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The current medical view of menopause is more as a disease rather than a normal physiological process, and the approach primarily involves the use of hormone replacement therapy, featuring the combination of estrogen and progesterone. This differs from the naturopathic philosophy and treatment of menopause.

The obvious question, "is hormone replacement therapy necessary?" The answer in most cases is "no" if a woman utilizes an effective natural approach. In addition, if a woman has a history of cancer, unexplained uterine bleeding, liver and gallbladder disease, pancreatitis, endometriosis, uterine fibroids or fibrocystic breast disease, then estrogen replacement therapy is often not even an option.

The herbal approach
The most widely used and only thoroughly studied herbal approach to menopause is a special extract of Cimicifuga racemosa (Black cohosh) standardized to contain 1 mg of triterpenes calculated as 27-deoxyacteine per tablet.

Since 1956, over 1.5 million menopausal women in Germany have used the Cimicifuga extract with great success without side effects. Clinical studies have shown the special Cimicifuga extract relieves not only hot flashes, but also depression and vaginal atrophy. In 1994, over 6.5 million monthly dosages of Cimicifuga extract were utilized in menopausal women in Germany, Scandinavia, and Austria. How does it work?
With menopause, the absence of active egg-producing follicles in the ovaries results in a significant drop off in estrogen and progesterone levels. In response to this drop in estrogen, the pituitary increases secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). After menopause, FSH and LH are secreted in large and continuous quantities. Many of the symptoms of menopause are suspected to be a result of the increased levels of LH.

Cimicifuga extract has been shown to lower LH. This effect signifies an estrogen-like effect. Because of this effect and others, Cimicifuga extract is referred to as a phytoestrogen. However, its effects go well beyond simply an estrogenlike effect. In addition, the estrogenlike effect of Cimicifuga extract is actually an "estriol-like" effect. Estriol is one of the body's estrogens. However, unlike other estrogens, estriol actually exerts anti-cancer properties.

Clinical summaries
The special extract of Cimicifuga is by far the most well-documented natural alternative to hormone replacement therapy. Several studies have compared Cimicifuga extract to hormone replacement therapy in menopausal women as well as in younger women having hysterectomies.

The Cimicifuga extract actually produced better results in several of the studies, especially regarding the improvement of the vaginal lining and psychological symptoms. While there is significant risk with hormone replacement therapy, no side effects have been reported with the Cimicifuga extract. The dosage used successfully in the clinical trials is two tablets twice daily (providing a total of 4 mg 27-deoxyacteine daily).

Study I A large open study employing 131 doctors and 629 female patients demonstrated that Cimicifuga extract produced clear improvement of menopausal symptoms in over 80 percent of patients within six to eight weeks. Both physical and psychological symptoms improved.

Study 2 Sixty patients were given either Cimicifuga extract, conjugated estrogens (0.625 mg daily), or Valium (2 mg daily) for 12 weeks.'Results from standard indexes of menopausal symptoms indicated a clear advantage of Cimicifuga extract over both drugs.

Study 3 Eighty patients were given either Cimicifuga extract, conjugated estrogens (0.625 mg daily), or placebo for 12 weeks. Cimicifuga extract produced better results in the Kupperman Menopausal Index, the Hamilton anxiety test, and the vaginal lining than estrogens or placebo. The effect of Cimicifuga extract on improving the vaginal lining was remarkable enough for the author of the study to conclude that Cimicifuga extract is suited as the drug of first choice to treat menopausal symptoms.

Study 4 In a study of 60 women under the age of 40 who had hysterectomies leaving at least one intact ovary, the Cimicifuga extract was shown to produce effects comparable to estrogens in relieving the symptoms of "surgical menopause." Study 5 In a double-blind study of I 10 women, Cimicifuga extract was shown to exert significant improvements in menopausal symptoms and blood hormone measurements.

The extract of Cimicifuga racemosa standardized to contain I mg 27-deoxyacteine per tablet has been shown to produce symptomatic relief comparable to that of hormone replacement therapy without the risk of serious side effect. In summary, the following can be stated about Cimicifuga extract: A safe and effective alternative to hormone replacement therapy. It is the number one selling herbal product for females in Germany (6.5 million units were sold in 1994).

Cimicifuga extract is effective in in relieving all of the following menopausal symptoms:

Physical, hot flashes, night sweats, headaches, heart palpitations, vaginal atrophy, psychological, depression, anxiety, nervousness, sleep disturbances, decreased libido. by Michael T. Murray, N.D.