Two Herbs for a Change

As more women enter the time of menopause, the issues of hormone cessation and their possible replacement become important. The wisdom of estrogen replacement (ERT), with or without progestins, will be discussed in a later column. But many women are unable or unwilling to take hormone replacement. For them, two herbs are of critical importance.

In 1995, six million monthly doses of one herb used in menopause were sold in Germany and Australia alone. The product, called Remifemin, is a formulation of Black Cohosh (cimicifuga racemosa) which has been standardized to contain 1 mg of a group of substances known as triterpenes. It has been tested in double-blinded and placebo-controlled studies, and compared to estradiol (the common estrogen replacement in Premarin and other medicines). Triterpenes and other flavones (the components of herbs and flowers that give them flavor, color and, frequently, medically activity) in black cohosh seem to affect a number of areas in the pituitary, hypothalamus and vasomotor centers. They inhibit leutinizing hormone (LH), without affecting the other pituitary hormones as does estrogen. They have a proportional effect on the vaginal lining (increasing the protective cells of that tissue) as opposed to estradiol, which seems to affect the uterine lining more. And they have a positive action on hot flashes and on the depression and anxiety that can occur with menopause.

Remifemin has been used in well over one million women world-wide, and side effects are known to be minimal, mostly some minor digestive disturbance if not taken with meals. It seems to take 1-2 months to see results of the therapy, which in most studies has been 2 pills twice daily (giving a total of 4 mg triterpenes, or more specifically a substance called 27-deoxyacteine). Other forms of black cohosh may be as effective, although they have not been studied as thoroughly as Remifemin. Cimicifuga racemosa has been used for centuries, both in Western herbology and in Oriental medicine, where it is known as an herb which tonifies and moves blood.

The fruit of the “chaste tree“, a small tree that grows in subtropical climates throughout the world, has been known for centuries as a medicinal herb of extraordinary usefulness. Even the name given by the Romans, “Vitex“, sounds like a Madison Avenue label for an all-purpose tonic. In fact, Vitex is a tonic (strengthener) of the hormonal system, particularly in women where it is the cornerstone of many herbal remedies.

The ancients clearly knew of vitex’ affect on female hormones. The name “chaste tree”, in fact, came from a popular belief that vitex “checks violent sexual desire” (in the words of Pliny the Greek historian). This belief carried through to the last century, where vitex was given to nuns in convents. Modern knowledge of vitex, however, began in this century with European scientific research on its hormonal uses.

Vitex seems to have its main effect on the anterior lobe of the pituitary, or master gland. It is here that the hormones that control the menstrual cycle, and therefore influence the production of the ovarian hormones estrogen and progesterone. One of the main uses of vitex in the West currently is in menopause. This herb appears to be a natural way of augmenting the body’s progesterone, and therefore modifying some of the hormone-withdrawal effects of menopause in those women choosing not to take estrogen replacement therapy (ERT), or even those who are on estrogens. For this indication, vitex is best used in conjunction with other “like-minded” herbs such as Dong Quai (angelica sinensis), Blue Cohosh and Wild Yam, all of which support the effects of the female hormones present at menopause.

As with much of herbal medicine, vitex is best used over a period of time, and the results may not be obvious for a few months. For this reason, the treatment course (other than in pregnancy- related situations and treatment of severe cramping) should be six months minimum. The fruit can be mixed with other herbs into a tea (the active ingredients are water-soluble) for a nice tonic beverage. It can be powdered and put into capsules. In most studies, it is used as a tincture, in a dropper form (usual dose is about 30-40 drops in water per day) or a standardized solid extract, 175 mg capsule. Side effects are minimal; however, it probably should not be used without supervision when progesterone is being given.

When used properly, this versatile herb can truly be a VITal EXample of herbal medicine.