Abstract
Objectives
Every year, millions of women begin the peri-menopause and may experience a number
of symptoms related to this transition. Many women are reluctant to use exogenous
hormone therapy for treatment of menopausal symptoms and are turning to botanical
and dietary supplements (BDS) for relief. This paper reviews the literature on alternatives
to plant estrogens for relief of menopausal symptoms.
Methods
The MEDLINE database was searched for clinical trials of non-estrogenic plant extracts
for menopausal symptoms. To be included, studies had to include peri- or postmenopausal
women as subjects. All clinical trials (randomized-controlled trials, open trials,
and comparison group studies) were included for this review.
Results
Black cohosh appears to be one of the most effective botanicals for relief of vasomotor
symptoms, while St. John's wort can improve mood disorders related to the menopausal
transition. Many other botanicals have limited evidence to demonstrate safety and
efficacy for relief of symptoms related to menopause.
Conclusions
A growing body of evidence suggests that some botanicals and dietary supplements could
result in improved clinical outcomes. Health care providers should discuss these issues
with their patients so they can assist them in managing these alternative therapies
through an evidence-based approach.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to MaturitasAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- World menopause day [website].International Menopause Society, Lancaster, England2005 ([accessed December 2, 2005], available from: http://www.imsociety.org/pages/wmday.html)
- Women's sexual functioning, lifestyle, mid-age, and menopause in 12 European countries.Menopause. 2004; 11: 778-785
- A historical perspective on menopause and menopausal age.Bull Indian Inst Hist Med Hyderabad. 2002; 32: 121-135
- The age and symptomatology of natural menopause among United Arab Emirates women.Maturitas. 1998; 29: 197-202
- The prevalence of menopausal symptoms in a community in Singapore.Maturitas. 2002; 41: 275-282
- Menopausal transition in Movima women, a Bolivian Native-American.Maturitas. 2005; 51: 380-385
- Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups.Soc Sci Med. 2001; 52: 345-356
- Race to fill the void in menopause drug market.The New York Times, New York2002 (p. 1)
- Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the women's health initiative randomized controlled trial.JAMA. 2002; 288: 321-333
- Botanicals and botanical preparations widely used as food supplements and related products: coherent and comprehensive risk assessment and consumer information approaches [website].European Food Safety Authority, Brusselsc 2004 ([updated September 21, 2004, accessed November 14, 2005], available from: http://www.efsa.eu.int/science/sc_commitee/sc_documents/616_en.html)
- The regulation of dietary supplements.J Am Acad Nurse Pract. 2003; 15: 410-414
- Am Fam Physician. 2005; 72: 821-824
- Black cohosh: efficacy, safety, and use in clinical and preclinical applications.Altern Ther Health Med. 2001; 7: 93-100
- Attitudes towards and use of dietary supplementation in a sample of postmenopausal women.Climacteric. 2002; 5: 374-382
- Botanical dietary supplement use in peri- and postmenopausal women.Menopause. 2003; 10: 65-72
- Alternative therapies for menopause.Clin Obstet Gynecol. 2000; 43: 162-183
- Use of and satisfaction with homeopathy in a patient population.Altern Ther Health Med. 1998; 4: 60-65
- Complementary medicine.Curr Opin Oncol. 1997; 9: 327-331
- Alternative therapies used by women with breast cancer in four ethnic populations.J Natl Cancer Inst. 2000; 92: 42-47
- Alternative treatments for menopausal symptoms. Qualitative study of women's experiences.Can Fam Physician. 1998; 44: 1271-1276
- The landmark report on public perceptions of alternative care.Landmark Healthcare, Sacramento, CA1997
- Attitudes and behaviors of health care providers for botanical and dietary supplement use for menopausal health.Menopause. 2005; 12: 49-55
