The McDougall Newsletter

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Index of back issues of the McDougall Newsletter and previous articles that appeared on Dr. McDougall's site: Index of past articles

Below is one of the Articles from the March/April, 1998 issue of "The McDougall Newsletter" as well as a Recipe for Herbed Rice Casserole.  This page is updated every couple of months, so keep checking back!

Herbal Treatments For Menopause

Many distressing symptoms appear at the time of menopause.  The most commonly reported are hot flashes, and  problems caused by atrophy (thinning) of the genital tissues.  Hot flashes are experienced by over 75% of menopausal women following the Western diet.  Other common complaints associated with menopause include nervousness, anxiety, depression, fatigue, irritability, insomnia, night sweats, forgetfulness, pain with intercourse, and weight gain, especially in the lower abdomen.

These signs and symptoms of menopause are often relieved with estrogen and progesterone; in other words, by hormone replacement therapy (HRT). However, no more than 20-30% of eligible women ever start HRT and  about 50% of those who do start, stop shortly thereafter.  Common reasons for stopping include fear of cancer and a lack of perceived benefits from hormones for improved general health or soundness of vaginal tissues.

So what can be done for women who fear taking HRT, but still suffer?  Herbal preparations are commonly recommended for a "natural treatment" of menopause.  Unfortunately, there are currently no government standards on the quality of herbal products in the United States, and little is known about them scientifically.  While most have few adverse effects, some can be unsafe.

How do you tell if the herbal medication is worthwhile? You will be the best judge based upon how it makes you feel.  This is no different than how you determine the value of HRT. Guidance for the proper dosage is obtained with the package instructions. These preparations should not be taken by women who are pregnant or nursing or by anyone known to have adverse reactions to any of these herbal preparations.

There are those herbs that are said to effect the female hormones and those that relieve mental and emotional distresses associated with menopause. The following are some of the commonly self-administered herbs used by women for menopause symptoms:  


The estrogen and progestin bioactivity of foods, herbs, and spices was recently reported on over 150 herbs traditionally used by herbalists for treating a variety of health problems (Proc Soc Exp Biol Med 217:369, 1998).  They were tested for their relative capacity to compete with estradiol and progesterone binding to intracellular receptors for progesterone (PR) and estradiol (ER) in intact human breast cancer cells (This does not mean these herbs cause or promote cancer). The six highest ER-binding herbs that are commonly consumed were soy, licorice, red clover, thyme, turmeric, hops, and verbena. The six highest PR-binding herbs and spices commonly consumed were oregano, verbena, turmeric, thyme, red clover and damiana.  However, modifying estrogen and progesterone activity is probably only one role herbs play in  helping women with menopausal symptoms.  


Other Names: (Cimicifuga racemosa), baneberry, squawroot (from treating women's disorders), bugbane, black snake root (treating snake bites by Native Americans), rattle weed.

GENERAL DESCRIPTION: Black cohosh is a flowering plant that grows to 8 feet tall in the northern hemisphere.  It is the best-studied herb for relieving menopausal symptoms. The herb is obtained from the rhizome (a creeping stem with scales, leaves, and roots lying horizontally at or under the surface of the soil).

MEDICAL BACKGROUND: Traditionally, it has been recommended for female problems, indigestion, and arthritis. Benefits for women during menopause are supposed to come from its estrogen-simulating effects.  Black cohosh has been studied mostly in Germany, where it is used to treat hot flashes. Experiments have shown that the herb has substances that bind to estrogen receptors in animal models and lower pituitary hormones in both animals and humans. However, a recent study from Denmark found no sign of estrogen activity on the uterus and vagina of rats (Maturitas 25:149, 1996).  The authors conclude this herb's benefits for menopausal symptoms cannot be explained as a traditional estrogen effect as measured in biological experiments.  Therefore, the herb may work by other means, such as influencing pituitary hormones.

Elevated levels of a pituitary hormone, known as luteinizing hormone, is thought to contribute to hot flashes, insomnia, and depression in menopause.  When 110 women took black cohosh or placebo for two months, luteinizing hormone was decreased by 20 percent for those taking the herb (Planta Medica 57:420, 1991).  Two studies compared black cohosh to conjugated estrogens, and diazepam (Valium).  Women in the black cohosh group had greater relief of menopausal symptoms and greater reduction in anxiety and depression than those taking the prescription drugs.  (Med Welt 36:871, 1985; Theripeuticon 1:23, 1987).  Vaginal atrophy also improved. Other research has found significant relief of menopausal symptoms such as hot flashes, profuse perspiration, headache, dizziness, heart palpitations, ringing in the ears, nervousness, depression, and sleep disturbances  (Zentralblatt Gynakol 110:611, 1988; Gyne 1:14, 1982).

