Botanicals for Women’s Health

Botanicals for premenstrual syndrome (PMS)

PMS is defined as recurrent, cyclical, physical and/or psychological symptoms that occur 7-14 days
before the onset of menses. Symptoms may include pelvic cramping, bloating, headaches,
nausea/vomiting, change in bowel movements, acne, and mood swings. Sometimes these symptoms are
severe enough to interfere with daily life. Chastetree and ginkgo may be useful in the treatment of PMS
symptoms.

Chastetree (Vitex agnus-castus)

The Latin name of the chastetree plant (Vitex agnus-castus)
means “chaste lamb” because it was thought the seeds could be
consumed to decrease sexual desire. Indeed, monks used to
consume chastetree with the thought it would decrease their
libido. You may hear this plant more commonly referred to as its
Latin name vitex, or sometimes as chasteberry.
In current times, chastetree is used to ease the symptoms of
PMS. It’s thought that chastetree affects prolactin and
progesterone, two important hormones that contribute to the
symptoms of PMS. Scientific research1 supports the use of this
botanical for breast pain and mood swings associated with PMS,
and it is approved by the German Commission E for this purpose.
There is a folk tradition of using the botanical to help with
infertility; however, there is insufficient medical research to
support this claim. It’s best to avoid this botanical during
pregnancy.

Ginkgo (Ginkgo biloba)

You may be surprised to see ginkgo in the section for PMS! One
of the most interesting things about the plant world is that there
are so many botanicals that can be used for more than one
therapeutic purpose. You may recall that ginkgo has anti-
inflammatory properties, which may explain why it’s useful for
PMS symptoms. While more research is needed, there have
been several scientific trials2,3 that have found benefit in using
this botanical for PMS symptoms, especially for breast pain and
mood swings.
Ginkgo may cause several herb-drug interactions and should not
be used in patients who are on blood thinning medications.

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Botanicals for Women’s Health

Botanicals for menopause

Menopause is defined as the cessation of menses in women from a natural decline of reproductive
hormones. The age at which this occurs is different for each woman, but the average age is 52 years.
During this change, women experience a range of symptoms including hot flashes, night sweats, and/or
mood swings. Black cohosh, rhubarb, sage, and red clover may be useful in the treatment of these
symptoms.

Black cohosh (Cimicifuga racemosa)

Hormone replacement therapy (HRT) was the mainstay of
treatment for menopause. However, a large research trial
known as the Women’s Health Initiative found that HRT had
serious side effects, including an increased risk of blood clots,
cancer, and even death. This spurred the medical community to
research other potential treatments for menopause, and black
cohosh is one of the most heavily researched botanicals for
treating menopausal symptoms.
Although the World Health Organization and the German
Commission E approve using black cohosh to treat menopause
symptoms, evidence to support its effectiveness is inconclusive.
Some research trials show a benefit, but others do not.4,5 It’s still
reasonable to consider use, as it may work for some women.
Avoid black cohosh in patients with known liver disease, as this
botanical may affect the liver.

Rhubarb (Rheum rhaponticum)

Rhubarb is a popular plant grown in many gardens throughout
the world. Aside from use in culinary delights, a certain species
of rhubarb, rheum rhaponticum, has been used for decades in
Germany to treat the symptoms of menopause. Rhubarb is
thought to have weak estrogen-like effects. Modern science is
slowly getting on board with rhubarb: a clinical trial done with
109 women showed significant benefit with use of rhubarb over
placebo, especially in the reduction and severity of hot flashes.6
More research needs to be done to further define rhubarb’s
effects on menopause, but results are promising thus far.

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Botanicals for Women’s Health

Sage (Salvia officinalis)

Sage enjoys popularity as a spice, but this botanical has been
used in folk medicine for the treatment of menopause. One
research study6 found that sage was effective in reducing the
frequency of hot flushes. More rigorous research needs to be
done before definitive conclusions can be drawn.
An important safety concern regarding sage is that it contains a
compound called thujone, which can cause vertigo, kidney
damage, and/or seizures when consumed in large doses or over
long periods of time. Avoid ethanolic extracts and essential oils
of sage for this reason.

Red clover (Trifolium pratense)

Known for its cheerful pink flower heads, red clover is the
national flower of Denmark, as well as the state flower of
Vermont. More than just a pretty face, this plant contains
compounds called isoflavones, which act in ways similar to
estrogen. Because of this, red clover has been studied for its
potential role in the treatment of menopause. Research data has
been mixed as to the effectiveness of red clover, so definitive
conclusions cannot be drawn and more research is needed.
Because of its weak estrogenic properties, red clover should be
avoided in women with breast or ovarian cancer, or those who
are at high risk for either condition.

Botanicals for breastfeeding

Nursing mothers and healthcare professionals who interact them will attest that low milk supply can be
a source of stress and anxiety. As the name of the action implies, lactagogues are botanicals that help
with lactation by increasing the production of breast milk. The exact mechanism is unclear, but it may be
due to effects on prolactin, the hormone that increases breast milk production by stimulating the
mammary glands. Classic examples of lactagogues include fennel and fenugreek. While there is an
abundance of anecdotal reports from women that consuming fennel and fenugreek helped to increase
their breast milk supply, neither lactagogue has a sufficient scientific evidence base to confirm the
claims.

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Botanicals for Women’s Health

It is important to note that fennel and fenugreek should both be avoided in pregnancy. As such, neither
botanical is recommended to take prior to delivery, nor should they be taken by individuals who are
simultaneously pregnant and breastfeeding.

Fennel (Foeniculum vulgare) Fenugreek (Trigonella foenum-graecum)

References
1. Schellenberg, R., et. al. (2001). Treatment for the premenstrual syndrome with agnus castus fruit
extract: prospective, randomised, placebo controlled study. BMJ 322:134-137.
2. Tamborini, A., et. al: (1993). Value of a standardized Ginkgo biloba extract in the management of
congestive symptoms of premenstrual syndrome. Rev Fr Gynecol Obstet. 88:447-457.
3. Ozgoli, G,., et al. (2009). A randomized, placebo-controlled trial of Ginkgo biloba L. in treatment of
premenstrual syndrome. J Altern Complement Med 15:845-851.
4. Leach, M.J. & Moore, V. (2012, Sep 12). Black cohosh (Cimicifuga spp.) for menopausal
symptoms. Cochrane Database Syst Rev (9):CD007244
5. Newton, K.M., et al. (2006, Dec 19). Treatment of vasomotor symptoms of menopause with black
cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med
145(12):869-79.
6. Heger, M., et al. (2007 Mar-Apr). Efficacy and safety of a special extract of Rheum rhaponticum (ERr
731) in perimenopausal women with climacteric complaints: a 12-week randomized, double-blind,
placebo-controlled trial. Menopause 14(2):339.

 2018 Regents of the University of Minnesota. All rights reserved.