Understanding Herbal Remedies for Women’s Health
Written by the PharmCon freeCE Team, based on a freeCE Monograph developed by Peter Kreckel, RPh., Retired Adjunct Assistant Professor, Saint Francis University.
Over the past two decades, significant advancements have been made in understanding and managing hot flashes, a common symptom experienced during the menopausal transition.
One notable trend in managing hot flashes is “sleep divorce,” a term used by the Cleveland Clinic to describe the practice of partners sleeping in separate beds or bedrooms. This practice is gaining popularity, with about 1 in every 5 couples opting for separate sleeping arrangements.
Differing temperature preferences and issues like snoring are common reasons for this trend, which has been found to improve sleep quality, mental health, and relationship satisfaction. The term “sleep divorce” can carry a stigma, and many prefer alternatives like “sleep separation” or “alternative sleep arrangements.”
Estrogen replacement therapy (ERT) has long been a common treatment for menopausal symptoms. However, discontinuation of ERT poses challenges for many women who rely on it for relief from hot flashes.
The HERS trial, conducted at the turn of the millennium, significantly altered the use of estrogen. Previously, it was widely prescribed for various conditions, including osteoporosis, hot flashes, colon cancer prevention, and cardiac protection. Now, estrogen is primarily recommended for the relief of vasomotor symptoms at the lowest possible dose and for the shortest duration. It is no longer advised for the prevention of chronic heart disease, osteoporosis, or dementia.
Given these shifts, many women are turning to herbal remedies and over-the-counter supplements as alternatives to manage their symptoms. Understanding these herbal options and their efficacy is crucial for healthcare professionals who guide female patients through their menopausal transition and other transitions.
This article will explore various herbal remedies, their uses, benefits, and potential side effects to provide a comprehensive overview of alternative treatments for women’s health.
Black Cohosh
Hot flashes are the most common complaint during the menopausal transition, affecting up to 80% of women, though only 20-30% seek medical treatment. With estrogen falling out of favor, many women turn to over-the-counter supplements like black cohosh, the active ingredient in Remifemin.
Common Names and Uses
Black cohosh, scientifically known as Cimicifuga racemosa, belongs to the buttercup family. The rhizomes and roots are used medicinally. Extracts of black cohosh can modestly reduce menopausal symptoms like hot flashes. Historically, it was an ingredient in Lydia Pinkham’s Vegetable Compound.
Remifemin: A Trusted Formulation
Remifemin, containing only black cohosh, has been one of Germany’s top proprietary herbs since the 1960s. Germany’s Commission E approved this extract for treating dysmenorrhea, PMS, and menopausal symptoms since 1989. However, it is not recommended for use beyond six months.
Dosing and Efficacy
In U.S. studies, the daily dose of black cohosh is typically 40 mg, with an average treatment duration of 23 weeks. Studies comparing black cohosh to placebo, hormone therapy, red clover, and fluoxetine showed no significant difference between black cohosh and placebo.
Adverse Effects and Drug Interactions
Common side effects of black cohosh include stomach upset and headache. There have been reports of liver damage, with one patient requiring a liver transplant. Due to its potential estrogenic effects, black cohosh should not be recommended for patients taking tamoxifen (Nolvadex). No other significant drug interactions have been reported.
Non-Hormonal Alternatives for Hot Flashes
Most references recommend venlafaxine (Effexor), desvenlafaxine (Pristiq), paroxetine (Paxil, Brisdelle), citalopram (Celexa), and escitalopram (Lexapro), which have a similar modest benefit for hot flashes. Most sources seem to favor citalopram as the favorite at a 10-20 mg dose for hot flashes.
Gabapentin (Neurontin) is also a good option for women who have their hot flashes at night. It is effective when the hot flashes occur in the first four hours of sleep, especially if the hot flashes wake up the patient.
So, as with so many herbal preparations, there just isn’t a lot of evidence for the use of black cohosh. This drug seems to be safer than most herbal supplements for women, and for some it might be worth a try. Be sure to share the information that there isn’t much evidence for black cohosh.
A Cautionary Note on Blue Cohosh
Blue cohosh, often confused with black cohosh, has no value in women’s health and can be dangerous. It can cause significant side effects, including mucus membrane irritation, stomach upset, diarrhea, cramping, and severe cardiovascular issues in newborns when used by pregnant women. It is teratogenic and can induce labor, making it a risky choice.
Ginger Use During Pregnancy
Common Names and Uses
Ginger, or Zingiber officinale, is widely known for its culinary uses, such as in ginger snaps and ginger ale. Medicinally, ginger has been used for thousands of years, particularly in eastern medicine, to treat stomachache, diarrhea, and nausea.
Dosing and Efficacy
Ginger supplements commonly come in 250 mg and 550 mg strengths. For pregnancy-related nausea, the typical dose is 250 mg four times daily. A meta-analysis by the American Board of Family Medicine found that ginger, at 1 gm/day, significantly improved early pregnancy nausea when taken for at least four days. However, while the American College of Obstetricians and Gynecologists (ACOG) lists ginger as a treatment option, its safety during pregnancy has not been adequately proven.
Adverse Effects and Drug Interactions
Common side effects of ginger include gastrointestinal reflux. In studies, 8% of subjects reported heartburn after taking 1 gm of ginger. Patients taking anti-platelet drugs (aspirin, clopidogrel) or anticoagulants should use ginger cautiously due to a potential increase in bleeding risk.
Evening Primrose Oil
Common Name and Uses
Evening primrose oil, derived from the seeds of the plant Oenothera biennis, is used to alleviate breast pain by altering the balance of fatty acids in breast tissue. It contains linoleic acid and gamma-linolenic acid (GLA), essential components of myelin and neuronal cell membranes.
Dosing and Efficacy
Despite lacking proven efficacy in previous studies, evening primrose oil may be used as a supportive measure for breast pain, with a recommended observation period of 3-6 months. It is also used in Europe for mastalgia (breast tenderness) and was previously used in Great Britain for eczema, though this indication was withdrawn due to insufficient evidence.
Adverse Effects and Drug Interactions
Evening primrose oil has anticoagulant and antiplatelet effects, so it should be used cautiously with drugs like clopidogrel and warfarin. There is also a potential increased seizure risk when taken with phenothiazines.
Main Takeaways
Herbal remedies like black cohosh, ginger, and evening primrose oil offer potential benefits for female patients seeking alternative treatments for common ailments. However, their efficacy and safety vary, and it is essential for healthcare providers to stay informed about these alternatives to guide patients effectively.
For more comprehensive education on herbal remedies and other relevant topics, explore the extensive range of courses available at freeCE.
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References:
A “Sleep Divorce” Might Be Exactly What Your Relationship Needs. Cleveland Clinic. https://health.clevelandclinic.org/sleep-divorce
2. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms.
Cochrane Database of Systematic Reviews. 2012;(9). doi: https://doi.org/10.1002/14651858.cd007244.pub2
