Nothing in the human organism surpasses the complexity of responses that the female reproductive system possesses. When this miraculous system comes to the limits of its functional potential, a wide range of symptoms, and even health problems, can arise, leading her to seek medical help. Medicine calls that perimenopause syndrome. This diagnosis encompasses an almost infinite variety of clinical situations, where hormone therapy alone does not always resolve all complaints.
There are also situations where hormone supplementation is contraindicated, such as in cases of gynecological cancer with a positive hormone receptor. In the last 50 years, clinical and pharmacological investigation of phytochemicals has disclosed activity in many medicinal plants traditionally used in the treatment of menopausal symptoms and complaints related to the female reproductive system, showing potential to add more therapeutic tools to the approach to these symptoms. So, these new actors that can be added to current therapeutics can also significantly contribute to treating problems and improving quality of life during the perimenopause period, at a time when healthy longevity is becoming a goal pursued by modern medicine.
We have called this fusion between conventional medicine and traditional therapeutic actions with scientific validation "integrative medicine". This is undoubtedly a strong trend, especially when considering the movement to individualize treatments and seek well-being, and not just the correction of medical problems. The biggest challenge here is that we are integrating therapeutic tools that have very different essences and logics. Therefore, for there to be a truly effective "integrative medicine", the healthcare team needs to be familiar with these differences and know how to take advantage of their complementarity.
One of the main paradigms that needed to be broken is that medical science methodology was developed to investigate and approve single new molecules, with strong pharmacological potency, and their safety and efficacy in treating diseases. When the concern is phytomedicines, all these parameters change to very old chemicals that have been in close contact with the human species for centuries, most of them with weak or medium pharmacological potency, whose benefit results from the complex interaction of dozens of biologically active compounds and is more geared towards relieving symptoms and improving subjective well-being.
What Forty Years of Phytotherapy Teaches You
I trained as a physician in Brazil, then spent years studying integrative approaches across France, China, and Portugal. Phytotherapy has been part of my clinical practice for most of my career. Long enough to have watched the field move through several phases — from being dismissed as folklore, welcomed by society in general, and by a small group within academia that initiated scientific research in the 1990s, and finally its progressive incorporation into medicine, within an integrative perspective, by innovative medical trends in the last 15 years, as research proved its therapeutic value.
What that experience teaches you is that plants are not only a softer way to treat common health issues. They can be safe and effective in treating diseases, improving quality of life in severe conditions, like cancer, and enhance the potency of conventional treatments with medications and other therapeutic interventions, in many diseases. The great majority have a gentle profile and an excellent degree of safety. But there are some with potent pharmacologic action, capacity to modify other drugs' action, or even increase the risk of adverse reactions. Fortunately, these are exceptions, even though they are common enough to deserve attention. All this knowledge must be known and considered when used in medical treatments, which requires a deep understanding of the recently produced science on these plant assets. The framing of "natural therefore harmless" is one misconception of therapeutic phytotherapy in disease treatment, as efficacy or safety can be compromised. Any patient in medical treatment who desires to adopt an integrative approach, incorporating herbal medicine into their therapeutic tools, should inform the doctor coordinating the treatment of this option, and then seek help from a healthcare professional trained in prescribing phytomedicines.
Besides that, the physician using phytomedicines must learn more about how plants deal with their challenges, as we are using their powerful chemical adaptation capacity, developed over thousands and thousands of years of evolution, for our benefit. Plants never use single compounds, but complex mixtures of dozens of phytochemicals to achieve their goals. These chemical mixtures are called phytocomplexes. They work in the human body in a very different way from a single active ingredient, which predominates in modern pharmacology. Most phytomedicines need one week or more to achieve their full potency. For this kind of effect, the term "adaptogenic" was created to characterize the way phytocomplexes act.
Which herbal medicines have the strongest evidence and best results in menopause?
When evaluating phytomedicines it is necessary to use a different perspective from the one used in usual medical science, because what we do can be compared to a circle, where the end of the investigation is very close to the point where it began. In modern pharmacology, a new molecule is created with lab technology, then passes through in vitro studies, in vivo studies, and if all goes very well, you can consider trying it in humans. So it is a line with a beginning, middle, and end.
