Menopause, or change of life, affects all women, usually between the ages of 40 and 60 years of age, and may follow a total hysterectomy or illness.
As the reproductive cycle comes to an end, the female hormone oestrogen decreases. This decrease in oestrogen heralds the onset of a number of changes ranging from hot flushes to bad temper and depression. After age 30 , calcium in the body is leached from the bones into the blood, however, this increases markedly after menopause. During a woman's life, she will lose approximately 50% of the cancallous bone 30% of cortical bone. Men will lose 30% and 20% respectively.

The result for many women is a weakening of the bones and the onset of the disease osteoporosis. Dowager's hump and brittle bones which break easily are two results. Also as the oestrogen levels drop there may be an increased risk of cardiovascular disease.

Hormone replacement therapy may be prescribed by a medical practitioner in an attempt to replace the diminishing oestrogen levels. To minimise the side effects including increased risk of breast cancer, a formula containing the hormones oestrogen and progesterone are used. However, hormone replacement therapy is not without its problems. Dr. Renate Klein, deputy director of the Australian Women's Research Centre at Deakin University, said women were risking a higher possibility of breast cancer, migraines and high blood pressure as well as severe weight gains through H.R.T. and only 2-3% of women taking H.R.T. actually needed to.
A study conducted by Harvard Medical School involving 122,000 women, published in June 1995 in the New England Journal of Medicine found that women who have been taking HRT for more than five years increased the risk of breast cancer by an average of 30-40 per cent, and for those 60 - 65 years of age the risk increased to a staggering 70 per cent.
One of the most important treatments in managing menopause is to adjust the diet. Don't drink as much coffee and alcohol as these can increase the excretion of calcium in the urine. Eat foods high in calcium such as dairy products, salmon and eggs. Studies have also found the women whose diet is abundant with plant-derived oestrogens such as soy beans and sweet potatoes have very little menopausal discomfort (Gleason, S. "Menopause: I's Not a Disease: Natural Approaches to a Change of Life", Good Medicine , Spring 1994;8-10 ) It is also important to reduce the protein content of the diet to around 10% of the total energy intake. Aluminium based antacids also reduce calcium absorption and should be restricted. A better alternative to antacids is ACID-EZE. This formula is based on micro-pulverised slippery elm and peppermint and will not affect the absorption of calcium but will relieve the symptoms of acid stomach. It is not based on aluminium that has been associated with Alzheimer's disease.

If there is a medical condition such as advanced osteoporosis that requires H.R.T. then it is important to follow your doctor's advice, however your doctor should closely examine your family history with particular reference to cancer before prescribing HRT.

Hormone therapy is not new, as the Chinese have used herbs as hormone replacement therapy for thousands of years. An example of the power of herbs is the fact that the Aztec Indians used a herb (wild yam) as a contraceptive for thousands of years. Today modern medicine still uses an extract of this herb in the manufacture of one of the contraceptive pills. The Chinese have used Dong quai for many female problems including menopause. Dong quai contains plant oestrogens or phyto-oestrogens and it is also an adapting or adaptogenic herb. When the body's oestrogen level is low, it adds to the oestrogen in the body, increasing circulating oestrogen. When the oestrogen levels are high it competes for the binding sites reducing the effect of oestrogen. Dong quai will reduce hot flushes and may reduce calcium loss. Another herb that is of benefit and also with oestrogenic activity is Cimicifuga racemosa (black cohosh). A number of studies have found that black cohosh has oestrogen-mimetic activity, and was effective in the treatment of neurovegetative and psychic problems associated with menopause and early post -menopause, as an alternative to HRT. One placebo controlled clinical trial (Duker, E.M., Kopanski, et al,"Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovaeiectomized rats". Planta Medica 1991;57:420-424, found that black cohosh significantly lowered luteinizing hormone (LH) and was able to bind to oestrogen receptors. The reduction of LH in menopause is important as an increase in this hormone is associated with the experience of menopausal hot flushes.

