Menopause, Managing Hot Flushes

Research is confirming what herbalist have known for years, that herbal medicine can offer a real option for women experiencing menopausal symptoms.

According to the Women's Health Council the top four menopause symptoms experienced by women in Ireland were hot flushes, night sweats, irritability and mood swings.

It's important to remember Menopause is not a disease or illness that needs to be treated; it's a transition, a biological process that requires facilitation. Even though it is a natural process, you shouldn’t hesitate to get help if you are having severe symptoms. Physical and emotional symptoms of menopause can disrupt your sleep, sap your energy and can indirectly trigger feelings of sadness and loss.

Herbal medicine can help the system to safely and effectively adapt during this transition, minimising symptoms without side effects or increased risks of cancer.

Women experiencing mild symptoms may find relief from over the counter remedies however if you are experiencing prolonged or severe symptoms which have not responded to over the counter herbal medications, then it is time to see your local medical herbalist who can assess and individually tailor a prescription to address all your symptoms.


I regularly treat menopausal women who say , ' I have tried x, y, and z and they didn't work for me'. There are a number of reasons for this, firstly one pill or supplement or herb cannot treat the numerous and variable symptoms which many menopausal women experience. Secondly, women may have different triggers for their symptoms, which may have pre-existed their transition into menopause, such as dietary or lifestyle choices. Only when both these aspects are looked at can you truely have an individual approach to treatment.




Technically, you don't actually "hit" menopause until it's been one year since your final menstrual period. The average age is 51 in Ireland.

The signs and symptoms of menopause, however, often appear long before the one-year anniversary of your final period. They include:

§       Irregular periods

§       Decreased fertility

§       Decreased libido

§       Vaginal dryness

§       Hot flushes

§       Sleep disturbances

§       Mood swings

§       Increased abdominal fat

§       Thinning hair

§       Loss of breast fullness

§       Premenstrual migraine (in perimenopause)

If you've skipped a period but aren't sure you've started menopause, you may want to check to see if you may be pregnant or see your medical herbalist or GP, who may perform blood tests to help determine if you are entering the period of change (perimenopause) in the months or years prior to menopause. If necessary your level of follicle-stimulating hormone (FSH) and estrogen (estradiol) may be checked. As menopause occurs, FSH levels increase and estradiol levels decrease. Your doctor may also recommend a blood test to determine your level of thyroid-stimulating hormone, because hypothyroidism can cause symptoms similar to those of menopause. Many of the above symptoms are experienced by women with PMS, generally perimenopause is accompanied by cycle irregularities and flushing.

Always seek medical advice if you have bleeding from your vagina after menopause.



Cardiovascular disease

When your estrogen levels decline, your risk of cardiovascular disease increases. Yet you can do a great deal to reduce your risk of heart disease. These risk-reduction steps include stopping smoking, reducing high blood pressure, getting regular aerobic exercise, and eating a diet low in saturated and hydrogenated fats, and plentiful in whole grains, fruits and vegetables. A medical herbalist can prescribe you medication to help lower high blood pressure and deal with high cholesterol.


During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Osteoporosis causes bones to become brittle and weak, leading to an increased risk of fractures. Postmenopausal women are especially susceptible to fractures of the hip, wrist and spine. That's why it's important during this time to get adequate calcium and vitamin D — about 1,200 to 1,500 milligrams of calcium and 800 international units of vitamin D daily.

 It's also important to exercise regularly. Strength training and weight-bearing activities, such as walking and jogging, are especially beneficial in keeping your bones strong.

Restless Leg Syndrome (RLS)

Restless legs can often accompany insomnia; in menopause this can often be associated with lack of magnesium which can be lost from the body during times of stress. Solution: 250mg of Magnesium citrate at bed time. RLS may have a family link in 30% of cases where it is associated with a higher need for folate in the form of folic acid. Solution : get blood tests before supplementing
. If RLS is ongoing throughout the day it may also be associated with low iron stores, this can be checked by assessing the serum ferritin levels in the blood, and this type of RLS can be especially common in the elderly who may not absorb iron well.