SIDE EFFECTS:  Few side effects are seen with recommended doses.  Ingestion of large doses of leaves may result in nausea, vomiting and may induce miscarriage (Lawrence Review of Natural Products Sept. 1992).  This herb may have additive blood pressure lowering effects so people taking blood pressure pills should be cautious.


OTHER NAMES: (Agnus castus) Vitex, Chaste Tree

GENERAL DESCRIPTION:  As its name suggests, chaste berries were once believed to suppress the libido.  The chaste berry is the fruit of a small Eurasian tree.  The berries and leaves are used in the herb preparation. The chaste berry was well known to many of the ancients, "If blood flows from the womb, let the woman drink dark wine in which the leaves of the Vitex have been steeped." Hippocrates ( 460-377 B.C. ).

MEDICAL BACKGROUND: Chaste berry extracts inhibit prolactin secretion of rat pituitary cells (Horm Metab Res 25:253, 1993)  A randomized placebo-controlled, double-blind, study of 52 women with elevated prolactin production (hyperprolactinemia), using a daily dose of one capsule (20 mg) of a chaste berry preparation, found after 3 months of therapy that prolactin release was reduced and estrogen (17 beta-estradiol) production increased (Arzneimittelforschung 43:752, 1993). Side effects were not seen.  Therefore, this herb has effects on female pituitary and ovarian hormones and has some scientific support for use in menopause.  In addition, it is an alternative treatment for elevated prolactin production in women in their reproductive years.

SIDE EFFECTS: May cause itching, rash, or nausea. Not recommended for use in pregnancy.  


Other Names: (Glycyrrhiza glabra)

GENERAL DESCRIPTION:  Say "licorice" and most people think of a candy, but it is also a powerful herb.  Licorice is from a perennial plant native to southern Europe, Asia and the Mediterranean; distinguished by tiny violet flowers. It is one of the most popular and widely consumed herbs in the world.  It is said to be 50 times sweeter than sugar.

MEDICAL BACKGROUND: The main constituent found in the root is glycyrrhizin, which stimulates the secretion of the adrenal cortex hormone aldosterone. The root extract produces mild estrogenic effects, and it has proven useful in treating symptoms of menopause. Licorice is found to bind to estrogen receptors in the cells of the uterus of experimental animals (Acta Obstet Gynecol Scand 65:839, 1986).

SIDE EFFECTS: Headaches, diarrhea, lethargy, fluid retention, weakness, or shortness of breath.  Heavy use of licorice can affect the production of adrenal hormones (aldosterone) causing electrolyte imbalance with sodium retention and loss of potassium.  This in turn can lead to high blood pressure and edema.  


Other Names: (Panax ginseng), Ren Shen, Chinese Ginseng, Korean Ginseng.

GENERAL DESCRIPTION: Ginseng is native to China, Russia, North Korea, Japan, and some areas of North America. Ginseng is the most famous Chinese herb and its use dates back 7,000 years.   The name panax is derived from the Greek word panacea meaning, "all healing."  It was first cultivated in the United States in the late 1800's and it takes 4-6 years to become mature enough to harvest.  The root provides the herb.

MEDICAL BACKGROUND: Ginseng is known to have estrogenic activity (Br Med J 281:1110, 1980). Ginseng face cream has been reported to cause vaginal bleeding in a postmenopausal woman; demonstrating its potential for powerful estrogenic activity (Am J Obstet Gynecol 159:1121, 1988).

SIDE EFFECTS: Very rare.


Other Names: ( Humulus lupus )

GENERAL DESCRIPTION: The female flowers of the climbing shrub are used to make the herb. Historically hops have been used as a sleeping aid and to flavor beer.

MEDICAL BACKGROUND: Hops appear to have an estrogen effect and bind to estrogen receptors of human cells (Proc Soc Exp Biol Med 217:369, 1998). .



OTHER NAMES: (Angelica sinensis), Chinese Angelica, Dong Guai, tang-kuei, Dang-gui, Umbelliferae, toki, Japanese angelica, tanggwi

GENERAL DESCRIPTION:   The Chinese have been using this herb for more than 2,000 years to treat gynecological problems.  The rhizome is the source of the herb.

