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Alternative Therapies: Other Alternatives

In the past alternative products have not been subject to the strict regulations, which apply to drugs.

thrRecently the regulatory authorities have developed a system, called the Traditional Herbal Medicine Scheme (THR). Products that have been approved by this system have a THR logo on their packs and this means that the product has the correct dosage, is of high quality and has suitable product information (drug interactions and side effects) included in the pack. Only select products that have the THR logo on their packs or seek advice from qualified healthcare professionals.

alertNOTE: be careful, as 'natural' doesn't necessarily mean 'safe'.

This and other changes have resulted in more confidence about products bought over the counter, however you must still be careful, as 'natural' doesn't necessarily mean 'safe'. Some products had been found to contain contaminants and some Chinese medicines had been found to contain small amounts of active drugs. Cases of kidney toxicity have been reported. Consequently, if you have any doubts, ask a qualified healthcare professional.

AGNUS CASTUS This is a compound known as Monks Pepper or Chasteberry extract. Agnus Castus has been well studied and is available as a tincture or in tablet form. The tablets have a very strong smell and most people find the tincture easier to take. Studies reported in the British Medical Journal have shown its value for the treatment of Pre-menstrual Tension/Syndrome. It has a hormone regulating effect and is particularly useful in the peri- menopausal phase to help settle the hormone fluctuations. Agnus Castus is only useful if hormones are not already being taken. It has been used in Germany widely where herbal medicines are often used alongside traditional medicines. It is used for impaired ovarian function, period problems and PMS. Little is known about its effect on specific menopausal symptoms.

BIO-IDENTICALS Bio-identical hormones are marketed as being naturally produced hormones which aim to resemble our own hormones and which replace the hormones according to individual requirements. They are in fact very similar to the hormones used in Hormone Replacement Therapy, which are also produced from natural sources, but, unlike HRT hormones, are given in uncontrolled, unregulated amounts, with little evidence available on effect and safety. Measurment of salivary hormone levels is often used to determine the amounts of bio-identicals which are prescribed, but salivary hormone levels bear no correlation with hormone levels which are required to treat menopausal symptoms, or to provide beneficial effects on bone or the cardiovascular system. For more information, see this article on bio-identicals from our magazine. (PDF 1Mb)


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BLACK COHOSH Cimicifuga Racemosa, also known as bugbane is a member of the buttercup family and a woodland perennial. It was used by the North American Indians who called it "black snake root" because of its gnarled black root. They boiled up the root and drank the tea, when it was used to ease menstrual cramps and childbirth pains. It was thought that it had similar properties to plant estrogens and binds to the same receptors in the body that estrogen does, although recent research suggests more of a serotonin effect. Black Cohosh may be effective for the emotional symptoms which accompany the menopause. It is thought to help with the mood swings, depression and weepiness that are associated with hormone fluctuation. It also may help alleviate hot flushes, though studies have shown varying results.


  1. Black cohosh does not relieve menopausal hot flushes – British Medical Journal updates and summary of study on our news page here
  2. Safety and effect of Black Cohosh and Red Clover for hot flushes here


  1. New THR legislation now supports the use of black cohosh in the management of menopause.

Black cohosh is available as a "tincture" putting drops into water to drink, and also as tablets, e.g. MenoHerb. The doses vary with the product.
One case has been reported of a woman developing autoimmune hepatitis while taking black cohosh.
From the BBC News - Liver warning over Black Cohosh: 18 July 2006 - BBC News Online.
Liver toxicity has now been associated with contaminants, no studies using high quality black cohosh extracts have shown any changes to liver function tests. The regulatory position for black cohosh is that the product is contraindicated in patients who have active liver disease or a history of liver damage These contra-indications are based on that although there is no causality data, erring on the side of caution is best policy.

DONG QUAI is derived from a perennial plant found in southwest China. It is often found in combination products claiming to relieve menopausal symptoms. No evidence exists to show a beneficial effect on menopausal symptoms and there have been reports of bleeding when taken with warfarin.

EVENING PRIMROSE OIL is well known for its breast pain relieving properties. Evening primrose oil was available as EFFAMAST or EPOGAM on prescription for breast pain and eczema respectively. Unfortunately, it has now been withdrawn as a prescription drug but can be bought over the counter, either as Evening Primrose Oil or Borage Oil. There are a variety of strengths and potencies. Look for the amount of GLA (gamma linoleic acid) in each capsule. Aim for 240mg per day for at least 2 months and then try reducing the dose. It has been found to be useful for breast pain and mood swings but is unlikely to be helpful for hot flushes. Adverse effects include headache, skin rashes and nausea.

GINKGO BILOBA is known as Maidenhair Tree or the "Memory Tree" extract. It is reported to be helpful with circulation and therefore memory. It helps improve glucose and oxygen supply to the brain. Caution: risk of prolonged time for blood to clot and thus haemorrhage. Should not be taken with drugs that reduce clotting such as Warfarin, Aspirin or coumarins.

KAVA KAVA - WITHDRAWN This was first described by Captain Cook who was offered this as a "welcome drink" when he arrived on the Polynesian islands. It was helpful in alleviating anxiety without being addictive. Unfortunately it has been withdrawn due to reported liver damage as a side effect.

MACA is a root from Peru which contains high amounts of vitamins, minerals, enzymes and essential amino acids. It is said to enhance hormone production and is promoted as a libido enhancing agent, but very little scientific information on its effect is available.

PROGESTERONE CREAM "Natural" progesterone cream is available on private prescription in varying strengths. Studies have shown inconsistent results on effect on menopausal symptoms. Claims for a protective effect on bones have not been confirmed. Women who take systemic estrogen for menopausal symptoms must also take progestogen to protect the womb lining from being stimulated by the estrogen. Progesterone cream is not suitable for giving protection to the womb lining and should not be relied on for this purpose.

SAGE This herb can be taken as a tea or as an extract in tablet form to help with hot flushes. There are studies ongoing into its effectiveness but does seem to have a regulating effect on hormones. Caution with HIGH BLOOD PRESSURE and if taking TAMOXIFEN

ST JOHN'S WORT Hypericum perforatum or commonly known as St John's Wort or "Nature's Prozac". This extract acts by inhibiting neurotransmitters in the brain to have an anxiety reducing and anti-depressant effect. Shown in studies to be as effective as some traditional anti-depressants but better tolerated without the side effects. It may be useful for women suffering mild to moderate anxiety and depressive symptoms at the menopause. Caution: many drug interactions-Check with your pharmacist. Common drugs affected: DIGOXIN, THE ORAL CONTRACEPTIVE PILL, MIGRAINE DRUGS, ANTI ASTHMA (THEOPHYLLINE) AND ANTI EPILEPTIC DRUGS, WARFARIN, CYCLOSPORIN, HIV DRUGS AND OTHERS. DO NOT TAKE WITH OTHER ANTI DEPRESSANT DRUGS. St John’s Wort can cause a rash that develops in sunlight.

WILD YAM Although many HRT preparations are extracted from Yams the human body is incapable of breaking down the Yam into the sex hormones therefore they CANNOT have any effect on estrogen or progesterone in women. The sex steroids are only produced in the test tube!

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