, although there's not enough evidence to know for certain. In particular, some studies suggest it may be as good as prescribed antidepressants at relieving low mood.

Considerations: It has a high risk of adverse effects from interactions with other drugs, and checking with a healthcare professional before use is advisable. St John's wort should not be taken by women on hormone therapy for breast cancer, as it makes treatment less effective.

Ginseng for menopause

What: A plant root originating in China and used in traditional Chinese medicine.

Benefits: Studies show mixed evidence for the use of ginseng to treat menopausal symptoms in comparison to placebo drugs. A review of research concluded that most have a high risk of bias.

Considerations: Ginseng has been shown to decrease the effectiveness of certain medications, including chemotherapeutic drugs, HIV drugs, and antidepressants. There is also some evidence that ginseng might affect blood sugar levels.

Evening primrose oil for menopause

What: The seeds of evening primrose, native to North America.

Benefits: There is some limited evidence for the effectiveness of primrose oil, although it should be noted that most studies conclude it is no more effective than a placebo. It is generally considered safe and is well tolerated by most people.

Considerations: Although it's widely used, there's insufficient scientific evidence to support its use for menopause treatment. Primrose oil may also interact negatively with certain HIV drugs and, as with all supplements, it's worth checking with a professional if you're on other medications.