Chinese herb mix may cool hot flashes a bit

A mix of certain traditional Chinese herbs thought to have weak estrogen-like activity might help ease menopausal hot flashes, a small clinical trial suggests.

But the herbal mix, dubbed Jiawei Qing’e Fang, is not widely available. And while the new study suggested some benefits, it had enough limitations that the true effects of the herbs are still unclear, according to an expert not involved in the work.

For the study, reported in the journal Menopause, researchers in China randomly assigned 72 women to either take Jiawei Qing’e Fang everyday for eight weeks, or use a placebo mix of starches that were made to look, taste and smell like the herbs.

All of the women were relatively young - between the ages of 45 and 55 - and either had irregular menstrual periods, or had recently stopped menstruating. At the outset, all said they were having at least 14 bouts of hot flashes per week.

After eight weeks, women on the herbal mix showed a 70 percent drop in their hot flash “score” - which reflects how often and how severe their hot flashes were. The placebo group also showed a big, though not as dramatic, improvement: a 56 percent decline in hot flash scores.

The benefit in the placebo group may reflect psychological effects (that is, women who thought they were receiving the real thing felt better), according to senior researcher Dr. Xiumei Gao, of Tianjin University of Traditional Chinese Medicine in China.

Hot flashes are one of the most common symptoms of menopause and around 80% of women will suffer from them as they reach the end of their reproductive life. Although it’s commonly know that hot flashes are caused by changing hormone levels during menopause, the longevity of hot flashes suffered by some women post menopause is still relatively little researched.

A study has highlighted the plight of a significant minority of women post-menopause who have been suffering from uncomfortable and upsetting hot flashes ever since the onset of menopause. The three year survey began by using a questionnaire which 3167 women completed. All the subjects involved were post menopausal and suffering from osteoporosis. Of all the women, 11.8% (375 women) reported highly irritating hot flashes after the first questionnaire. Researchers were keen to say that of the group of 375 women suffering from hot flashes, a range of contributing factors were present. For instance, educated women tended to suffer less from hot flashes whilst women with a higher body mass index were generally found to suffer more hot flashes post menopause. This could be due to a link between education and a healthier lifestyle. Women with weight issues, although they might have higher estrogen levels, are known to suffer more during menopause. Subjects who had been previously treated with hormone therapy were also more likely to suffer from hot flashes post menopause as were those suffering with high FSH levels.

But the current findings suggest that Jiawei Qing’e Fang has benefits beyond the placebo, Gao told Reuters Health in an email.

There’s also some lab research suggesting that the trio of herbs used in the mixture has estrogen-like activity - which, in theory, could help cool hot flashes.

Traditional Chinese Medicine (TCM) and Menopause Symptoms

Western medicine recognizes many symptoms of menopause. Hot flashes, night sweats, irregular periods, lower libido, vaginal dryness, mood swings, and fatigue are the most common. Doctors of Chinese medicine also recognize these as menopause symptoms. Other symptoms of menopause recognized by Western medicine, such as hair loss, some sleep disorders, loss of memory or concentration, dizziness, weight gain, bloating, allergies, assorted aches and pains, irregular heart beat, and even osteoporosis are not signs or symptoms of menopause, to practitioners of Chinese medicine, but rather indications of other disharmonies existing together with or interacting with normal menopause symptoms.

To understand menopause symptoms as a practitioner of Chinese medicine would, forget about hormones and see your body in terms of yin and yang. Activity, movement and metabolism are called yang. Yang metabolic activity generates friction and heat. Bodies require circulating fluids, known as the yin, to cool and insulate us from this heat. The yin has been described as a mist that cools the heart, liver, lungs, stomach, and intestines. If this yin is deficient, you’ll feel the heat or the effects of the heat.

The syndrome of feeling hot because your cooling system is weak has many names: yin deficiency fire, vacuity fire, deficiency heat, weak heat, false fire and other similar terms. In truth, menopause is never simply yin deficient heat. After approximately fifty years of life, a person arrives at menopause with a complex set of deficiencies and discomforts. Some of these are caused by diminished yang, qi and blood, as well as by deficient yin.

Most true menopause symptoms come from a combination of both yin and yang deficiencies, in which yin deficiency predominates. This results in dryness sometimes accompanied by minor inflammatory symptoms.

The mix used in this study was based on a traditional Chinese preparation known as Qing E Fang, whose first recorded use for menopause symptoms goes back more than 1,000 years, according to Gao.

The researchers used two herbs from that formulation - cortex eucommia and fructus psoraleae - plus a third, called Salvia miltiorrhiza that is used in Chinese medicine to treat “gynecologic diseases.”

The study is interesting, said Dr. Gregory A. Plotnikoff, director of the Institute for Health and Healing at Abbott Northwestern Hospital in Minneapolis.

But there are also a number of important limitations to the research, according to Plotnikoff, who researches herbal medicine, including its use for menopause symptoms.

For one, he told Reuters Health in an email, the placebo response in this study “is huge in comparison to most clinical trials and every menopausal hot flash trial I have ever reviewed.”

And that raises questions, Plotnikoff said - including whether women in the study could have been reporting hot flash improvements in order to “prove something,” or even to please the researchers.

He also said that the study was simply too small to know whether the statistically bigger improvement in the herb group was a real advantage over the placebo group. The difference was “barely” statistically significant, Plotnikoff said, and “could easily disappear” if a larger group had been studied.

Gao said that a further, larger trial is now underway to try to confirm the current findings.

But even if the herb mix proves to be better than a placebo, Plotnikoff questioned the appeal it would have. The herbs are thought to have estrogen-like activity, and many women want hot flash relief without hormonal effects.

Right now, hormone replacement therapy (HRT) is considered the most effective therapy for severe hot flashes.

But its use sharply dropped after a large 2002 U.S. clinical trial found that women on hormones had higher rates of heart attack, stroke, breast cancer and blood clots than placebo users.

Experts now advise that if women use HRT for menopausal symptoms, they should take the lowest possible dose for the shortest time possible.

There are several herbal or “natural” products marketed for easing menopause symptoms, including black cohosh, soy, red clover and dong quai. But there is little evidence from clinical trials on whether they work, according to the North American Menopause Society.

Black cohosh is probably the best studied, but trials have come to mixed conclusions about whether it is helpful.

If hot flashes are not severe, experts say, simple steps like avoiding hot and spicy foods, turning down the thermostat, or relaxation techniques, such as yoga or meditation, may help.

For most women, hot flashes gradually get better with time.

Another issue with the current study, according to Plotnikoff, is that the women were fairly young and in the middle of transitioning to menopause a time when hot flashes are naturally highly variable.

Because of that, Plotnikoff said, data from such women would not be accepted by the U.S. Food and Drug Administration as evidence of an effective hot flash remedy.


SOURCE: Menopause, online November 14, 2011.


Xia, Ye MSc; Zhao, Yingqiang MD; Ren, Ming MD; Zhang, Junhua MD; Wang, Yuefei PhD; Chang, Yanxu PhD; Fu, Shufei MD; Fan, Guanwei MD; Zhu, Yan PhD; Huang, Yuhong MD; Gao, Xiumei MD, PhD

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