Evening primrose oil is of advantage to many women. The essential fatty acids in the oil have hormonal balancing properties, This action is due to their action on the prostaglandin pathway. Many women have found that evening primrose oil is of benefit for P.M.T. and mastitis, especially when combined with a vitamin B complex.

Women suffering from depression during menopause should eat whole rolled oats (Avena) or take an oat supplement. Oats help balance the fluctuations of moods during menopause, and are an effective antidepressant. Oats are also nutritious, high in fibre and beneficial for good health. Menopausal depression can be devastating to some women, and in some cases, including oats in the diet may not be enough. If this is the case then taking the herb hypericum may be of real befit. Hypericum has both mild antidepressant and antianxiety action, and this herb may help balance the emotions and improve the enjoyment of life. The good news is that there is a lot that can be done to help naturally. Menopause's emotional symptoms are not unlike premenstrual tension and as for PMT, supplementing with a B group vitamin will also help through the menopausal changes.

Bone fractures could be reduced by taking fish oil. Vitamin D or preformed vitamin D found in cod liver oil, has been found to help prevent osteomalacia. This is one of the causes of bone fractures, particularly as we grow older. Studies have shown that elderly people are at risk of suffering from vitamin D deficiency. This would have a direct effect in reducing the absorption and utilisation of calcium. Low dietary intake, sun screens and a reduced ability to synthesise the vitamin all can contribute to the problem. Woman should take extra vitamin D even if taking HRT.

Supplementing with fish oil ( cod liver oil ), extra calcium and multi vitamin mineral formula, reduce the incidence of osteoporosis and osteomalacia. A teaspoon of cod liver oil a day will supply half the daily vitamin D required without overdose of vitamin A. If you are eating large quantities of kidney or liver then you may be receiving to much vitamin A. Do not rely on offal as your source of these vitamins as the toxins built up in these organs can cause a build up of toxins your own body.

One of the common reasons given for HRT is the reduced incidence of heart disease. Again the natural way could be the best. A study conducted by Harvard University's School of Public Health and published in the New England Journal of Medicine in May 1993 found, after evaluating more than 87,000 females between the age of 34 and 59 years of age, that those who supplemented their diets with vitamin E had a greater reduction in the risk of coronary heart disease (up to 50% reduction) than those on low dietary levels of vitamin E.

It is vital to reduce the chance of weakening bones and osteoporosis. To exercise regularly, 30 minutes walking four times a week, will help strengthen bones. Bones can actually grow with exercise, even after menopause has taken place. It is important not to over exercise, studies have shown that amenorrhoea induced by exercise is associated with a detrimental effect on bone mass.
Calcium is also critical to the diet. Between 800 and 1,700 milligrams a day is required. Studies have shown that by increasing the amount of calcium and vitamin D in the diet to the levels mentioned can reduce calcium bone loss by up to 50%.

One placebo controlled study, Aloia et al , found that women who had gone through menopause 3 - 6 years previously that were either given 1,700mg of calcium; a placebo; or conjugated equine oestrogen at 0.625 mg per day from day 1 to day 25 of the cycle, progesterone at 10mg per day from day 16 to 25, and 1,700mg of elemental calcium daily. All participants in the study also were given 400iu of vitamin D daily. Bone density declined significantly in the placebo group compared to the calcium and the calcium plus HRT group. The calcium only group although not quite as effective as the HRT plus calcium group showed significantly slowed bone loss.

Natural medicine can address the symptoms associated with menopause, including reducing heart disease, bone calcium loss (osteoporosis), hot flushes and mild depression, without the side effects that may accompany HRT.