Anaemia might develop due to heavy periods during the perimenopause.  Your medical herbalist can prescribe you herbs to reduce the blood loss and also offer dietary advice to help increase overall iron levels.


Dietary Hints and Tips

Eat plenty of plant oestrogen foods:

soya beans, fennel, celery, parsley, lentils, barley, mung beans (these are the bean sprouts you find in Chinese food), split peas, alfalfa (sprouted alfalfa seeds available in your health food store, they are a super food!) fenugreek seeds and red clover tea.

Suggestions: Soya can be cooked as the whole bean in soups and stews
The next best is Tofu which is a block of soya curd. It resembles a block of cheese and has a very neutral taste. Use small amounts to start with and put it in lots of things. The simplest is mixed into a stir fry, use about the same amount as you would like to find mushrooms in your meal!. A meatier version is Tempeh, which is a more mature tofu, this may appeal to those who find the tofu texture difficult to swallow. 
Pearl or soup barley and lentil and split pea soup mix are available in every supermarket and can be added to soups and casseroles. As always start with a little to gradually get used to the texture.

Whole grains; whole wheat, buckwheat, oats, barley etc

Vegetables and fruit: A wide variety, include a range of all colours and textures, these contain a variety of helpful vitamins, minerals, antioxidants etc. to keep you healthy.

Essential Fatty Acids:

Nuts: (except peanuts and pistachios), almonds, brazils, walnuts, cashews, hazelnuts, pine nuts etc

Seeds; sunflower, pumpkin, sesame, alfalfa, fenugreek (add to homebaked bread).

Total nuts and seeds per day 2-3 tbsps. Mix and eat as a snack or add to salads, porridge and smoothies.

Oily fish: Sardines in oil or tomato, mackerel (fresh, tinned or vacuum packed), wild salmon (fresh in season, tinned or smoked), fresh tuna.

Take 2-3 portions per week.

Cold Pressed oils: (These are full of essential fatty acids) especially Flax and Linseed oil. Use these on salads, or drizzle over a stir fry, Mash into potatoes. Do not cook them they lose their goodness and are too expensive to waste.

Avocados: enjoy half to one per week.

Calcium: Good sources include all dairy products, tinned bony fish, nuts and seeds, green leafy vegetables 
(Including broccoli, spinach, cabbage, lettuce) blackstrap molasses, dried figs and prunes, green tea, legumes (bean/pea family).

Vitamin E: Has been found to reduce hot flushes and vaginal dryness, both topically and internally.
Exercise: Research has shown that women who do just 30 mins a day of exercise have significantly less hot flushes.

Evening Primrose Oil: Many studies show that Evening Primrose Oil has little more effect on menopausal symptoms than placebo but what it is shown to help is PMS symptoms – much of which is what you will be dealing with during the perimenopause. Dose: 1-3g daily.

Try to avoid artificial sweeteners particularly those containing aspartame, these are generally products labelled, sugar free, or low calorie, aspartame is 180 times sweeter than sugar and has been found to lead to weight gain, and low mood.


General Hints:

Keeping the bowels clear is important so that the body does not recycle hormone waste products eliminated in bile. Ground linseeds can help (also providing Essential Fatty Acids and minerals).

Water is important particularly so if you are taking linseed.


Herbal treatment of symptoms is quite different to the medical approach where HRT is used to replace the lost hormones. Herbs do not work in this way and are not the same as replacement hormones – if they were, herbalists would be experiencing the same difficulties with adverse effects that are now confronting doctors using HRT. Generally a number of herbs are combined to address each woman’s unique array of symptoms.


Sage (Salvia officinalis)

Sage can be taken as a cold tea or as a tincture for hot flushes; the quantity required can sometimes depend on the severity of the flushing. If a larger quantity is required then a tincture may be more suitable. Most herbalists will use sage in combination with other hormonal herbs to treat menopausal symptoms; however some women find that if the flushing is mild a tea can be enough to control them.

