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St. John's Wort Relieves Menopause Symptoms

Menopausal symptoms affect approximately two-thirds of women as they transition out of their reproductive years. The scientific literature on St. John's wort (Hypericum perforatum L., Clusiaceae) briefly mentions the herb as a possible treatment for menopausal complaints (Roth, 1990; Wagner et al., 1995), but the first clinical trial to investigate this use was conducted only last year.

While depression is one symptom of menopause that St. John's wort (SJW) might be expected to improve, German researchers designed a trial to assess its effects on other problems more specific to menopause (Grube, et al., 2000). Their results suggest that SJW not only helps relieve psychological and physical symptoms, but also helps enhance sexual well-being for menopausal women. Specifically, 76 percent of study participants experienced a statistically significant lessening or disappearance of symptoms after 12 weeks of treatment with SJW, and participating physicians observed improvement in 79 percent.

For the open trial, 106 women took three Kira® tablets (Lichtwer Pharma, Germany) per day for 12 weeks. Each tablet contained 135 to 225 mg SJW extract standardized to 300 mcg hypericin. None of the women had received hormone replacement therapy. Study participants were assessed at baseline and then again after 5, 8, and 12 weeks of treatment. At each assessment, the participants reported the frequency and severity of psychological, physical, and vasomotor menopausal symptoms she was experiencing, according to the Menopause Rating Scale. (Psychological symptoms included irritability, poor concentration, tension, anxiety, and depression. Physical symptoms included headaches, heart palpitations, and disturbed sleep. Hot flashes, excessive sweating, and dizziness were considered vasomotor symptoms.) She also responded to a short sexual health questionnaire designed for this study. A physician scored each patient according to the Clinical Global Impression scale to document therapeutic efficacy and side effects. At the start of the study, 80 to 90 percent of all symptoms (except dizziness and heart palpitations) were "moderate" or "marked" in severity. By the end of the study, only 20 to 30 percent of women were still experiencing psychological and physical symptoms of "moderate" or "marked" severity. The researchers reported, "The overwhelming majority were symptom-free, or their symptoms had become merely 'slight' by this time." Scores for intensity of symptoms on the Menopause Rating Scale were also significantly different after treatment, dropping from 63.4 (marked) to 23.5 (slight). Apparently, there was no significant change in vasomotor symptoms. Only four patients reported adverse events during the trial.

Responses to the Sexuality Assessment questionnaire showed that patients felt more physically attractive, saw sexual intercourse as more valuable, and were more likely to initiate sex at the end of treatment than they had before taking SJW. Of 82 women who said they no longer felt physically attractive at their first interview, 77 had changed their view by the end of the study. Overall, approximately 80 percent of the patients agreed that their sexuality had been "substantially enhanced" by SJW treatment. The investigators noted, "This represents a significant advantage over synthetic antidepressants, especially in these patients."

- Nancy Hoegler, Herb Research Foundation [Grube B, Walper A, Wheatley D. St. John's wort extract: efficacy for menopausal symptoms of psychological origin. Advances in Therapy 1999; 16(4): 177-186. Roth L. Hypericum-Hypericin. Botanik, Inhaltsstoffe, Wirkung. Landsberg: Ecomed Verlag; 1990. Wagner H, Wiesenauer M. Hyperici perforati herba (Johanniskraut). In: Phytotherapie. Phytopharmaka und pflanzliche Homoöpathika. Stuttgart: Gustav Fischer Verlag; 1995]

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