Herbs for Women’s Health
The use of botanical medicines in women’s healthcare is an ancient practice. Dong quai (Angelica sinensis) has been used in Traditional Chinese Medicine (TCM) for at least two thousand years and black cohosh (Cimicifuga racemosa) by Native Americans for centuries. In Germany, St John’s wort (SJW; Hypericum perforatum) is prescribed by doctors for depression, while in other European countries and in the United States, SJW is available as an over the counter dietary supplement. SJW has also been studied for the treatment of premenstrual syndrome (PMS). Modern research has analyzed the used of herbs and found some botanical treatments to be quite effective at treating hot flashes, depression, PMS, and other ailments.
Dong quai is a perennial herb found in mainland China, Japan, and Korea. It’s dried root if prized for its medicinal value, which delivers a distinct blend of bitter, sweet, and pungent taste to its overall warming effect. Among other medicinal actions, dong quai is considered a uterine tonic, as an antispasmodic in painful menses, and for hot flashes associated with menopause. While one human clinical trial for the use dong quai to reduce hot flashes showed no difference between the treatment group and placebo, dong quai is most frequently used in combination with other herbs and may have a synergistic effect that provides benefit included in an herbal formula.
A native of North America, black cohosh is a perennial herb that grows 3-9 feet high, and found in shady woods from Maine to Ontario, and from Wisconsin south to Georgia and Missouri. The rhizome (trailing root) of the plant is used medicinally. Native Americans used black cohosh to alleviate pain during childbirth and menses.
It has also been used, and studied, extensively for the treatment of hot flashes. One particular standardized extract of black cohosh, marketed as Remifemin has been evaluated in multiple clinical trials. Positive results for Remifemin for hot flashes were shown in 3 of 4 clinical trials. And in another study, women with breast cancer who were also taking tamoxifen were given black cohosh extract for 12 months. showed that “almost half of the patients” in the treatment group “were free of hot flashes, while severe hot flashes were reported by 24.4% of patients of the treated group.” In contrast, 73.9% of those in the placebo group reported severe hot flushes.
The mechanism of action of black cohosh is incompletely understood; however it does not appear to have estrogen-like activity. An in vitro study determined that black cohosh did not bind to estrogen receptors in endometrial or breast cells cultures.5 The recommended dose of black cohosh is 40 mg/day.
St. John’s wort
SJW has many documented medicinal properties. Clinical trials comparing SJW to standard antidepressant medications (e.g., Prozac) have shown SJW to as effective for the treatment of depression with less side effects. SJW is sold as the raw herb and as a standardized extract. The most frequently studied SJW preparation studied was a standardized extract called LI160 given to volunteers at a dosage of 300 mg three times daily.
Research has also shown SJW effective at treating symptoms of premenstrual syndrome (PMS). In one study, 19 women received 300 mg of SJW standardized to 0.3% hypericin three times daily. PMS symptoms decreased by 51% overall, and more than two thirds of the women experienced at least a 50% reduction in symptom severity.
There is one important note of caution for people considering taking SJW. It interacts with many prescription medications and decreases their effectiveness. If someone is taking immunosuppressive drugs (e.g., Cyclosporine), or anticoagulant medication (e.g., Warfarin), the results could potentially be deadly. SJW may also decrease the effectiveness of oral contraceptive pills. SJW can also cause photosensitivity, which makes your skin more sensitive to the sun and easier to sunburn. On the other hand, there have been no documented herb-drug interactions with dong quai or black cohosh; however, as with any herbal medicine, consult a healthcare professional knowledgeable in herb-drug interactions before taking any herbs.
Black Cohosh root. Herbal Medicine: Expanded Commission E 2000; accessed July 16, 2018. [Article]
Haimov-Kochman R, Hochner-Celnikier D. Hot flashes revisited: pharmacological and herbal options for hot flashes management. What does the evidence tell us? Acta Obstet Gynecol Scand. Oct 2005;84(10):972-979. [Article]
Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med. 2002;137(10):805-813. [Article]
Klein KO, Janfaza M, Wong JA, Chang RJ. Estrogen Bioactivity in Fo-Ti and Other Herbs Used for Their Estrogen-Like Effects as Determined by a Recombinant Cell Bioassay. J Clin Endocrinol Metab. 2003;88(9):4077-4079. [Article]
Behnke K, Jensen GS, Graubaum HJ, Gruenwald J. Hypericum perforatum versus fluoxetine in the treatment of mild to moderate depression. Adv Ther. Jan-Feb 2002;19(1):43-52. [Article]
Fava M, Alpert J, Nierenberg AA, et al. A Double-blind, randomized trial of St John’s wort, fluoxetine, and placebo in major depressive disorder. J Clin Psychopharmacol. Oct 2005;25(5):441-447. [Article]
Haller CA. St John’s wort, depression, and catecholamines. Clinical Pharmacology & Therapeutics. 2004/11 2004;76(5):393-395. [Article]
Stevinson C, Ernst E. A pilot study of Hypericum perforatum for the treatment of premenstrual syndrome. Bjog. Jul 2000;107(7):870-876. [Article]
Neustadt J. Herb-Drug Interactions: What Clinicians Need to Know. Integrative Medicine. 2006;5(1):16-26. [Article]
Monograph. Angelica sinensis. Altern Med Rev. Dec 2004;9(4):429-433. [Article]
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