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Female - The use of botanical medicines to treat menstrual irregularities

by Jill Stansbury

Medical Herbalism: 10-31-97 9(3): 1, 3-5

When treating menstrual irregularities, it is first necessary to rule out pregnancy, thyroid disorders, anemia, ovarian cysts, and numerous other pathologies. This article will address menstrual irregularities that are not due to other underlying pathologies, and that are often known as “Dysfunctional Uterine Bleeding.” When no overt thyroid, anatomical, or reproductive abnormalities or cancers are found or suspected, problems with the hormonal and metabolic control of the menstrual cycle is usually assumed. Natural alternative therapies have much to offer in the treatment of this group of complaints.

Conventional therapy employs synthetic hormones to force a hormonal action on the uterus to either stop or start menstrual bleeding, but such cures are typically only temporary. Pharmacological therapies are valuable in acute hemorrhage and crisis situations as emergency tools, but are less desirable in long-term management of menstrual irregularities. Synthetic hormones may enable the desired uterine function, but they will not correct an underlying hormonal imbalance, and may even add to it. Synthetic hormones can worsen hormonal imbalance in the long run by putting a strain on the liver’s task of metabolizing and excreting estrogen.

Naturopathic strategies aim to support the body’ s innate hormonal cycle, and restore a natural rhythm without synthetic hormonal controls. Diet, botanicals, and nutrients can often effectively support the production and regulation of hormones and correct the symptoms due to to their imbalance. According to naturopathic theory, botanical agents can improve the metabolism of hormones by the liver. Many of the botanical agents classically referred to as alteratives are cholagogues and may improve the liver’s conjugation of estrogen and enhance its elimination from the body. Alterative herbs such as dandelion root (Taraxacum officinale), burdock root (Arctium lappa), and many other traditional cholagogues are traditionally used for conditions or symptoms suspected to be due to elevated estrogens. Reducing the hormonal and toxic load on the liver by reducing the consumption of drugs, alcohol, animal products, and the hormones they often contain, may also assist the liver in metabolizing hormones. Other botanicals that have specific indications based on the nature of the menstrual difficulty, can be combined with the alterative herbs and dietary and environmental considerations, to correct the menstrual cycle without the use of synthetic hormones.

Heavy menstrual periods

Menses that are too prolonged or too heavy may respond to botanical agents. Uterine astringents and hemostatic botanicals are of use for heavy menstruation. The common herb cinnamon (Cinnamomum verum) may reduce bleeding in some circumstances. Cinnamon tincture or strong tea may be taken hourly in emergency circumstances or used preventively in the latter half of the menstrual cycle for those prone to heavy periods. Fleabane (Erigeron canadense) and shepherd’s purse (Capsella bursa-pastoris) are also considered to be uterine hemostatics most often used in acute situations. The cereal grain Secale cornatum will often support the ergot fungus, a powerful hemostatic agent. Ergot alkaloids are often used in hospitals for acute uterine hemorrhages following childbirth. Secale cornatum tincture, containing small amounts of ergot, can also be used for obstetrical and gynecological hemorrhages. These herbs, however, allay heavy menses by constructing the blood vessels. They should therefore be avoided by those with high blood pressure and cannot be relied upon for long-term management by anyone.

The following botanicals can also accomplish a great deal and are appropriate for long-term therapy and improving hormonal control.

Yarrow (Achillea millefolium) improves the uterine tone which may correct bleeding when it is too heavy due to uterine atony. Yarrow may also improve bleeding that is profuse due to spasm of the uterus (Hoerhammer; Nissim; Tawari et al.; Zelylstra).

Ladies mantle (Alchemilla vulgaris) has been used throughout folkloric traditions for heavy bleeding and other menstrual irregularities. It should be consumed in the last half of the menstrual cycle as either a tea or tincture to reduce heavy menses (Petcu).

Irregular menses

Menstrual cycles that occur too frequently, such as every 2-3 weeks, or too infrequently skipping one or more months, can often be corrected with botanical agents.

Chaste tree berry (Vitex agnus castus) has been found to exert a progesteronic effect via acting directly on the pituitary gland in the brain to increase LH luteinizing hormone) and decrease FSH (follicle stimulating hormone) (DeCapite; Weiss). This may serve to promote progesterone in cases of excess estrogen or in poor regulation of hormones. Vitex will often promote more regular menstrual cycles.

Stoneseed and Gromwell (Lithosperma ruderale, L. officinale) are useful to reduce hyperestrogen states with a progesteronic action (Nissim). Like Vitex, Lithosperma may act directly on the hypothalmus to improve the regulation of hormones and promote a regular rhythm to the cycles.

Saw palmetto (Serenoa repens) may be of use for women with polycystic ovaries or Stein-Levanthal disease where there is elevated testosterone relative to estrogen, hirsuitism, cysts on the ovaries, anovulatory cycles, and menstrual irregularities. Liposterol constituents within the Serenoa plants have been shown to inhibit the formation of dihydrotestosterone (Tasca et al.; Champault et al.; Carilla et al.) and may improve reproductive function in such women (See also Saw palmetto, page 1 of this issue).

Dysmenorrhea or painful menses

(See also “Herbs for Dysmennorhea”)

Cramps, bloating, fluid retention, pelvic aching and discomfort are another aspect of menstrual cycle difficulties. Herbs such as cramp bark (Viburnum opulus), black haw (V. prunifolium), blue cohosh (Caulophyllum thalactroides), wild yam (Dioscorea villosa) and others have an antispasmodic action on the uterus and may be extremely effective for simple menstrual cramps. Crampbark is particularly noted for relieving uterine cramps and need not be taken the entire cycle. Begin cramp bark a day ahead or even at the time of uncomfortable uterine cramping for fast acting relief. Viburnum tincture is safe to take by the dropperful and may be repeated every 15 minutes for several hours, and every 3-4 hours for several days when needed for cramps of the uterus and other muscles (Nicholson et al; Jarboe et al.).

Yarrow (Achillea millefolium) is an antispasmodic and anti-inflammatory making it useful for pain and uterine cramps (Hoerhammer; Petcu et al; Sticher; Goldberg et al.).

Dang gui or dong quai (Angelica sinensis) is a popular women’s herb used for both menstrual and menopausal difficulties. It contains many physiologically active constituents and is useful for menstrual pain, atony, and hormonal insufficiency. Angelica sinensis acts as a smooth muscle relaxant overall, which will improve many cases of menstrual cramps, but animal studies have also shown angelica to tone and strengthen the uterus when it is lax and atonic (Yoshiro; Harada). These dual actions may account for dong quai’s wide success rate. Angelica may be taken all month long in many cases to tone the uterus and improve hormonal regulation, but for some women it may increase pelvic circulation and aggravate heavy menses. In such cases, angelica can be avoided during the period, opting for other uterine hemostatic herbs instead. (See also the subheading for dang gui in “Herbs for dysmennorrhea,” page 13).

Blue cohosh (Caulophyllum thalictroides) is another botanical having an antispasmodic action that is particularly useful in cases of uterine atrophy. When pelvic pain and menstrual cramping begin following multiple pregnancies, obesity, or other loss of pelvic tone, caulophyllum is well indicated. Many of the early American physicians and medical texts recommend blue cohosh for improving pelvic tone and preparing the uterus for childbirth. Caulophyllum was especially recommended for pelvic pain in cases of prolapsed lax tissues where menstrual cramps are heavy, aching in character often affecting the low back and thighs (Felter; Ellingwood). Caulophyllum has been found to contain saponins that are hormonally active (Costello and Lynn).

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