MEDICAL BACKGROUND: Stimulation of uterine tissue has been observed (J Chinese Materia Medica 20:173, 1995).  Dong quai does not act like an estrogen, but may have some direct action on the reproductive organs (uterus) and possibly on other hormones.  A recent double-blind, placebo-controlled study examined the effects of dong quai on the vaginal cells and endometrial thickness in 71 postmenopausal women, and found no statistically significant differences between the endometrial thickness, vaginal cells, or the number of hot flashes between the herb and a placebo.  (Fertil Steril 68:981, 1997).  The authors concluded dong quai is no more helpful than placebo in relieving menopausal symptoms.

SIDE EFFECTS:  Components of this herb may interact with sunlight to cause rashes.  There is also concern that some of the chemical components may cause cancer.   The Lawrence Review of Natural Products reports, "...the potential toxicity posed by the coumarins and safrole in the essential oil outweigh the benefits of ingesting this plant, and its use cannot be recommended."  



OTHER NAMES: (hypercium perforatum), Goat weed.

GENERAL DESCRIPTION: St. John's wort is a bushy perennial plant with numerous yellow flowers. It is native to many parts of the world including Europe and the United States, growing wild in northern California, southern Oregon, and Colorado.  The herb comes from the flowering plant.

MEDICAL BACKGROUND:  St John's Wort is licensed in Germany for treatment of anxiety, depression, and insomnia. There are at least 10 compounds that may provide effects, but hypercium appears to be the most active ingredient.   This compound changes the neurotransmitters in the brain resulting in emotional benefits.  There have been 23 randomized trials done on a total of 1757 outpatients with mild to moderate depression.  Hypericum extracts , after 2 to 4 weeks were found to be more effective than placebo, and about as effective as standard antidepressants (Med Lettr 39:107, 1997). Two to four weeks are required to develop mood elevating effects.

SIDE EFFECTS: Some patients report dry mouth, dizziness, constipation, gastrointestinal upset, and confusion.  In trials, fewer than 2% stopped their herb because of side effects.  One patient reported photosensitivity (reaction with sunlight).  Depression is a serious illness and should be treated by a doctor. Do not combine this herb with other antidepressant medication.  


Other Names:  (Ginkgo biloba)  Maidenhair Tree, Bai Guo ( EGb 761 ).

GENERAL DESCRIPTION:  Gingko biloba is extracted from the leaves of cultivated maidenhair trees.

MEDICAL BACKGROUND: It is a traditional Chinese medicine used to treat asthma and bronchitis. Gingko is licensed in Germany to treat cerebral dysfunction with, for example, memory loss, dizziness, ringing in the ears, hearing loss, headaches, emotional instability with anxiety, and for intermittent claudication.  Benefits have been reported for poor circulation to the brain, hands, legs (intermittent claudication), and feet (Lancet 340:1136, 1992). Ginkgo has been shown to improve memory and to slow the progress of dementia (JAMA 278:1327, 1997).  Four to 12 weeks of treatment are usually required to see results.

SIDE EFFECTS: There are no serious side-effects.  In rare cases there have been reported mild stomach upset, headache, and allergic skin reactions. 


Other Names: (Piper methysticum), Kava kava, Kawa.

GENERAL DESCRIPTION: More than 20 varieties have been identified. Kava is prepared from the rhizome of a sprawling evergreen shrub found in Polynesia, Melanesia, and Micronesia.   It has traditionally been used as a beverage to induce relaxation.  Kava produces mild euphoric changes characterized by feelings of happiness, more fluent and lively speech, and increased sensitivity to sounds.  Chewed, it can cause numbness of the mouth. The most effective way to use kava is as a ground-rhizome powder mixed with cool water.

MEDICAL BACKGROUND: A study of women with menopausal complaints found reduced symptoms after only 1-week with improvements in feelings of well-being and less depression (Fortschr Med 109:119, 1991).  A multicentered, randomized, placebo-controlled 25-week outpatient trial of the active ingredient of kava compared to commonly prescribed antidepressants and tranquilizers, found kava to have superior benefits over the drugs, with rare adverse effects (Pharmacopsychiatry 30:1, 1997).  The authors suggested kava as a treatment alternative with proven long-term benefits and none of the tolerance problems associated with antidepressants (tricyclics) and tranquilizers (benzodiazepines).  Other research has shown similar benefits (Arzeimitteelforschung 41:584, 1991).  Use for treating alcohol abuse and some forms of psychosis also have been suggested (Aust NZ J Psychiatry 20:70, 1986).

