Dietary supplements are defined by the Dietary Supplement Health and Education Act (DSHEA) of 1994 as “products that contains substances like vitamins, minerals, foods, botanicals, amino acids and which are intended to supplement the usual intake of these substances.” Herbal remedies are also known as botanicals, and are a subset of the larger group of dietary and nutritional supplements.

Women have been using herbs to combat the symptoms of menopause for centuries — in fact, only in the past century have any other options been available. As pharmaceutical science has evolved over the past hundred years, so has our understanding of the benefits of supplementing a healthy diet with vitamin and mineral compounds. Today, nearly every woman takes some form of vitamin, herb, or nutritional supplement at some time — if not throughout her life. Most health care experts recommend that women supplement a healthy diet with certain vitamins and minerals as they approach menopause.

Many women turn to botanical compounds, plant and herb extracts, and nutritional supplements to alleviate the symptoms of perimenopause and to offset the physical changes the body can experience because of lowered estrogen and the natural aging process.

Black Cohosh

Black cohosh is perhaps one of the most popular herbal remedies used for the management of menopausal symptoms. Native American women have used its roots for centuries for relief of a number of symptoms associated with menstruation and menopause. Long-term studies through the National Institutes of Health (NIH) have shown it to be only as effective as placebo in treating menopausal symptoms.

In previous studies, black cohosh was found to lower luteinizing hormone (LH) levels by binding to certain estrogen receptors. Double-blind tests conducted on Remifem, an over-the-counter supplement that contains black cohosh, found that some participants felt some relief from symptoms including hot flashes, depression-like symptoms, and occasional sleeplessness. It has a good safety record so far and is still being studied for its potential in treating menopausal symptoms.

It's not clear whether black cohosh is safe for women with breast cancer and other estrogen-sensitive cancers. Side effects of black cohosh include nausea, vomiting, dizziness, and at least one reported case of nocturnal seizures, and it should not be used during pregnancy as it may cause miscarriage or premature birth. In menopause or peri-menopause, its use is not recommended for more than six months.

Gingko Biloba

Many women turn to gingko biloba supplements, extracted from the leaf of the gingko biloba tree, as treatment for the mental fogginess that seems to descend upon them as menopause approaches. Gingko biloba has been studied in placebo-controlled tests and shown to work better than a placebo at aiding memory and concentration. Gingko has been shown to improve circulation and may, therefore, aid the supply of nourishment to the brain through the circulatory system. Results of studies have been mixed. The National Institute on Aging has studied the use of this extract in the treatment of Alzheimer's disease, but did not see significant effectiveness. The National Institutes of Health (NIH), through its National Center for Complimentary and Alternative Medicine (NCCAM), is conducting a longer-term study of 3,000 volunteers to determine whether gingko biloba can reduce or delay the onset of dementia, and what effect it has on cardiovascular disease. Typical dosages of gingko are forty to eighty milligrams (taken in capsule form) three times daily. Most sources indicate that you need to take this dosage for up to twelve weeks in order to feel the effect. Talk to your health care provider for the latest information about dosage and appropriateness for your symptoms.

Kava

Also known as kawa, or kava kava, this member of the pepper family is used for anxiety and insomnia. Sometimes called “the intoxicating pepper,” the root of the plant has been shown to have its greatest usefulness as an anti-anxiety agent, and it has not been proven effective in reducing hot flashes. Kava is addictive and can cause extreme drowsiness if you use it while drinking alcohol or taking antihistamines. The FDA has issued a warning that it may be associated with liver damage, linking it to at least twenty-five cases worldwide. So while the danger of liver problems is low, it does seem to exist with this botanical.

Finding Out about Other Herbs and Supplements

This chapter has explored only the most commonly used compounds and nutritional supplements available for the treatment of menopausal symptoms. Others include:

• Chasteberry (in Latin vitus agnus castus) is said to balance hormonal fluctuations. Thought to act on the pituitary, it is used to relieve hot flashes, vaginal dryness, and depression. It is used for many uterine conditions and is also a libido balancer and lactation stimulant. It interacts with hormones and some other medications, so you should talk to your medical provider before using it.

• Dong quai, believed by some to treat hot flashes, was found ineffective in recent studies and may increase the flow of menstrual blood. Other side effects include photosensitivity and photodermatitis (sun rash), and it may cause cancer or mutations or increase the effects of the drug warfarin (Coumadin — a frequently prescribed blood thinner) and antiplatelet agents.

• SAMe (S-Adenosylmethionine) shows good evidence that it can repair damaged cartilage for better joint health. It is also being studied for its use as an antidepressant, and while promising the results are not yet definitive. SAMe does seem to have a good safety record. However, it can interact with some medications for Parkinson's disease and with other antidepressants.

• Ginseng root is considered by many to aid well-being, mood, and sleep, and is available in many forms. It may lower blood sugar, so if you have diabetes, discuss this with your care provider.

• DHEA (Dehydroepiandrosterone) is a hormone that can be synthesized from yams, but is also made by the adrenal gland. It is metabolized into estrogen and testosterone, and has been credited with improving many menopausal symptoms including bone density loss, hot flashes, decreased libido, anxiety, vaginal dryness, and insomnia. Studies have had mixed results for all of these symptoms, and no rigorous randomized studies have yet shown it to be effective for any of them.

You'll find many other herbal compounds and nutritional supplements on grocery and pharmacy shelves. As recommended earlier, do your own research and discuss it with your care provider before you begin using it.