Common Complaints and Selected Herbal Therapies

Hot Flushes, Flashes and Sweats

Approximately 75-85% of perimenopausal and menopausal women complain of hot flashes, flushes and sweats, and about 33% seek medical attention. ^1,12,13 Sudden feelings of heat (flashes) occur, with flushing from the waist moving up to the chest, neck, and face, accompanied by perspiration. These can last seconds or up to 20 minutes and may occur infrequently or as often as 15 times a day. Some women awaken suddenly, drenched in perspiration, and suffer from insomnia. On the average, hot flash attacks last about 2-3 years; some last up to 5 years without HRT.¹³ Triggers include warm environment, alcohol, certain food, such as spicy foods, caffeine, hot drinks, stress, embarrassment, and exercise immediately before bedtime.¹ One causal theory is that central temperature-regulating control is lost secondary to decreases in estrogen, with subsequent loss of autonomic control of the peripheral vasculature. ¹³ The flush is not a release of the heat that has accumulated, but an inappropriate, sudden excitement of the mechanisms that control heat release.¹²

The usual medical therapy for hot flashes is estrogen with or without progestin (HRT) or vasodilator therapy. Herbs recommended by the laypress include black cohosh, dong quai, ginseng, gotu kola, licorice root, sage, and sarsaparilla. The lay press claims and the scientific evidence bearing on these claims of selected agents are discussed below.

Menstrual Irregularities

Follicular decline in the perimenopausal period is accompanied by decreasing estrogen levels that can lead to annovulation and menstrual irregularities.¹ Ideally, bleeding episodes become scantier and farther apart until menses stop altogether. For many women, however, the episodes wax and wane with fluctuating estrogen levels, becoming heavier then lighter, and closer together then farther apart, in an irregular pattern. Period may be excessively heavy lasting 10-12 days or more.

With anovulation, no progesterone is produced to convert the endometrium from a proliferative to a secretory state. Irregular abnormal bleeding results, and the constant influence of estrogen may lead to hyperplasia and even carcinoma.¹² It is mandatory to make a proper diagnosis of any irregular, heavy and frequent bleeding. Pregnancy must be ruled out, as well as hyperplasia, carcinoma, fibroid tumors, and polyps. The traditional treatment, once pathology and pregnancy are excluded is periodic medroxyprogesterone or another progestin, low-dose combined oral contraceptives (unless contraindicated) or HRT. ^{2, 12} Nonsteroidal antiinflamatory drugs, androgen compounds and endometrial ablation are other measures to decrease the amount of bleeding.² Anemia must always be considered when blood loss is heavy.

One significant concern is that some herbal therapies may have estrogenic properties that could stimulate the endometrium. Thus the dangers must always be considered with these as estrogen therapies. For additional details on herbs recommended by the laypress for menstrual irregularities, see angelica, chaste tree, dandelion, fenugreek and life root.

Dyspareunia and Vaginal Urinary Complaints

With declining estrogen levels, atrophy of the vagina, urethra, bladder, and vulva becomes a significant problem for many women. ^1,12,14 The mucosa becomes pale, thin, dry, and inelastic; friability increases, as does the risk of infection leading to erythema, discharge and bleeding. Dyspareunia is a frequent complaint, and its impact on sexual functioning may cause psychologic distress. Other symptoms are pain, itching, urinary discomfort, frequency, urgency, and stress incontinence. Inflammation and infection are common.

Traditional management is HRT. It takes about 1 month for significant response and up to 1 year for full recovery.¹² Lubricants are frequently advised, such as commercial water-soluble lubricants, vegetable oils, and unscented oils such as mineral oil. Some authors suggest a combination of herbs for these conditions as a tea, douche, or ointment.^15-17 Herbs recommended for various vaginal complaints by the laypress include agrimony, chaste tree, dong quai, and witch hazel.

Cultural factors can influence the use of herbs. Two studies evaluated the use of herbs to enhance sexual experience in Zimbabwean women.^{18, 19} Most women interviewed in both studies stated they routinely inserted herbal agents into the vagina to achieve satisfactory sexual experience. The goal was to facilitate "dry sex," which is regarded as a necessary part of successful marital relations. Although many of the women were aware of a possible increased risk of cervical cancer with the practice, most were not aware of contracting human immunodificiency virus (HIV) or other sexually transmitted diseases.