- Black cohosh.Am Fam Physician. 2003; 68: 114-116
- Upton R. Black cohosh rhizome [monograph on the internet]. American Herbal Pharmacopoeia, Santa Cruz, CA2002 ([accessed 2006 July 17]. Available from: http://www.herbal-ahp.org/documents/mono_contents/black_cohosh.pdf)
- Critical evaluation of the safety of Cimicifuga racemosa in menopause symptom relief.Menopause. 2003; 10: 299-313
- Cimicifuga and Melbrosia lack oestrogenic effects in mice and rats.Maturitas. 1996; 25: 149-153
- Lack of promotion of estrogen-dependent mammary gland tumors in vivo by an isopropanolic Cimicifuga racemosa extract.Cancer Res. 2002; 62: 3448-3452
- Pharmacology of Cimicifuga racemosa extract BNO 1055 in rats: bone, fat and uterus.Maturitas. 2003; 44: S39-S50
- Estrogenic effects of Cimicifuga racemosa (black cohosh) in mice and on estrogen receptors in MCF-7 cells.J Med Food. 2001; 4: 171-178
- Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor.J Agric Food Chem. 2003; 51: 5661-5670
- Is black cohosh estrogenic?.Nutr Rev. 2003; 61: 183-186
- Black cohosh.in: Blumenthal M. The ABC clinical guide to herbs. American Botanical Council, Austin, TX2002: 13-22
- Estrogen and progestin bioactivity of foods, herbs, and spices.Proc Soc Exp Biol Med. 1998; 217: 369-378
- Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms.J Agric Food Chem. 2001; 49: 2472-2479
- Antiestrogenic activities of Cimicifuga racemosa extracts.J Steroid Biochem Mol Biol. 2002; 80: 125-130
- Influence of Cimicifuga racemosa on the proliferation of estrogen receptor-positive human breast cancer cells.Breast Cancer Res Treat. 2002; 76: 1-10
- Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms.Obstet Gynecol. 2005; 105: 1074-1083
- Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial.Maturitas. 2005; 51: 397-404
- The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers.Maturitas. 2003; 44: S67-S77
- Efficacy and tolerability of the black cohosh (Actea racemosa) ethanolic extract BNO 1055 on climacteric complaints: a double-blind, placebo- and conjugated estrogens-controlled study.Maturitas. 2006; 55: 83-91
- Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats.Planta Med. 1991; 57: 420-424
- Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol.Gynecol Endocrinol. 2005; 20: 30-35
- Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect.J Womens Health Gend Based Med. 2002; 11: 163-174
- Clinical and endocrinologic studies of the treatment of ovarian insufficiency manifestations following hysterectomy with intact adnexa [German].Zentralbl Gynakol. 1988; 110: 611-618
Raus K, Brucker C, Gorkow C, Wuttke W. First time proof of endometrial safety of the special Black cohosh extract (Actea racemosa or Cimicifuga racemosa extract) CR BNO 1055. Menopause, 2006 [Epub ahead of print].
- The effects of remifemin on subjective symptoms of menopause.Adv Ther. 2005; 22: 148-154
- Pilot evaluation of black cohosh for the treatment of hot flashes in women.Cancer Invest. 2004; 22: 515-521
- Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer.Maturitas. 2003; 44: S59-S65
- Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer.J Clin Oncol. 2001; 19: 2739-2745
- Black cohosh, Cimicifuga racemosa.Am J Health Syst Pharm. 1999; 56: 1400-1402
- Acute liver failure associated with the use of herbal preparations containing black cohosh.Med J Aust. 2003; 179: 390-391
- Black cohosh and other herbal remedies associated with acute hepatitis.Med J Aust. 2002; 177: 440-443
- Autoimmune hepatitis associated with the use of black cohosh: a case study.Menopause. 2004; 11: 575-577
- Workshop on the safety of black cohosh in clinical studies, National Center for Complementary and Alternative Medicine; NIH Office of Dietary Supplements: Washington, DC2004
- Hepatotoxicity from Cimicifuga racemosa? Recent Australian case report not sufficiently substantiated.J Altern Complement Med. 2003; 9: 337-340
- Acute liver failure associated with the use of herbal preparations containing black cohosh.Med J Aust. 2004; 180 ([author reply 99–600]): 598-599