Phytomedicines come from medicinal plants that were already used for very long periods of time to treat symptoms, or even diseases, before they were analyzed by the tools of modern science. So, when you begin investigating and find chemicals or pharmacological activity that support the popular use, you already have two endpoints of the rational therapeutic line filled. The probability of these two pieces of information being unrelated is near zero. And as most popular medicinal plant uses have shown some coherence, it's time to respect the cultural process more as a reliable source of information in the construction of scientifically accepted evidence. This already exists, although outside the medical science bubble, through the ethnosciences, where ethnopharmacology and ethnomedicine can be used as scientific evidence in the study of medicinal plants. So many phytomedicines meet these requirements, although they don't have a huge volume of clinical studies and meta-analyses.
Modern pharmacology
A line: beginning, middle, end
- A new molecule is created in the lab
- In vitro studies
- In vivo studies
- Trials in humans
Phytomedicines
A circle: the end meets the beginning
- Long traditional use to treat symptoms
- Chemical and pharmacological analysis
- Findings support the traditional use
Most clinical research
Soy, black cohosh and sage, mainly for hot flashes
Strong for premenstrual symptoms
Chaste tree, with fewer studies in menopause
Traditional use and early research
Mexican yam and dong quai
Mexican Yam Dioscorea villosa
A medicinal plant originating from the Americas, used for various health problems by the Incas and Aztecs, and later by populations in Mexico, Central America, and South America. Among its many uses were treatments for perimenstrual syndrome and menopausal symptoms. Analyses of this plant carried out in the 1950s and 60s revealed it to be rich in steroidal saponins, the main one being diosgenin. This substance showed many similarities to female sex hormones and was therefore exploited for over 30 years to produce the steroidal base of estrogens and progestogens used in the manufacture of contraceptives. Studies conducted on laboratory animals have shown that diosgenin reduces menopausal symptoms caused by the removal of the ovaries. Also, there is evidence that diosgenin increases progesterone production, even during menopause. There are few clinical data published, but Mexican Yam has been shown to increase bone mass in menopausal women. It also helps a lot of old ladies with osteoarthrosis symptoms, as diosgenin has an anti-inflammatory effect.
Chaste-tree nut Vitex agnus-castus
A plant native to the Mediterranean region and south-central Asia, its use has been recorded for over 3,000 years. Its use in treating perimenstrual syndrome and menopause also dates back to antiquity; however, the dissemination of its medicinal use was carried out by Jesuit priests, who took it with them wherever they went. This is because it also has the property of reducing male libido, and this effect was considered miraculous. Vitex possesses several active compounds, including alkaloids, flavonoids, and triterpenes that act at different levels, either peripherally or at the pituitary level, where they inhibit the production of hormones (FSH and prolactin). Its flavonoids exhibit a weak phytoestrogenic effect. It may be indicated for menopausal patients with very high FSH, those with mood swings, and as a potentiator of hot flash reduction when combined with Black Cohosh. Chaste-tree nut has very strong clinical evidence for perimenstrual syndrome, but there are only a few clinical studies for menopause.
Dong Quai Angelica sinensis
A plant of Chinese origin with strong ethnopharmacological support for use in various problems associated with female hormonal disorders. Legend says that Emperor Shen Nong (a mythological figure considered the creator of Chinese herbal medicine) once went in search of a plant to help women with their problems, and returned bringing Dong Quai as his special gift to the opposite sex. Since time immemorial, this plant has been widely used in formulas for problems such as amenorrhea, dysmenorrhea, menopausal symptoms, and infertility. Modern pharmacology has not revealed any molecule with affinity for hormone receptors, but clinical research shows benefits such as improved libido, treatment of amenorrhea, menopause, and infertility. Most of the literature is published in Chinese, and therefore little valued in the West. In laboratory animals, effects such as increased copulation, increased lactation, and increased fertility have been reported. Doctors who use herbal medicine advise Angelica sinensis as a potentiator in formulas aimed at reducing symptoms such as fatigue, depression, reduced libido, insomnia and hair loss during menopause.
Soy Glycine max
Soybeans are a legume domesticated by humans in ancient times, originating in Central Asia. No native forms of soybeans are known, only domesticated varieties. Widely cultivated as food, it is one of the largest sources of plant protein reported by science. Soybeans began to attract attention when researchers identified that Asian populations, who consumed them in large quantities in their diet, experienced several health benefits, such as a low incidence of gynecological cancer and a low incidence of menopausal syndrome. It was also observed that the bone mass of elderly individuals in these populations was greater than that of controls who did not consume the legume in their diet. Phytochemical investigation identified compounds from the isoflavone class with affinity and capacity to stimulate estrogen receptors, with genistein being the most abundant and potent. There is ample scientific literature, including clinical studies and meta-analyses, supporting this therapeutic effect.