As a tea:  Take 5-10 sage leaves chop up finely, pour boiling water over the leaves and cover them 
. Allow to infuse for at least 15 minutes. Allow to cool and drink throughout the day, add to daily drinking water or sip as required.

Available as tincture (take as directed) €10.50 or tea bags €2.20 from your local healthfood store. I look to use the fresh herb where possible, dry it to store for the winter.


Black Cohosh (Cimicifuga racemosa)

Black Cohosh has an oestrogenic like activity in the body, however it does not exert any of the harmful oestrogenic effects on the uterus or the breast.
Black Cohosh is effective on its own or in combination with other herbs for combating hot flushes, vaginal dryness, mood changes and other menopausal symptoms associated with oestrogen decline.

Black Cohosh can be taken as a tincture or as a tablet as directed.


Wild Yam (Dioscorea villuosa)

Taking this herb internally is markedly different form taking it as a 'cream', no evidence exists that wild yam cream is of any use in reducing menopausal symptoms even though it is marketed as a progesterone cream. When taken internally, this herb is thought to act as an oestrogenic herb by influencing the hormonal feedback system in the body. Wild Yam is an ideal herb where there may be pain or cramping with the periods accompanying the transition to menopause as it also has anti-spasmodic and anti-inflammatory properties.


Psyllium Husks and Linseeds

Proper bowel function is important in maintaining hormone balance in the body. 
Psyllium husks are a bulking laxative which will provide a source for soluble fiber which can help maintain regular bowel function.
Linseeds provide a source of fiber and are broken down by the gut micro flora into phytoestrogens.

Both can be purchased in a local health food store. Psyllium husks €3.88 for 250g. Take 3-45g daily in divided doses 20 minutes before meals. Mix husks in a full glass of juice, water or soya milk and follow on with another full glass of water. Increase dose gradually over 3-4 weeks to allow the body to adjust to the increase in fibre.


St Johns Wort (Hypericum perforatum)

Many women may experience depression, anxiety or insomnia for the first time around the menopause. Both observational and clinical studies have found that such symptoms improved in menopausal women taking St Johns Wort. Studies have shown this herb to be effective in treating mild to moderate depression. Furthermore when taken in combination with Black Cohosh these mood symptoms were found to improve even more than taking Black Cohosh on its own.

St Johns Wort is on prescription only in Ireland this means it can be dispensed by a qualified medical herbalist or general practitioner. It is a very safe herb to use long term but can interact with certain medications therefore it is important that you obtain it from a professional source.


Articles of interest.....

Black cohosh with or without St. John's wort for symptom-specific climacteric treatment–Results of a large-scale, controlled, observational study.


Briese V, Stammwitz U, Friede M et al. Maturitas 2007; 57(4): 405-414


Black cohosh (Cimicifuga racemosa) alone or in combination with St John's wort (Hypericum perforatum) has demonstrated benefit for menopausal symptoms in randomised, placebo-controlled trials. A large scale, observational study compared the effect of black cohosh alone (monotherapy) and black cohosh in combination with St John's wort (combination) in women from all parts of Germany. The study was conducted between March 2002 and March 2004

and included 6141 women with any menopausal symptoms who had not taken hormone replacement therapy (HRT) in the 4 weeks preceding the study. The participants had mostly mild to moderate symptoms and were treated with recommended doses of monotherapy or combination. The treating physician determined the choice of treatment.


Key Finding: Combination of St John's wort and black cohosh was somewhat superior to black cohosh alone in alleviating mood symptoms of menopause in an observational study. More robust results may be obtained by using higher doses.


Please note that the advice given in these notes is not intended to be a replacement for professional medical advice and treatment. Always visit a fully qualified medical herbalist or G.P. for diagnosis. If you are pregnant, have an existing condition or are currently taking medication consult a medical herbalist to see which herbs are appropriate for you to take.

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