- Effects of black cohosh on mammary tumor development and progression in MMTV-neu transgenic mice.Am Assoc Cancer Res Proc. 2003; 44: R910
- The immediate effect of natural plant extract. Angelica sinensis and Matricaria chamomilla (Climex) for the treatment of hot flushes during menopause. A preliminary report.Clin Exp Obstet Gynecol. 2003; 30: 203-206
- Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial.Fertil Steril. 1997; 68: 981-986
- Vitex agnus-castus essential oil and menopausal balance: a self-care survey.Complement Ther Nurs Midwifery. 2002; 8: 148-154
- Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women.Climacteric. 2001; 4: 144-150
- Effect of oral gamolenic acid from evening primrose oil on menopausal flushing.BMJ. 1994; 308: 501-503
- Limited cognitive benefits in Stage +2 postmenopausal women after 6 weeks of treatment with Ginkgo biloba.J Psychopharmacol. 2005; 19: 173-181
- Effects on cognition and mood in postmenopausal women of 1-week treatment with Ginkgo biloba.Pharmacol Biochem Behav. 2003; 75: 711-720
- Gincosan (a combination of Ginkgo biloba and Panax ginseng): the effects on mood and cognition of 6 and 12 weeks’ treatment in post-menopausal women.Nutr Neurosci. 2004; 7: 325-333
- Effect of Korean red ginseng on psychological functions in patients with severe climacteric syndromes.Int J Gynaecol Obstet. 1999; 67: 169-174
- Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Swedish Alternative Medicine Group.Int J Clin Pharmacol Res. 1999; 19: 89-99
- Psychosomatic dysfunctions in the female climacteric. Clinical effectiveness and tolerance of Kava Extract WS 1490.Fortschr Med. 1991; 109: 119-122
- St. John's wort extract: efficacy for menopausal symptoms of psychological origin.Adv Ther. 1999; 16: 177-186
- Hypokalaemia and hypertension associated with use of liquorice flavoured chewing gum.BMJ. 1997; 314: 731-732
- Radix angelicae sinensis.WHO monographs on selected medicinal plants. WHO, Geneva, Switzerland2001
- Herbal medicine: expanded Commision E monographs.Integrative Medicine Communications, Newton, MA2003
- The use of Vitex agnus castus for hyperprolactinemia.Q Rev Nat Med. 1997, Spring; : 19-21
- Complementary and alternative medicine and physical activity for menopausal symptoms.JAMWA. 2004; 59: 270-277
- Ginkgo biloba.Lancet. 1992; 340: 1136-1139
- Effect of Ginkgo biloba extract in arterial occlusive disease. Randomized placebo controlled crossover study [German].Fortschr Med. 1987; 105: 397-400
- 6-Month double-blind randomised clinical trial of Ginkgo biloba extract versus placebo in two parallel groups in patients suffering from peripheral arterial insufficiency.Arzneimittelforschung. 1984; 34: 716-720
- Ginkgo biloba for cognitive impairment and dementia.Cochrane database syst rev. 2002 ([CD003120])
- Herb–drug interactions.Lancet. 2000; 355: 134-138
- Estrogenic activity of herbs commonly used as remedies for menopausal symptoms.Menopause. 2002; 9: 145-150
- Blumenthal M. The ABC clinical guide to herbs. American Botanical Council, Austin, TX2003
Motherwort [website]. Science Views.com; c2003-04 [accessed December 01, 2005]. Available from: http://scienceviews.com/plants/motherwort.html.
- Effect of valerian on human sleep.Psychopharmacology (Berl). 1985; 87: 406-409
- Aqueous extract of valerian reduces latency to fall asleep in man.Planta Med. 1985; : 144-148
- Aqueous extract of valerian root (Valeriana officinalis L.) improves sleep quality in man.Pharmacol Biochem Behav. 1982; 17: 65-71
- Valeriana officinalis.Alternative medicine review, vol. 9. 2004 (p. 438–40)
- St John's wort for depression-an overview and meta-analysis of randomised clinical trials.BMJ. 1996; 313: 253-258
- St John's wort for depression: meta-analysis of randomised controlled trials.Br J Psychiatry. 2005; 186: 99-107
- Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders.Adv Ther. 1998; 15: 45-53
- Pharmacokinetic interactions of drugs with St John's wort.J Psychopharmacol. 2004; 18: 262-276
Article info
Publication history
Published online: July 18, 2006
Identification
Copyright
© 2006 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
