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By David Schiedermayer, MD
The proven benefits of post-menopausal estrogen hormone replacement therapy include the prevention of bone loss and reduced risk for coronary heart disease. A possible benefit is a lessened risk of Alzheimer's disease. Estrogen is clearly the preferred drug for the long-term treatment of women who are post-menopausal, and estrogen completely relieves most menopausal symptoms.
Some women, however, are concerned about the risks of estrogen (particularly the increased risk of uterine cancer) and wish to use an herbal remedy as a short-term adjunctive measure for treating the troubling symptoms of menopause.
Ginseng may help relieve some of these symptoms (night sweats, hot flashes, headaches, palpitations, and atrophic vaginitis).1 Unfortunately, the evidence of ginseng's effect on menopausal symptoms is little more than anecdotal at this point,2 and few studies have addressed this important clinical issue. What is known is that prolonged use of ginseng may be associated with uterine bleeding and sore breasts in women, so the question of an estrogen-like effect is raised.
Ginseng's active ingredients include at least 18 identified saponins or "ginsenosides" (GS), which are oligoglycosides.3 Studies show a complex profile of activity that may include some hormonal effects.4-8
Mechanism of Action/Clinical Studies
Some of the symptoms of menopause may arise from an increased LH level, but no studies are available of LH levels in women treated with ginseng. Men treated with ginseng were found to have increased levels of both testosterone and LH.9 GS may act at different levels within the hypothalamic-pituitary-ovarian axis. Studies of other "traditional medicines" used for hot flashes, such as megesterol acetate, clonidine, and medroxyprogesterone, have inadequate numbers of women enrolled to determine medical effectiveness. Lifestyle interventions such as adopting regular physical activity, eating a balanced diet, avoiding alcohol and caffeine, and reducing stress may be of some benefit in decreasing vasomotor flushing.
Ginseng is marketed in the form of root slices, tonics, powders, tablets, teas, extracts, confections, fruit and mineral drinks, toothpaste, cosmetics, soaps, and candies.10 Some consumers prefer the capsule or gel form. The recommended dose of a typical product containing 4% ginsenosides is two 100 mg capsules daily, in single or divided doses, with or without food. Powdered or cut ginseng dosage is variable in strength, but the dosage is generally between one-half to two teaspoonfuls. The dose of tinctures or concentrated extract varies between 10 and 30 drops. While other forms may be equally efficacious (or inefficacious), the lack of a standardized dosing makes monitoring difficult. Adulteration and contamination of ginseng products can be a problem, since some preparations contain various other substances, including the toxic compound germanium.
Tinctures are often more expensive, but they last for years. They taste bitter, and most contain alcohol. Powder capsules cost less, are tasteless, but have a shelf life of only one year. Teas are warm and soothing and may be sipped throughout the day, but these are time-consuming to prepare and also have a limited shelf-life.11
Most reports of toxicity have been traced to mislabeled or adulterated products. People should avoid products that contain multiple herbs or germanium. Prolonged used of ginseng may be associated with increased blood pressure, insomnia, and uterine bleeding and sore breasts in women.
Ginseng was associated with an elevated serum digoxin level in one case. A probable interaction between warfarin and ginseng exists.
Ginseng is a relatively safe herbal remedy except when used in high doses for prolonged periods or when used by women with estrogen-related breast and uterine diseases. There is insufficient evidence to judge ginseng's benefit in the treatment of hot flashes. Estrogen therapy is effective and beneficial for both menopausal and post-menopausal women, but alternatives to estrogen (including megesterol acetate, clonidine, and medroxyprogesterone, as well as ginseng and other herbal remedies) have not been well-studied. Regular physical activity, a balanced diet high in phytoestrogens and low in fats, avoidance of alcohol and caffeine, and stress reduction are likely to be of benefit in the treatment of hot flashes.