Hot Flashes and Alternative Medicine
Conventional medicine has very little to offer with regard to the treatment of hot flashes. This is not the case with alternative therapies. For approximately a year before natural hormones became the best option for treatment of hot flashes, herbal supplements seemed the only viable possibility in my practice.
Vitex, Black Cohosh and Oil of Evening Primrose are the most popular herbal supplements in this category. Over the years I have found that some women swear by these supplements, while others find them totally useless. You may find these herbs to work for a while, especially in younger women with occasional hot flashes. When hot flashes increase in frequency and other symptoms of hormone depletion compound the picture, herbal remedies rapidly become less effective.
Vitex (also known as chasteberry, monk’s pepper, agnus castus, agni casti fructus, chaste tree) has more than one active ingredient, including flavonoids and iridoids. Some clinical data exist to support the use of Vitex extract in infertility associated with corpus luteum insufficiency, PMS and PMTS (premenstrual tension syndromes), acne especially associated with PMS, amenorrhea ( lack of periods), polymenorrhea ( too frequent periods) and mastodynia ( breast discomfort). Most of the research on this product so far has been in Germany; results have led to the belief that Vitex acts on the anterior pituitary decreasing prolactin levels and increasing progesterone levels. Women with PMS have high levels of prolactin and lower-than- normal levels of progesterone. Vitex does improve the hormone balance and thus may relieve the symptoms. Although its use is wide-spread, the side-effects are quite limiting. They include diarrhea, weight gain, rashes, nausea and headaches. Vitex should not be used in combination with hormone treatment, birth control pills, or while breast feeding.
Black Cohosh– Its primary application is to help ease the physical and mental changes associated with perimenopause and menopause- hot flashes, headaches, irritability, depression. Black cohosh has also been used to symptomatically treat hormonal deficits arising from ovariectomy and hysterectomy in younger women. While some clinical studies do exist to support the primary application of Black cohosh for the treatment of perimenopausal symptoms such as hot flashes, headaches, palpitations, ringing in the ears, sleep disturbances and mood disorders, its mode of action is poorly understood or described. Treatment requires at least eight weeks to alleviate symptoms. Clinical studies have ranged from eight weeks to six months, the results are equivocal at best. Side-effects include stomach irritation, nausea, and dizziness. Although the supportive literature on black cohosh states that it can be used in conjunction with estrogen supplementation without side-effects, I would not recommend it. Once on natural hormone supplementation, there is no reason to take additional supplements.
Oil of Evening Primrose– Classified as an essential nutrient, evening primrose contains essential fatty acids ( EFAs) particularly omega-6 and gamma linoleic acid ( GLA). Used for skin disorders and hyperactivity in children, evening primrose has found a great niche in women’s health: PMS, breast health, pregnancy and lactation. A study in Lancet in 1985 compared the effect of oil of evening primrose and two conventional medications on breast pain. Improvement of symptoms was not significant with oil of evening primrose, but there were fewer side-effects than with conventional medications. Although often prescribed for symptoms of menopause, oil of evening primrose alone, is of no value in the treatment of hot flashes. I must also caution you that seizures have been reported in patients on antipsychotic medications who took oil of evening primrose with the medication (Internal Medicine- May 2001- Alternatives Ease Some Menstrual Symptoms).
A word of caution when it comes to herbal supplements and soy derivatives: black cohosh, isoflavones, ipriflavones, soy derivatives, soy milk, soy nuts, Vitex and Dong Quai are phytoestrogens. Their chemical make-up resembles human estrogen molecules closely enough for the body to misread them as estrogens. For that reason they do work on alleviating some of the symptoms of estrogen deficiency. But they are not estrogens and they do not offer the beneficial effects we obtain from estriol, estrone or estradiol- natural estrogens. There are no research data to substantiate beneficial estrogen-like effects on the heart, bones or brain.
Thus, while we think we are helping our situation by reducing the discomfort associated with the symptoms we experience, we may be doing ourselves a disservice. Heart disease and osteoporosis progress unimpeded when all we take are phytoestrogens.
A commonly used proof of the positive effects of soy is rooted in the Japanese culture. Japanese women are known to suffer few if any side effects of menopause. Japanese diet is rich in soy products- tofu, soy milk and nuts. The connection between soy and the lack of menopause symptoms was thus made. However, no scientific data have substantiated this theory. Maybe it is genetics. Maybe Japanese women are genetically programmed to suffer fewer effects of hormone imbalance.
Until we have definite proof of soy’s benefit to women, I do not recommend soy derived supplements to my patients. I emphatically advise against isoflavones, ipriflavones, genistein- all found in capsule, powders and gelcap forms. This does not mean you should stay away from soy milk, tofu or other soy products. Soy – in natural form and in moderation- is an excellent source of protein and should be used as such.