Herbs, Herbal OBGYN Remedies, and Alternatives to Conventional Hormonal Therapy

Capitalism Always Wins

For generations, organized medicine has always been a bit snooty regarding holistic approaches to treating ailments. Long neglected in the "official" medical literature, herbal remedies have been dispensed over the counter without prescription by any self-appointed guru regardless of knowledge or experience. When these herbal remedies and nutritional supplements began raking in millions of dollars, however, suddenly organized medicine perked up.

Now we are seeing the big established vitamin makers including herbal ingredients in their formulated pills. And now I'm seeing herbal ingredients being studied in the medical literature. And some of them work. In fact, some of them are such substantial medicines that they can even be dangerous if taken the wrong way, just like "real" medicines.

The number of people, especially women, using alternative remedies has been rising faster than Internet stocks. Menopausal women, and now the vaguely designated "perimenopausal" group of women between ages 37 and 52, have been frequenting herbal counters more than ever before. What have they been buying?

St. John's Wort

St. John's wort (Hypericum perforatum) does seem to have antidepressant and anti-anxiety properties, but can have serious side effects when taken with other medication like Prozac.

The standardizations patients should seek are 0.3% hypericin or 0.5% hyperforin. 300 mg of the plant extract in tablet form should be taken three times a day, but may not show benefits for 8 to 12 weeks.

It can be safely taken with prescribed estrogen replacement.

Ginkgo

Ginkgo (Ginkgo biloba) has been recommended by naturalists to improve memory, stop age-related mental decline, and enhance blood flow and oxygen to the brain. Studies as of 1999 imply that these claims may be valid.

It can also help in treating sexual dysfunction associated with prescription antidepressants.

It is standardized for flavone glycoside content at 24% and 6% terpene lactones. Recommended is one tablet (60 mg.) twice daily, with an increase to two tablets twice a day if there's no benefit after 6 to 8 weeks.

It has anti-coagulation affects, so it should not be taken along with aspirin, non-steroidal anti-inflammatories (like ibuprofen), or other anticoagulants (like Coumadin and heparin).

Dong Quai

Dong quai is touted as causing relief of menstrual and menopausal problems, but so far the studies have not shown that it helps replace estrogen or prevent menopausal symptoms like hot flashes.

Kava-Kava

Kava-Kava (Piper methysticum) can be helpful with anxiety and sleeplessness. Because of its sedative qualities, it should not be mixed with prescription sedatives, sleeping pills, or alcohol.

It should be standardized to 70 mg. of kava lactones per capsule, with the daily dose being in the 140-280 mg. range of kava lactones.

It can even be used on an "as needed" basis for occasional stress or sleeplessness.

Valerian

Another natural sleep aid is Valerian (Valeriana officinalis), especially effective if sleeplessness is related to hot flashes or other symptoms of menopause. Valerian is usually available in tea, tincture, and other mixtures. Patients should use only products that standardize the dosage and take between 300-600 mg. of standardized extracts, best taken an hour before retiring, and best started at the lower dosage.

Isoflavones

Plant estrogens, like those found in red clover isoflavone extract, although weaker than the estrogens given by prescription, are present in body storage 1000 times as abundant than the body's natural estrogens.

Red clover extract has passed medical studies and shown to be helpful in menopausal symptoms, but strangely enough has not been shown to raise the body's natural estrogen supply (of estradiol). This is important when worrying about breast cancer patients who shouldn't be taking estrogen. In fact, it has been shown that women with breast cancer excrete lower than normal amounts of isoflavone, so there is a logic to increasing the supply of isoflavone. This is being studied as possibly beneficial for these women, acting more like the selective estrogens (e.g., Tamoxifen) given women to decrease the risk of breast cancer.

Ginseng

Ginseng is supposed to have estrogenic effects, but the studies so far have had mixed results, so the jury's still out on it.

Soy

Soy is not as successful an estrogen supplement as is advertised. In premenopausal women, though, it can adversely alter the menstrual cycle, adversely affect ovulation, and make the cycle irregular. But it can also help build bone density in menopausal women suffering from osteoporosis.

DHEA

DHEA, dehydroepiandrosterone, is a real hormone made by our own bodies. Taking extra has been espoused to make you feel better, which it seems to do; increase libido, which it doesn't do; and improve sleep. It does raise the testosterone level, but also lowers HDL, the "good" cholesterol. It can also cause hypertension and diabetes-like alterations in insulin.

Other Natural Remedies

Besides dong quai and ginseng, other herbs are regularly sold to relieve the symptoms of menopause by claiming estrogen-like effects. Motherwort, ginger root, flaxseed, licorice, dandelion root, wild yam root, and primrose oil are being investigated, but soy milk, licorice, red clover, and mandrake seem to have the strongest estrogen effects.

But people swearing by these natural remedies must remember that there are toxic levels to these substances. Because they're considered "nutritional supplements," they escape the policing of the FDA.

High doses of ginkgo biloba can cause hemorrhage.
Licorice in toxic levels can deplete potassium levels, leading to fluid imbalance and possibly even heart arrhythmias.
Pennyroyal toxicity can cause liver failure.

And it is quite possible to be taking more than what your body can take even when doing the arithmetic on the labels that come with these substances, because there is no one watching the consistency of manufacturing techniques, meaning that the same product by the same company may not have the same dosage every time. This is frightening when you think about it. One should look for the standardizations.

The established medical intelligentsia have a long way to go before sorting out the alternative methods according to stringent academic criteria. Natural supplements would have probably remained on the "bastard" list of voodoo therapies had not unscientific merchants made millions of dollars. Whatever the reason, the long road toward catching up has begun.

Capitalism wins again.