Natural Doesn’t Mean Side Effect-Free

In the online perimenopausal community, there appear to be some battle lines drawn. If you thought these virtual watering holes were full of women supporting one another with no judgement or disagreement, then you would be mistaken. Just as in real life, factions are present, and strong opinions drive polarities that sometimes erupt in typed jabs and laughing, angry and crying emojis.

One of the more obvious and ever-present ones is the pharmaceutical vs. natural camp.

Simply put, one group of women is more open and receptive to prescribed medications that have been battle-tested in clinical trials, and this includes FDA-approved hormone therapy (estradiol and progesterone) that is produced by major pharmaceutical companies and available in generic and name brand formulations (vs. hormones made by compounding pharmacies). This group of women may include those who tried natural remedies that proved inadequate, harmful or ineffective as well as those who trust conventional medicine because it has been trialed, tested, in many cases with proven efficacy, and is produced according to regulations, with known and documented side effects.

The other group of women trends toward the “natural at all costs” philosophy. This is the group that may discourage going to conventional doctors and favors naturopathic and functional medicine practitioners instead. They are also the ones likely to caution against using prescribed medications, such as antidepressants (including but not limited to other drugs prescribed off label to help with perimenopausal hot flashes, night sweats, anxiety and more), as well as pharma-grade HRT. Their rationale may be that Big Pharma drugs have harmed them personally or those they know, that there is an unsavory profit motive involved in the practice of medicine that doesn’t put people first and that natural alternatives can’t harm you.

Naturally (pun not intended), there is a deep affinity among women thrust into perimenopause to try what’s close at hand, readily available and perceived as harmless. So many of us had no warning and little or no education about what would happen to our bodies and minds in midlife. We just knew that when we hit our late 30s to mid 40s, we started feeling different, off-kilter and a bit abnormal. Thus, we are fending for ourselves – at least those of us with the grit and resilience to even try to address the panoply of hormonal change symptoms. And that self-advocacy often starts with over-the-counter supplements and various concoctions, potions and pills recommended by word of mouth and easily obtained.

The problem is that just because something is natural, doesn’t mean it’s good for you, beneficial to your individual biochemistry or without side effects. Here are some commonly suggested natural remedies, bandied about through the grapevine among communities of women, or offered to us by supplement companies and holistic non-MD providers whose biggest competitors are, in fact, the commercial pharmaceutical industry and the very few mainstream physicians skilled in caring for midlife women (oh, those precious few!).

5-HTP:

• A nervous system and brain neurochemical used to boost serotonin, a mood regulator, in the body with the goal of reducing depression.
• Sometimes used to help treat insomnia and anxiety.
• Possible risks include heartburn, nausea, diarrhea, stomach pain, drowsiness, muscle spasms. Avoid use if taking antidepressants.
• May be safe if taken for up to one year.

Black Cohosh:

• An herb original to North America commonly deployed as an estrogen booster, even casually called “herbal estrogen.”
• Often sought to help with hot flashes and commonly included in so-called menopause supplements.
• Potential side effects are upset stomach, rashes, headaches, weight gain, bloating and liver damage.

Chasteberry / Vitex:

• Also known as Vitex agnus-castus, chasteberry and monk’s pepper, an herb used to help with infertility, PMS (migraines, depressed mood and breast pain in particular), menopause (specifically mood and sleep improvement), acne, breastfeeding, inflammation, bone repair, headaches and epileptic seizures.
• Potential risks: nausea and upset stomach, skin rashes, acne, headaches, heavy menstruation and should not be taken with antipsychotic medications, birth control pills and HRT.

Evening Primrose Oil:

• Comes from a plant and used historically to treats skin problems, wounds and hemorrhoids; also contained omega-6 fatty acids.
• Often used for breasts pain, PMS, arthritis, asthma and eczema.
• Possible side effects: upset stomach, dizziness, nausea, headaches, rashes and not recommended for those taking anticoagulant, antiplatelet, blood pressure, antidepressant and phenothiazine medications.

Inositol:

• Also known as myo-inositol, a type of sugar involved in bodily insulin response and hormones linked to mood and cognition, also called vitamin B8.
• Has antioxidant features that may counteract free radicals in the brain and circulatory system and naturally occurring in fiber-dense foods, such as beans, brown rice and wheat bran.
• Used to treat high cholesterol, insulin regulation, anxiety and panic, depression and polycystic ovarian syndrome (PCOS).
• Potential side effects: stomach pain, headaches, nausea and dizziness.

Kava Kava:

• Sourced from the pipe methysticum plant, often purported to help with anxiety, drug withdrawal, insomnia and stress due to impact on the brain and central nervous system.
• May be safe to use for up to six months, but is linked to liver damage and should be avoided by breastfeeding women, those with Parkinson’s disease and at least two weeks prior to surgery.

Maca:

• A root vegetable known to be used for at least 3,000 years, sourced from the Andes Mountains.
• Used to help male infertility, decrease depression, aid hair growth, stimulate libido and address menopausal symptoms (hot flashes).
• Side effects could include unpredictable impact on hormone levels and should not be taken by those with fibroids, thyroid issues, breast cancer, uterine cancer, ovarian cancer or endometriosis.

Red Clover:

• A plant used in traditional medicine to treat osteoporosis, heart disease, arthritis, cancer, menstrual symptoms and menopausal issues.
• Contains isoflavones, a variety of phytoestrogen, that weakly mimics estrogen in the body, with most research inferring benefits for menopause produced by supplement manufacturers. 
• Also claimed to help with anxiety, depression and even vaginal dryness.
• Possible side effects: vaginal bleeding, skin irritation, headaches, nausea and potential contraindications with various medications.

Tryptophan:

• Also known as L-Tryptophan, an amino acid needed for protein production, naturally occurring in protein-rich foods such as poultry, eggs and red meat.
• A precursor to 5-HTP, which converts to serotonin, a mood-balancing brain neurotransmitter that is also responsible for a host of other bodily functions, and used to help with PMS, depression and insomnia.
• Possible side effects: drowsiness, stomach pain, vomiting, blurry vision, diarrhea and, potentially, a neurological disorder called eosinophilia-myalgia syndrome (EMS) [possibly connected to contaminated products].

Valerian Root:

• Commonly used for insomnia, believed to affect GABA receptors in the brain responsible for controlling fear and anxiety.
• Also used to address headaches, anxiety, digestive problems, menopause symptoms (hot flashes), pain and fatigue.
• Possible side effects: headache, dizziness, itchiness, upset stomach, dry mouth, vivid dreams, daytime drowsiness and liver damage.
• Probably should not be combined with over-the-counter cold and flu medicines, antidepressants, sleeping pills or alcohol.

As you can see, there are side effects and risks associated with “natural” agents as well as pharmaceutical prescriptions – the most commonly cited and warned against in perimenopause being antidepressants and HRT. Coincidentally, many of the side effects of these supplements mirror some of the side effects associated with certain medications.

Many supplements have not been thoroughly tested through randomized, double-blind clinical trials, and many reports of potential benefit for the symptoms they are said to address are limited at best. In perimenopause and menopause, women ultimately must decide which options work best for them. For some, it will mean medications of any type are off limits. For others, they will embrace FDA-approved medicines. And many, many more will adopt an integrative approach, blending options from both worlds.

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