Herbs & Health talked to leading South Australian naturopath Tracey Yeend on menopause. Also a nurse and midwife, Tracey specialises in women's health and hormonal issues and has been practising in this area for more than 20 years.

H&H: Why do so many women experience difficulty with menopause?

TY: In many cultures women pass through menopause without any real issues. In Western society we all do things that have negative effects on our bodies, such as eating too much poor-quality food and living with prolonged stress. If you've spent most of your life like this, you cannot expect to get through menopause unscathed. In essence, you reap what you sow and menopause is where your cumulative bad habits catch up with you.

H&H: Hot flushes appear to be the worst symptom of menopause. Why is this such a common experience?

TY: Hot flushes stem from long term-issues that relate to a poorly functioning liver. One of the liver's functions is to break down excess hormones that are then excreted from the body. If you've been under any form of stress for a prolonged period then menopause is just another stress that your body is forced to deal with. A poorly functioning liver cannot break down hormones effectively, hence the hot flushes.

H&H: Can you explain how a poorly functioning liver leads to hot flushes?

TY: When you experience prolonged stress your body remains in a permanent state of ‘fight or flight'. This is the response that originally enabled us to physically fight or run away when faced with danger. It's now activated in situations where neither response is appropriate, for example, in traffic jams or during a stressful day at work. The flight or fight process suspends many bodily processes, such as digestion, and diverts blood supplies to deal with what our body perceives as a threat. When that perceived threat has gone, our system is designed to return to normal function via the relaxation response. However, in times of chronic stress, this doesn't happen enough, resulting in physical damage that can often lead to secondary gut and liver issues. On the other hand, when your body is working optimally, it can utilise hormones better and you don't experience as many menopausal symptoms. As soon as patients present with hot flushes, I start them on a good liver tonic for at least a month. I also find underweight women experience more severe hot flushes because their bodies lack the fat cells vital for the process of breaking down hormones, such as androgens.

H&H: Women have been shying away from HRT (hormone replacement therapy) due to recent bad publicity. Do you think they've been turning to complementary therapies instead?

TY: Almost certainly. Recent information suggests that, since 2003, use of HRT has dropped by 40 per cent. Most women tend to self-prescribe and, as a general trend, would be trying oestrogenic herbs and menopause formulas intended to increase depleted oestrogen levels. What concerns me about this, is that in my practice I find as many as 65 per cent of women over the age of 35 suffer from uterine fibroids (with many unaware they have them as they often show no symptoms) and certain herbs may not be the most suitable choice for this condition. The most common symptom associated with fibroids is heavy bleeding. If you suspect you may have fibroids it is advisable to consult your healthcare professional.

H&H: What treatment do you find most effective for menopausal symptoms?

TY: Without a doubt, the most effective herb for so many reproductive issues is the herb Asparagus racemosa (also known as Shatavari). This herb can be used by young girls experiencing period pain right through to menopause and beyond. It's effective (and without side effects), lightening bleeding, normalising menstrual cycles, and alleviating sore breasts, fatigue, painful periods and painful intercourse. As Asparagus has known digestive and gut-emptying properties, it can also normalise bowel patterns and thereby reduce bloating. In fact, Asparagus was found in clinical trials to be comparable to the drug Maxolon for relieving nausea.1 As Asparagus normalises digestion, the absorption of nutrients from food improves, which increases overall wellbeing.

H&H: The other distressing symptom many women experience is poor memory and a general feeling of ‘brain fog'. How can it be overcome?

TY: Again, Asparagus is the answer. This symptom is caused by low progesterone levels. The two other important nutrients for restoring mental function are vitamin B6 and zinc. Both these nutrients are the precursors to serotonin and dopamine- the ‘feel-good' chemicals your body produces. If these nutrients are low you're bound to feel blue. As Asparagus is a hormonal normaliser, taking the herb will adjust the progesterone imbalance as well as improving gut function, allowing better assimilation of B6 and zinc. The other vital nutrient is vitamin C, which is necessary for the function of the adrenal glands and your immune system during times of stress.

H&H: What dosage of these nutrients would you suggest?

TY: Ideally I would recommend 100 to 200 mg of vitamin B6 per day. However this is a high dose and I would not recommend this to be taken on a long term basis. You also need to take a good quality B complex capsule, since B vitamins don't work in isolation. Choose a yeast-free brand to avoid encouraging thrush. Take a liquid zinc if possible, around 1 mL per day, with orange juice to aid absorption. For those who are extremely stressed, take 2 to 4 grams of vitamin C daily. If not so stressed, take 1 to 2 grams daily. Don't take these nutrients at the same time as calcium supplements, because the calcium uptake will be favoured over zinc.

H&H: What dosage of Asparagus do you recommend?

TY: A typical daily dose would be 1 to 4 grams daily. I find the root of Asparagus works much better than powders or liquids. Start with one Asparagus root capsule in the morning and one in the evening. In severe cases, taking two capsules morning and night should be sufficient. Most of my patients experience an improvement within the first cycle and optimum results after three cycles. What I like most about this herb is that you can only improve after taking Asparagus and it won't aggravate any secondary conditions such as fibroids. It's also affordable and has minimal side effects. I've only had one patient out of hundreds who's been unable to tolerate Asparagus. If you find these suggested dosages aren't showing an improvement I'd advise you to consult your healthcare professional.

H&H: What can women do about the fatigue that is a common experience of menopause?

TY: Combining one Asparagus capsule with one Withania capsule morning and night can make a huge difference to energy levels. This combination supports the adrenal glands and relieves the symptoms of prolonged stress. Asparagus can really restore your vitality.

H&H: Tracey, your one piece of final advice on menopause?

TY: Don't dread it! If you've looked after yourself, you won't have any problems. Even if you do, in my opinion Asparagus is a fantastically effective herb that will help relieve most hormonal symptoms women may experience from puberty onwards. And best of all, it won't create further problems. Embrace being female and remain vital until old age.

Reference: 1. Journal Postgrad Med 1990; 36; 91.