SIDE EFFECTS:  Even when administered within its prescribed dosages, this herb may adversely affect motor reflexes and judgment for driving.  May potentiate effects of alcohol.  Chronic ingestion causes dry, flaky, discolored skin and reddened eyes.  Heavy kava users are more likely to complain of poor health and a "puffy" face, and about 20% are underweight (Med J Aust 148:548, 1988).


Other herbs commonly recommended to treat some of the symptoms of menopause include: bilberry, black currant, bitter melon, chamomile, damiona, echinacea, feverfew, flax seed, goldenseal, hawthorn, horsetail, motherwort, oat straw, pasque flower, passion flower, sage, saw palmetto, uva ursi, valerian root, and wild yam.  Their benefits and risks have not been sufficiently tested. 


Your first and best efforts to have a happy and healthy life around the time of menopause should be focused on a healthy starch-based diet, exercise, stress reduction, and quitting bad habits, like daily use of coffee, tobacco, and alcohol (Ann Pharmacother 31:915, 1997).  Next you may want to try herbal treatments and or HRT.  (I recommend the use of estradiol and progesterone cream applied to the skin. See November/December 1995 Newsletter).

The herb that is most likely to give you relief from menopausal symptoms, like hot flashes, is black cohosh.  Chaste berry would be your second choice.  Ginseng is relatively safe and has many positive effects on a person's state of well-being.  The additional estrogen effects may be particularly helpful for postmenopausal women. Licorice has definite hormonal effects, but sometimes undesirable and serious side effects.  This herb should be used with caution.  Hops hasn't been studied enough, so its actual effects are still to be determined.  Because of  lack of effectiveness and potential toxicity you should not use dong quai.

There are four alternatives to doctor-prescribed drugs to relieve depression.  Exercise relieves mild depression and anxiety by producing endorphins in the nervous system.  A healthy, low-animal-protein diet, allows the production of neurochemicals, like serotonin, that elevate mood.  Avoiding too much sleep is one of the most powerful antidepressants, because for many people too much sleep produces depressogenic substances.

Herbs can also provide effective mood-altering therapy.  Three such herbs have proven effective and relatively safe:  St. John's Wort for depression, ginkgo biloba to help with memory and confusion, and kava for a relaxant.  Use all of these herbal preparations for their desired effects, but be observant of side effects and discontinue if they occur.

Check the accuracy of this information with your doctor before applying information in this newsletter to your health care. Don't change your diet or medication without your doctor's advice.
Thank you!
John McDougall, M.D.

If you would like to read the other articles in this issue:

  • Protein and Calcium Loss
  • Potassium for Blood Pressure
  • Bacteria and Stomach Trouble

Call and order the March / April 1998  issue of The McDougall Newsletter for $3.50.

Here is one of three Recipes you will find in the March /April 1998 issue.

Herbed Rice Casserole
Preparation Time:  15 minutes (cooked rice needed)
Cooking Time:  45 minutes
Servings:  4-6

cup water
1 onion, chopped
1 green bell pepper, chopped
2 stalks celery, chopped
pound sliced fresh mushrooms
2 tablespoons soy sauce
teaspoon sage
teaspoon marjoram
teaspoon thyme
teaspoon rosemary
teaspoon poultry seasoning
3 cups cooked brown rice
cup chopped green onions
1  15 ounce can kidney beans, drained and rinsed
1  2.5 ounce can sliced black olives, drained
cup grated fat-free soy cheese

Preheat oven to 350 degrees.

Place the water, onion, bell pepper and celery in a large pot.  Cook, stirring frequently, for 5 minutes.  Add mushrooms and seasonings.  Cook for 10 more minutes.  Stir in rice, green onions, kidney beans and black olives.  Mix well.  Transfer to a covered casserole dish, sprinkle with the grated cheese and bake for 30 minutes. 

The other Recipes are:

  • All Wrapped Up Potatoes
  • Wild Hash
  • Savory Bean Topping
  • Caribbean Rice Surprise
  • Lasagna

Call 1-800-570-1654 and order your copy of the March / April 1998  McDougall Newsletter. Or Better yet, subscribe, and keep these fact filled Newsletters coming every 2 months.

 Index of back issues of the McDougall Newsletter and previous articles that appeared on this page: Index of Past Articles