Menopause management, herbals courtesy of Ruth Trickey

Starting with the decade prior to the menopause, when people can have bodily, menstrual and mood symptoms from hormone imbalance.

Ruth Trickey has been a very valuable person in this neck of the woods, and her books on this subject¹ are worth hunting for.

First a word of caution. Don't just assume abnormal bleeding is from hormone imbalance. It is quite possible that persistent heavy periods could be treated as due to this with a good result, masking an early cancer of the uterus.

About a quarter of cancer of the endometrium  happens before the menopause, which by the way is actually defined as the date of the last period.

Actually, light spotting during the month is more of a worry re uterine cancer. Very heavy periods are usually not cancer, but fibroids, polyps or adenomyosis.

Apart from any abnormal bleeding, including after sex, any new pelvic pain or vaginal discharge warrants a professional checkup.

Cancer of the uterus, cervix and ovaries are relatively 'silent' in the early stages, with minimal pain and trivial or intermittent bleeding. It is really important that a proper diagnosis is made prior to treatment.

Unexplained heavy periods can be due to a bleeding disorder³.

Do you have a family history of a diagnosed bleeding disorder, a personal history of excessive bleeding after things such as delivery, miscarriage, surgery, tooth extraction, or a history of treatment for anemia?

Perimenopausal hormone changes

Women have more problems with their periods at the start and end of reproductive years. The hormones can start to slowly decline now, even a decade before any menstrual changes are noticed.

Oestrogen levels depend on body weight, due to production in fatty tissue. They may not decline as they should.
Progesterone levels can be erratic and low because of not ovulating every month, or inadequate corpus luteum formation.

[Eggs move towards the surface of the ovary during the month, and after they are released (ovulation) the little bubble there becomes a hormone factory (corpus luteum) to support an early pregnancy.]

Anything can happen to the periods, heavy or light, frequent or infrequent - but they should start and stop as before, with nothing in between.

Hot flushes, night sweats, insomnia and vaginal dryness can also come on at this stage, from low oestrogen.

Heavy periods and premenstrual syndrome can come from low progesterone (with relative oestrogen excess.)


Herbal preparations for hormone imbalances

Progesterone deficiency can be modified with herbs influencing the control of ovarian function...
Vitex agnus castus
Paeonia lactiflora
Steroidal saponin-containing herbs

...and herbs for treating stress...
Nervine² sedatives, tonics and adaptogen herbs.

Relative oestrogen excess is largely a matter of eating less and exercising more, but specific foods useful are...
Cabbage (Brassica) family                                                               Foods such as soy and herbs with phyto-oestrogens.


Vegetable fibre and probiotics, to ensure activation of the last, by our bowel germs
Bitter herbs such as Berberis vulgaris
Silybum marianum to help the liver⁴ deal with oestrogen.


Heavy or prolongued periods, after medical check for more serious causes, can also be treated with herbs which reduce the bleeding...
Trillium erectum
Achillea millefolium
Geranium maculatum
Equisetum arvense
Tienchi ginseng
hydrastis canadensis
Lamium album

...or which reduce uterine muscle tone...
Angelica sinensis
Mitchella repens
Aletris farinosa
Caulophyllum thralictroides
Chamaelirium luteum
Lamium album.


A good time for a new start

When you become aware of bodily changes and symptoms, it's a chance to contemplate, re-evaluate and possibly change direction.

I really like Dr. Christiane Northrup's take on PMT. When you're feeling delicate, note carefully what issues upset you - it's a time when your body and mind are telling you what needs work.

Menopause similarly may be a good time to perhaps start getting more exercise. The single most effective anti-ageing measure is to build up more skeletal muscle mass.

For mat and fitness ball based contemporary Pilates exercises, illustrated with short videos, see Pamela's my-pilates-site


"Conventional" medical hormone replacement therapy

When reading about any conventional medical subject, the Cochrane Database is a good place to start. This organization's volunteer reviewers work under strict guidelines, assessing the scientific literature carefully.

The Cochrane review of short term HRT for menopause symptom relief, found 24 double-blind, randomised, placebo-controlled trials of oral hormone therapy of at least three months duration  with over 3000 participants. This treatment was found more effective than dummy tablets

Another Cochrane review of longer term HRT was pretty damming because of the risks.


Bioidentical hormone replacement therapy

I'm all in favour of using compounds identical to those manufactured in our body. The Womens Health Initiative trial which overturned much thinking on menopause treatment, was stopped early because of side effects of synthetic progestin and horse oestrogen.

Dr. Thierry Hertoghe is a very good authority on this subject. He emphasizes that one should look at all the available hormones at the same time, rather than just one such as oestrogen.

Having said all that, a note of caution⁵. You need to get skilled medical assessment and adequate monitoring of doses and effects, possibly including periodic ultrasound and/or endometrial biopsy⁶.


Menopause references and notes

1. Problem Periods: Natural and Medical Solutions. by Kaz Cooke and Ruth Trickey

Women, Hormones and the Menstrual Cycle: Herbal and Medical Solutions from Adolescence to Menopause by Ruth Trickey

2. Nervines used here include...
Hypericum perforatum
Verbena oficinalus
Bupleurum chinense
Leonurus cardiaca
Humulus lupulus

3. In a recent study, of women with bleeding disorder and heavy periods, 55% had a platelet function defect, 5% had low von Willebrand factor, and 5% had coagulation factor deficiencies.

4. The liver enzymes (CyP450) which prepare (conjugate) oestrogen for excretion or elimination in the bile, also deal with lots of other more toxic substances. They may not be adequate because of diet or toxic load problems. Oestrogen may then build up in the bloodstream.
Oestrogen excretion may also be compromised if one has some bad germs in the bowel (dysbiosis) which release it from its conjugated form and allow the body to reabsorb it back into the bloodstream...

5. http://www.mja.com.au/public/issues/187_04_200807/ede10581_fm.html ...stories of inadequate HRT management having bad effects, quite unnecessarily.

6 http://en.wikipedia.org/wiki/Endometrial_biopsy





From menopause page back to home page


The endometrium (inside womb) is the lining skin of the uterus, shed each month with the menstrual blood (menstruation.)


Fibroids, or fibromyomata,are round lumps of fibrous and muscular tissue which develop in the wall of the uterus.

Polyps are fleshy thickenings of the lining of the uterus due to prolongued hormone imbalance.

Adenomyos is a condition where the lining of the uterus has grown out into the muscular uterine wall.

7 days or more and either flooding or bleeding through a tampon or napkin in 2 hours or less, is regarded as heavy for this purpose.

Once the egg is released, the follicle it came from starts to produce the hormone progesterone (promoting pregnancy) which acts on the lining of the uterus to ready it to receive a fertilized egg.

Adaptogen herbs increase our general ability to withstand stress, when this is dimished.


Phyto-oestrogens are very weak oestrogens which block our own (stronger) oestrogens from exerting their effects by sitting on receptors otherwise available to our potent oestradiol hormone.
Xeno-oestrogens is the name for synthetic chemicals with the same effect.

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