Last month, while attending the Scripps Conference on Natural Supplements, I met Dr. Tieraona Low Dog, whose presentation on Botanicals and Women’s Health drew a packed house of medical professionals eager to learn more about complementary and alternative medicine. And who better to learn it from than Dr. Low Dog, who was a highly respected herbalist before receiving her medical degree. Naturally, I was interested in what she would recommend for women who want to go through menopause “naturally.” That is – without the use of hormones. I think you’ll be surprised at her response as I was during our one hour conversation:
Wendy: What do you recommend to your patients who complain of feeling debilitated by the classic menopausal symptoms, such as hot flashes, insomnia or anxiety?
Dr. Low Dog: I first ask her what’s she looking for, what she has tried and what she wants. Some women don’t want any kind of hormone due to a family history of breast cancer. Others ask for it.
I would probably do a blended approach. For example, I’d use Hops instead of Valerian to help her sleep at night. I’d probably put her on fermented soy – not just soy, but fermented soy products to see if that helps. If she’s having a lot of anxiety, then I might use Kava. But there is not one, simple answer.
Natural products just don’t work as well as hormones. They don’t have the same degree of adverse effects, but they also don’t have the same degree of benefits. I tend to think that women who have more severe menopausal symptoms should use hormones and you can taper them down over time, unless she has a real risk. If you have mild symptoms, I don’t know why you’d pull out the heavy artillery. For many women, products like Black Cohosh will take the edge off and that’s all they will need. It’s a misperception that herbs will be as strong as hormones.
Wendy: You were commissioned by the NIH to review all the supplements for the State of the Science Conference. What’s the bottom line on Black Cohosh for hot flashes?
Dr. Low Dog: It helps in some women, but not in others. I like the combination of St. John’s Wort and Black Cohosh better and I recommend it for women who are not taking a lot of other medications. This approach is much more popular in Europe.
St. Johns Wort is undergoing a phase two trial at the National Cancer Institute, for women who’ve had breast cancer, who have hot flashes and symptoms, but can’t take hormone therapy. For many women, St. John’s Wort can be effective for hot flashes in the same way we’re using Effexor and Paxil and other anti-depressants.
Wendy: In addition to hot flashes – and often because of hot flashes, insomnia is a major problem for women beginning in their mid to late 40s. Is there a natural remedy that helps?
Dr. Low Dog: With insomnia, it’s not just about sleep – it’s about the quality of the sleep and there are many herbs that can help. If you have trouble falling asleep, then I’d suggest trying melatonin, where the best evidence is. If the problem is staying asleep, then I’d probably suggest a combination of valerian and hops for at least 2-3 weeks to see how you do. Sometimes inositol can be useful or L-theanine.
Sometimes people do really well with Kava. It was associated with some rare liver problems but in otherwise healthy people and good quality Kava products, I still use them and think they can be very effective for people with anxiety, irritability and difficulty sleeping.
I strongly suggest that any one with insomnia cut out caffeine in the daytime, eat lighter and not drink alcohol with dinner. Alcohol is one of the worst offenders for people who wake up in the middle of the night. A lot of people drink wine to help them fall asleep, but that’s the stuff that will disrupt your sleep.