By Trudy Norris

Female Aged 45 years Married women with 2 grown up children
Happy and positive relationship with very supportive husband.
Full time factory work on shift system.

Medication – Hormonal Replacement Therapy (oral and pessaries) ceased on advice of GP.Full Blood test including thyroid function all normal. Herbal approach suggested by GP.

Current Symptoms prioritised by patient:

  1. Hourly severe hot flushes worse at night to the extent of having to change nightwear and sometimes sheets
    Anxiety and sleep disturbance (as a result of sweats.)
  2. Past Medical History
    No operations or significant illnesses
  3. Family Medical History
    Father died of heart attack
  4. Dietary History
    Information sheet offered and discussed re dietary and lifestyle factors influencing osteoporosis
    Advised to eliminate coffee (10 cups per day), reduce carbonated drinks and increase water/herb teas.
  5. Musculoskeletal System:
    Some stiffness in hands and pain in right thenar eminence – exacerbated by working environment.
  6. Digestive System:
    No problems currently
  7. Respiratory system:
    Smokes 20 cigarettes per day. Discussed re osteoporosis and general health. To review when current symptoms are under control and client feels better.
  8. Circulatory system:
    Blood Pressure 100/75 Pulse regular. Cold extremities. No palpitations or other CV symptoms.
  9. Immune Function:
    No antibiotics in last year. No recurrent infections.
  10. The Skin:
    No problems or recent changes in skin/ hair /nails.
  11. Renal System:
    No problems or history of renal/bladder problems. Discussed benefits of pelvic floor exercises.
  12. Gynaecological History:
    History of painful periods which ceased 3 years previously. HRT for 3 years (now ceased)
  13. Nervous System:
    No problems. Occasional headaches when undertakes extra shifts at work and becomes over tired.
  14. Vision – good. Slightly hearing impaired.
  15. Lifestyle Factors:
    Very active rambler goes walking most weekends with husband. Enjoys camping and travelling.

[boxibt style=”gray”]Prescription:

To review after one week. Discussed the fact that quick withdrawal of HRT, though necessary, will have exacerbated symptoms.

Practitioner hopes for 50% improvement minimum, within one week and suggests 6 – 8 weeks required to achieve significant improvement and that a reduction in severity and frequency of sweats rather than complete cessation initially is expected since herbal approach will be supportive of the body
Therapeutic Aims:
[customlist icon=”ic-blue2″]

  • Reduce/eliminate sweats.
  • Enhance sleep
  • Tonify circulatory, endocrine, respiratory and nervous systems.
  • Support patient in reducing tobacco consumption
  • Maximise dietary practices
  • Establish good health and then slowly reduce herbs to maintenance doses.
  • Review as required until above achieved (probably monthly).

[boxibt style=”gray”]Prescription 1:

Leonorus cardiaca
Cimcifuga racemosa
Glycyrrhiza glabra
Turnera diffusa
Avena sativa
Valeriana officinalis

5mls 4 x daily in water Review by telephone in one week.
Although many women turn to herbs that influence the hormonal system (understandably) during the menopause I frequently find that a positive response is obtained by using herbs that restore and strengthen the whole system. Many women are exhausted due to sleep disturbances, lifestyle and spiritual changes associated with getting older (many of these changes are positive of course!). Addressing the exhaustion will often eliminate symptoms such as flushes and also serve to regulate sleep, reduce headaches etc.

One of the beauties of herbs is that they have a multi system approach i.e. it is almost as though they have an in built ‘knowing’ that if healing is required for one system in the body (such as the immune system) other actions are required, such as antibiotic/anti viral/ anti inflammatory etc.

Many herbs that influence the endocrine system have wide and varied influences i.e., Motherwort has hormonal activity yet also is a gentle relaxant and benefits the cardiovascular system. In this prescription Motherwort was chosen as a nervine and as a specific to reduce the hot flushes. This was coupled alongside Cimcifuga racemosa and Turnera diffusa. The latter is a useful herb for people who are exhausted, it is also a thymoleptic i.e. ‘lifteths the spirits’ Cimcifuga is a well known and researched herb which can be particularly effective where women are suffering from vaginal dryness. It is important to ensure this symptom is not a result of any local or internal infection. Cimcifuga rarely works in isolation here (I have found) and thus herbalists will frequently combine with other herbs depending upon individual need.

Many women that are experiencing ‘menopausal’ symptoms may be suffering from a hypo active thyroid gland; this must be verified clinically and via blood tests. One way to influence the thyroid gland is to use herbs that influence either the adrenal glands or the pituitary gland. Liquorice was chosen initially as an adrenal tonic.
Avena sativa is a useful herb for the nervous system and is also a very nutritious plant. Herbalists would class Avena as a trophorestorative for the nervous system alongside such plants as Lavender, Turnera and Hypericum (St Johns Wort). Avena is also a useful herb for the circulatory system.

Finally a small quantity of a more sedative herb Valeriana was added to the prescription to enhance sleep quality and quantity….a herb that creates a little ‘slack’ in the system, aiding rest and recovery.

Telephone review: sweats reduced in intensity, still 3 hourly and severe at night. Maintained original prescription for further week. Reassured patient as to time element.
Supplied pessaries to relieve vaginal dryness post cessation of prescribed pessaries.

[boxibt style=”gray”]Review at 2 weeks.

Improvement maintained as to previous review. Sleeping more heavily and more refreshed after sleep.
[boxibt style=”gray”]Prescription 2:

Replaced Turnera diffusa with Salvia officinalis. 4 weeks medicine supplied. Patient has reduced coffee intake and is drinking more water. Pessaries supplied for 1 month.
[boxibt style=”gray”]Review at 6 weeks.

Sweats significantly reduced. Mild sweats x 2 per day. Advised sweats may not completely disappear and that the body needs more time. Patient feeling well. Using a pessarie on alternate days. Advised to reduce further if symptoms of vaginal dryness reduced.
4 weeks medicine supplied. Maintain previous prescription
[boxibt style=”gray”]Review at 10 weeks.

Patient has occasional ‘sweat’. Feels well. Does not currently require pessaries. Advised that after another month we may reduce medicine to 2.5 ml three times daily depending upon circumstances.

The patient currently remains well and is taking 7.5ml of her prescription per day. She is trying to reduce her number of cigarettes and has maintained her dietary improvements.

Although I suspected the patient’s thyroid may be hypofunctioning this has not manifested either clinically or via blood tests.
[boxibt style=”success”]About the Author

Trudy L Norris B.A, M.N.I.M.H, P.G.C.E
Member of The National Institute of Medical Herbalists.
Trudy Norris has been a practising herbalist for 7 years. Currently the Information Officer and Vice President of The National Institute of Medical Herbalists. She works in Scunthorpe and Grimsby North Lincolnshire as an herbalist and part time teacher. She has a young family and enjoys every bit of her busy life..[/boxibt]