It is possible that health benefits similar or even better than those of HRT can be obtained from a combination of dietary changes and the addition of dietary supplements, thus avoiding the side effects of HRT. Vitamin E and other antioxidants can reduce the risk of coronary heart disease by 50%, and taking calcium plus vitamin D has been shown to be almost as effective as HRT in reducing the incidence of osteoporosis. Soya beans and many herbs, including dong quai and black cohosh, contain phytoestrogens (plant oestrogens) which mimic oestrogen in the body and reduce the symptoms suffered, including the symptoms of menopause, that result from diminished oestrogen levels. Studies have found that Japanese women have less menopausal symptoms, including hot flushes, than women in the western world. It is thought that the high intake of isoflavonoid phytoestrogens found in soya bean products, including tofu, miso and dong quai is responsible for this phenomenon. It has also been found that the inclusion of phytoestrogen containing foods such as soya bean products may also reduce the incidence of certain cancers. There is no doubt that increasing dietary intake of phytoestrogen containing foods and calcium, vitamin D and supplementing with antioxidants will reduce the symptoms associated with menopause.


dong quai 500 mg dried herb containing 1.5 of ligustilides
(standardised extract) morning and night

black cohosh 375 mg dried herb up to three times daily

Hypericum 375mg dried herb ( containing 76.2mcg of hypericin) up to three times daily if required for mild depression

evening primrose oil 2 to 4 capsules daily

cod liver oil 4 ml daily or two 1,000 mg capsules daily

vitamin D 800 iu daily; only if not taking cod liver oil, 400iu if taking cod liver oil

calcium 1,000mg daily ( total intake 1,500mg daily )

Note; one or all of the above can be taken in combination with food. Your health food stockiest has most of these herbs in combination in a single tablet.


1 Parfitt, A.M. et al. "Vitamin D and bone health in the elderly", Am. J. Clin. Nutr., 36;1014, 1982.

2 Harju, E. et al, "High incidence of low serum vitamin D concentrations in patients with hip fracture". Arch. Orthop. Trauma Surg. ,103;408, 1985.

3 Albanese, A.A. et al, "Calcium nutrition and skeletal and alveolar bone loss". Nutrition Reports International., 31;741-755, 1985.

4 Riggs, B. Lawrence M.D. et al," The Prevention and Treatment of Osteoporosis", New England Journal of Medicine , 327(9),620-627,27,August. 1992.

5 Aloia,J. et al, "Calcium Supplementation With and Without Hormone Replacement Therapy to Prevent Postmenopausal Bone Loss", Ann. of Int.Med. 129(2);97- 103, 15 January , 1994.

6 Gleason, S., "Menopause: It's Not a Disease: Natural Approaches to a Change of Life", Good Medicine , Spring;8-10, 1994.

7 Murray,M. Pizzorno, J. E."Herbs which possess both proven oestrogenic activity and a long history of use for female complaints, dong quai". 461-462;An Encyclopedia of Natural Medicine , Prima Publishing,1991.

8 Balch,James,(M.D.) " Dong Quai increases the effect of ovarian/testicular hormones",Prescription for Nutritional Healing , Avery Publishing.p51,1990.

9 Pizzorno, J.E. & Murray, M.T."Dong quai, phytoestrogen effects", V:Angeli-2 Angelica,
A Texbook of Natural Medicine, Bastyr College Publications, 1986.

10 Bensky, D. Gamble A., Chinese Herbal Medicine: Materia Medica, Easland Press, Seattle, WA p474-476, 1986.

11 Harada, M. Suzuki, M. and Ozaki, Y. "Effects of Japanese angelica root and peony root on uterine contraction in the rabbit in situ", J Pharm Dyn, 7;304-311, 1984.

12 Tanaka, S. et al," Antinociceptive substances from the roots of Angelica acutiloba .", Arzneim Forsch , 27;2039-2045, 1977.

13 Yamada, H. Kiyohara, H. et al," Studies on polysaccharides from Angelica acutiloba", Planta Medica , 48;163-167, 1984.

14 Blackmores Botanicals and Nutritionals Prescribers' Reference . "Dong Quai Complex', 8.2.1, 1986.

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Copyright Russell Setright 1996