Written by Sebastian Pole
In this article, we want to explore whether it is best practice for drugs to be the first port of call in the natural evolution of women’s health from menarch, through the menstrual years and menopause? We know that over-medicalisation has many different causes. These include the current drug-based medical paradigm, under or over-diagnosis, a conservative risk base for disease reduction targets, patient demand for treatment and, over the last 30 years, a surge in medicalisation of preventable diseases. Despite being generally healthier and longer-lived than men, women especially fall victim to this phenomenon.
The medicalisation of girls and women starts early in life; research shows that a third of teenagers taking the pill do so to treat menstrual cramps (Guttmacher Institute) rather than to prevent pregnancy. This is despite a Cochrane review (2001 Proctor et al) stating that ‘no conclusions can be made about the efficacy of commonly used modern lower dose combined oral contraceptives for dysmenorrhoea.’ More generally, 14% of women using the pill do so solely to treat dysmenorrhoea, acne or endometriosis. Hormone treatments are associated with multiple side-effects – weight and mood changes, lowered libido, depression headaches, clotting risks – that may lead to further medication. These, coupled with the loss of the benefits of a natural menstrual cycle, beg the question ‘can we do anything better to help young women?’.
However it doesn’t stop there. The current menopause conversation shines a welcome light on the need for a better understanding of menopause. But the push for HRT within this conversation exemplifies this trend towards medicalisation. During menopause over a third of women take HRT for relieving the uncomfortable symptoms, despite it linked with a three-fold increase in the risk of breast cancer and more blood clots. The UK Health Service recommends minimal use of HRT but offers minimal other empowering solutions, even specifically stating that complementary solutions should not be sought.
Further over-medicalisation of women, is apparent in the fact that women are prescribed anti-depressants twice as much as men with no evidence that women are more depressed than men. Given that many of the health issues that arise during a woman’s life have the potential to be managed naturally, why are we medicating women before educating them with a clear understanding of their menstrual health, effective diet, lifestyle and natural herbal solutions? Surely there is benefit to the individual, the health system and society as a whole if a multi-dimensional approach is taken?
Are there any alternatives to drugs?
As an example of how a herbalist may approach one aspect of women’s health, lets look at how dysmenorrhoea can be rebalanced. 1 in 5 women have their daily life seriously affected by painful periods; asprin and paracetamol are go-to temporary fixes, as are contraceptive hormone treatments, but is there something more long-lasting and empowering that can be included to help?
Herbalists will approach any solutions holistically to understand the person, the pattern and the problem. There are specific therapeutic approaches utilising the best of vitalistic and scientific medicine to address the root and the branch of the problem incorporating the below treatment strategies:
Moving the blood – To increase blood flow through the uterus
Turmeric and ginger root excel at increasing blood flow through the uterus to ameliorate painful cramps. Turmeric and ginger work in multiple ways including inhibiting substance-P, associated with pain perception, as well as inhibiting the inflammatory enzyme COX-2.
For a week before the period starts, drink hot ginger tea and a take a teaspoon a day of turmeric powder in food or a drink. Blood invigorating emmenagogue herbs such as Yarrow, Calendula, Dang gui and Dan Shen are often employed by herbalists too.
Relaxing the uterine muscle with warming anti-spasmodics
The essential oils in Fennel seeds are beneficial as uterine spasmolytic for pain relief. Drinking 2g of seeds in a tea every few hours throughout your period can help.
Tonify with adaptogens and uterine tonics
There are many respected women’s tonics to choose from; Ashwagandha, Dang gui, Black cohosh, and Tribulus, but one stands out as especially useful, Shatavari. It also has impeccable sustainability credentials. So many ‘women’s herbs’, such as false unicorn, lady’s slipper and black cohosh, are endangered or threatened from over-harvesting in the wild. Shatavari offers an easy-to-grow, sustainable and life-affirming alternative.
Enhance digestion, liver and bowel function assisting hormone clearance
Importantly, cook with plenty of herbs in each meal to enhance absorption and microbiome dialogue. Include linseeds, healthy oils and beetroots for the bowels. Aloe vera juice is a gentle liver and bowel regulator with added nourishing properties. In Ayurveda it is called ’the princess’ for its ability to transform inflamed skin and menstrual problems. Herbs such as Dandelion root, Artichoke, White Peony, Bupleurum and Vervain are also useful here.
Education about a pain-free lifestyle which reduces prostaglandin mediates inflammation
Typical vata symptoms of cold, aching, pain and digestive upset, can be soothed using a nourishing-warming diet, warm oil massage, topical heat with hot water bottles and towels, castor oil packs, rest and yoga poses such as the reclined thunderbolt (supta vajrasana). As so much inflammation is driven by an excess of poor quality oils in the diet, its essential to minimise omega-6 and optimise omega-3. Foods that are rich in saturated and omega-3 fatty acids includes plant based fats such as coconut oil, hemp seed oil, extra virgin olive oil (uncooked) and avocados. Raw nuts (other than peanuts) and seeds contain oestrogen balancing plant sterols.
The endocrine system is often referred to as an orchestra working as a symphony; if out of tune for any reason then it may be implicated in menstrual cycle disruptions. This synergistic quality plays to the herbalist’s strength, as plant phytochemistry’s multi-dimensional nature is capable of influencing the major endocrine glands at the same time.
Apigenin, a flavone found in chamomile and green tea, inhibits aromatase to prevent excess testosterone and progesterone converting to oestrogen. The flavones found in citrus fruits, in particular lemons and lime peels, help here too. Vitex agnus-castus is renowned for interactions at a hormonal level and is used to indirectly enhance progesterone levels.
Foods play a major role in hormone balancing. The brassica family contain several powerful nutrients that help metabolise oestrogen by enhancing liver detoxification processes. Broccoli and kale sprouts are especially potent. The alliums, including garlic, onions, scallions, chives and leeks, are rich in sulphur-containing amino acids and the powerful flavone anti-oxidant quercetin. These compounds help the liver detoxify and reduce the production of oestrogen. A few grams a day of seaweed influences nutritional and hormonal pathways to help reduce a sluggish metabolism and feed the endocrine system.
Phytoestrogens are also important. Phytoestrogens are plant compounds with structural features similar to endogenous oestrogen. However, because they are weaker, they can act as partial agonists. Lentils are a good source of phytoestrogens. Two tablespoons daily of freshly-ground flaxseed delivers a high lignan content assisting a healthy oestrogen balance. Mushrooms (such as shitake and reishi) regulate aromatase, regulate oestrogen levels and may be used to manage various hormone related pathologies. Herbs such as oregano, thyme, rosemary, sage and turmeric promote the metabolism of hormones.
The vast experience gathered over the generations by midwives, nurses and physicians has resulted in very detailed knowledge of how to support women’s health with foods, plants and life-style. Integrating this traditional knowledge with the detailed understanding we have today of menstrual health, leads to access to evidence-based natural solutions.
Perhaps the natural way to minimise over-medicalisation is to support young girls into womanhood by educating them about how their life-style, dietary and medical interventions may impact their health. Furthermore women going through menopause should be educated similarly too. We need to give knowledge, not just so there is free-choice, but empowering options to choose from too.
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