Black cohosh Cimicifuga racemosa / Actaea racemosa
This plant has a reported ancestral medicinal use by North American Indians. Among the different uses supported by ethnopharmacological data, there is a strong reference to its use in perimenstrual syndrome and menopausal symptoms. These indications led scientists to study the plant's effect on this latter clinical condition. It was demonstrated that the plant extract influences the hypothalamic-pituitary function of sex hormones, and that this may be its main mechanism of action. The standardized plant extract has been tested in several clinical series with patients experiencing menopausal symptoms, showing results primarily in controlling hot flashes. Currently, it is even available on the formal pharmaceutical market, positioned as a conventional medication.
Sage Salvia officinalis
Salvia is a European plant widely used almost as a panacea in the treatment of numerous clinical conditions, having been mentioned in the work of Galen. Its name comes from the Italian "salvare," as it was considered the last medicine that could be tried when all other attempts had failed. Among its strongest indications at that time was its use in complex female symptoms, known as hysteria, a disease attributed to a hormone that, at the time, was believed to be produced by the uterus. This motivated a Swiss company to investigate its use in treating menopausal symptoms, and the results were excellent, especially in controlling hot flashes, nervousness, and insomnia. Several clinical series have been conducted, with meta-analyses, but the mechanism of action is still unclear.
Besides the above-mentioned, there are many others, some less used, others with less scientific evidence, but that have been used by many integrative professionals on special occasions. Among the most popular, I can quote the following:
- Hibiscus
- Flaxseed oil
- Red clover
- Chamomile
- St. John's Wort
- Fenugreek
- Licorice
- Goji berry
- Mulberry
- Maca
How to obtain real balance and symptom relief with phytomedicines?
In my opinion, more than 50% of female patients can be treated with phytotherapy alone, controlling their main complaints, although low-dose transdermal estrogen combined with medicinal plants (an integrative approach) can obtain better results. Together the two do better than either approach separately. But to have good results with phytotherapy, the doctor needs to learn the main principles of how to associate the plants, because they do well only in formulas.
One of the main lessons that worldwide ethnomedicine teaches us is that herbs must always be used in combination to work properly. In all the different cultures that have developed medical herb approaches throughout human history, on the five continents of the earth, plants were always combined. This cannot be a coincidence. It is evidence. But as doctors are trained to see associations as increased risk (because this is the rule for synthetic drugs), they think the same logic applies to most phytomedicines. But I do not see them worried about what you are going to eat, although some foods also interfere with medication.
And what we see in epidemiologic evaluations is that food rich in vegetables is good for health. So nutrition says you should eat at least 4 or 5 different vegetables a day. You do not get upset if you eat a mixed salad. But cabbage has glucosinolates and isothiocyanates, both helping liver detoxification; lettuce produces flavonoids (quercetin), luteolin and procyanidin, with antioxidant properties; onion produces sulphurated essential oils that help digestion and have an antiviral effect; beetroot is rich in betaine, a substance that improves the body's methylation process, besides anthocyanidins and free citrulline, a vasoactive amino acid that improves cerebral circulation.
There is no plant that does not synthesize hundreds of active substances, because they would not survive if they had no chemical adaptation system. That allows them to adapt to climate variations, to defend themselves against the same pathogens that attack mankind (viruses, bacteria, fungi, parasites) and to promote their vital processes. There are cases of plant–drug interactions, but they are rare. It is not enough risk to stop using them for our benefit. So, when a doctor associates 4 or 5 herbs to treat menopause, there is no significant risk in doing so.
On the other hand, plant association allows you to adjust the formula to the specific set of symptoms presented by the patient in the face of ovarian failure. If the patient has a lot of hot flashes, you can choose Sage, Black Cohosh, and Vitex as the main ingredients. If bone mass is the question, prescribe Dong Quai, Mexican Yam and Soy, and so on. Just to give an example. In general, every patient has her complexity, and the more you know about the patient, the better your intervention will be.
Many hot flashes
Sage · Black Cohosh · Vitex
Bone mass
Dong Quai · Mexican Yam · Soy
How is menopause treated with phytotherapy and integrative medicine?
