HRT and menopause treatments

Negative publicity about HRT led to a flood of alternatives. Do they work?
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  • Updated:20 Jan 2009

02.Herbal remedies - are they effective?


We found more than 20 herbal remedies on the market that claim to relieve the symptoms of menopause. Following are some of the main ingredients and their likely effectiveness.

  • Black cohosh This North American root and rhizome is the most well-researched herbal product on the market. However, the results of clinical trials are mixed, with some studies finding it’s better than a placebo and others finding that while symptoms are indeed reduced, the effect is not much better than a placebo.

    Two studies testing a preparation of St John’s wort combined with black cohosh found the treatment improved menopausal symptoms, with one study also reporting improvements in depression. In Australia, the market-leading black cohosh product is Schaper & Brummer Remifemin. Flordis’ Femular is another such product. Several products contain black cohosh mixed with other ingredients.
  • SoySoy isoflavone extracts Both Blackmores Phytolife and Herron Menopause Relief contain soy isoflavones as their main active ingredient. In some products they’re mixed with other ingredients. Soy extracts came to prominence after it was observed that Asian women, who typically eat a lot of soy, don’t experience the same discomfort from menopausal symptoms as Western women. While it’s possible this has a cultural basis, or could have more to do with the relatively high vegetable/low meat intake of Asian women, soy’s mild oestrogenic properties could be at least partly responsible.

    A review of studies of soy extracts found that about half had evidence they helped, and half didn’t. The differences in results could not be explained by the quality of studies, dosage or severity of symptoms. The contradictory evidence makes it difficult therefore to provide an overall conclusion. It’s suggested that about one in three people respond better to these isoflavones than others, because they are able to convert one of the isoflavones, daidzein (which is also in red clover extracts, below), into equol, a more potent oestrogenic substance.
  • CloverRed clover isoflavones Like soy, red clover is a legume rich in isoflavones. There is some evidence it works, but it’s not conclusive. While a few small studies, of questionable quality and/or funded by the manufacturer, concluded it was effective in reducing symptoms, a placebo was also found to be effective. An analysis of results pooled from all available studies found there was no difference between red clover supplements and a placebo. The market-leading red clover product in Australia is Novogen Promensil.
  • Other herbs Dong quai root, licorice root, maca, evening primrose oil, Vitex agnus-castes (chaste tree), sage leaf, wild yam root (in tablets and topical creams) and ginseng are found in menopause herbal treatments, with a strong history of use in traditional medicine. However, scientific evidence for their effectiveness is lacking. A very small, short-term study of maca found it reduced anxiety and depression in menopausal women. A study of dong quai found it was no better than a placebo, but in Chinese medicine it’s usually combined with other herbs.

Traditional Chinese medicine

Clinical trials in China of Chinese herbal medicines have found them very effective in reducing the symptoms of menopause. As traditional Chinese medicine (TCM) becomes more popular in the West, Chinese herbs are becoming more widely researched.

The main stumbling block for TCM in Western evidence-based medicine is that there’s no one-size-fits-all formulation that can be tested for its ability to treat particular symptoms. Some companies have attempted to make a standard Chinese medicine formulation in a pill or similar, based on a combination of typically used herbs. One study of such a preparation showed it was no more effective than a placebo.

However, this doesn’t surprise TCM experts, who argue that women experience menopause differently and require different herbal combinations. A qualified TCM practitioner assesses each woman and her symptom profile and prescribes particular herbs accordingly.

Trials conducted in China operate according to the same principle; researchers look at herbal preparations (which are raw herbs, not pills) and if necessary they are altered over the course of the study according to individual responses – a very different approach from Western clinical trials.


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