Although menopause is not a disease, it is an adaptation crisis to a new reality, where the body must learn to live with much less female hormonal support than usual, as the woman's reproductive capacity has been exhausted and the stimuli necessary for reproduction cease. In general, this is a fast change and can even be almost abrupt. So, even if it is not a disease, because it is expected in all individuals, most women have an intense feeling of decreased capacity in many areas, besides symptoms such as disrupted sleep, fatigue, hot flashes, depression, acceleration of aging, etc.
So, like in other human development crises (childhood, adolescence, and pregnancy itself), having medical support makes a lot of difference in preventing future conditions and improving quality of life. Most women (more than 80%) become symptomatic with menopause, and even those who are asymptomatic should have medical supervision. So routine blood evaluation, including hormones, metabolism, blood cells, urine and stool, besides bone mass and internal organ imaging, is mandatory from time to time, to prevent or to promote early treatment of degenerative problems that can come with menopause.
Many of the interventions required may need to be kept for a long time, and others can be stopped if the woman is well and without symptoms. But the rule, for most patients, is that menopause support will be followed by geriatric support. Another very common aspect in our clinic is that the proposed treatment is always very personalized. We see every person as a unique complexity, and our goal at B-Life is to adjust every therapy to the specific needs of each of our clients.
We also have a deep respect for our clients' beliefs and values. This is a directive that helps us to build our treatment strategy. If the patient does not want to be submitted to any kind of intervention, this will be respected, and we will find another way to treat her, with our best knowledge. And for patients with that profile, integrative medicine is a choice that fits better than any other.
Frequently Asked Questions
What is phytotherapy, and how can it help during menopause?
Phytotherapy is the medical use of plant-based preparations. In menopause it can help ease symptoms such as hot flashes, disrupted sleep, mood changes and low energy. It can be used on its own or alongside conventional treatment. Plants act through complex mixtures of compounds, called phytocomplexes, so their effect tends to be gentler and more gradual than that of a single synthetic drug.
Which medicinal plants have the most evidence for menopausal symptoms?
Soy isoflavones, black cohosh and sage have the most clinical research, mainly for hot flashes. Chaste tree (Vitex) has strong evidence for premenstrual symptoms but fewer studies in menopause. Dong quai and Mexican yam are supported mostly by long traditional use and early-stage research. In practice, the choice depends on each woman's symptoms and health history, not on one plant alone.
Which herbs are used for hot flashes?
Black cohosh and sage are the plants most studied for hot flashes. Chaste tree may be added to strengthen their effect in some cases. Soy isoflavones can also help, as they act gently on oestrogen receptors. The right combination and dose should be defined by a physician trained in phytotherapy.
Are herbal remedies for menopause safe?
Most medicinal plants have a gentle profile and a good safety record. "Natural" does not mean harmless, though. Some plants have potent effects, can interact with medication or can raise the risk of side effects. This is why phytotherapy should be prescribed and monitored by a trained healthcare professional rather than self-administered.
Can phytotherapy be combined with hormone replacement therapy?
Yes, in many cases. An integrative approach may combine low-dose transdermal oestrogen with medicinal plants, and the two can complement each other. The combination should always be planned and followed by the physician coordinating your care.
What are the options if hormone therapy isn't recommended for me?
Hormone therapy is contraindicated in some situations, such as hormone receptor-positive gynaecological cancer. Phytotherapy may be one of the tools to consider in these cases. Plants with oestrogen-like activity, such as soy, need a specific assessment, and the decision should involve your oncologist or attending physician.
How long do herbal medicines take to work?
Most phytomedicines need a week or more to reach their full effect. They work progressively, helping the body adapt, so give them time and review how you feel with your physician before adjusting the plan.
Why are plants usually prescribed in combination?
Traditional medical systems across the world have always combined plants. Combinations let the physician tailor a formula to each woman's symptoms. For example, one formula can focus on hot flashes, and another can support bone health. Each formula is built around the individual, not a standard protocol.
Should I tell my doctor if I'm taking herbal supplements?
Yes. If you are already under medical treatment, tell the doctor coordinating your care before starting any herbal product. Then seek a professional trained in prescribing phytomedicines, so that possible interactions are assessed.
How does B-Life approach menopause care?
At B-Life, menopause care is personalised and continuous. It combines regular health assessments, conventional medicine and evidence-based phytotherapy, always respecting each woman's values and preferences. It is led by Dr. Alexandros Botsaris within B-Life Care, the clinic's continuous care membership.
This text is for informational purposes only. For medical advice or diagnosis, consult a professional.
