The internet is filled with numerous herbal medicine products and conflicting information, and it can be overwhelming to choose what is right for you – especially once you have had a cancer diagnosis. For this reason, it’s beneficial to equip yourself with knowledge from reliable sources and consult with a highly trained and registered herbal medicine practitioner who has extensive expertise in this field. We are therefore delighted to share with you the knowledge of Melinda McDougall, the former Vice President of the National Institute of Medical Herbalists. This information is an extract from a podcast episode we recorded with her.

Herbal medication is commonly used but seldomly discussed with a doctor

Herbal medicine is commonly used, but not always openly disclosed, by cancer patients. Indeed, research shows that large proportions of women are turning to complementary and alternative medicine (CAM), including herbal remedies for relief from their menopausal symptoms (1). With this in mind, this article investigates the main concerns surrounding the use of herbal medicine, explains who can assist you in its safe usage, highlights the precautions to take, and debunks common myths.

As Dani Binnington, Founder of Menopause and Cancer explains “You have already been through so much and have been dealt really difficult cards. If we believe that herbal medication can be of benefit to us, we really have to do it properly.”

 

How Natural and Surgical or Chemical Menopause Differ

According to Melinda, “The natural progression of menopause is about 20 years in total, however, with chemical or surgical menopause you are plunged into menopause overnight. You don’t get any of the mental or physical preparation. Women experiencing this need a lot of support for symptoms that can be particularly harsh.” Often, women are faced with the questions of “Is this it?” or “How am I going to manage for the next… years?”

 

How could herbal medicine help you during long-term cancer treatment?

Often, cancer medications can negatively affect your mood which can have a knock-on effect on how you feel about yourself, influencing factors such as weight and sleep. There are many herbal medicines that can help you to feel better. For example, Blue Skullcap (Scutellaria lateriflora) is a very calming and relaxing plant that is good for anxiety, without a sedative effect. Lemon Balm (Melissa officinalis) can help you feel boosted and is good for digestion. Rose (Rosa damascena) is an uplifting herbal medicine. And Valerian (Valeriana officinalis) and Passionflower (Passiflora incarnata) can help with sleep and night sweats.

 

How do I check for contraindications of herbal medicine and cancer medications?

Herbal medicine can be taken as liquid extracts or tinctures, capsules or tablets, or as a tea to sip. It is, however, strongly advised to check first for any contraindications with medicines that you may be taking. A medical herbalist or pharmacist can help advise you.

 

Is a cup of tea enough to ease symptoms?

“The power of herbal medicine is often underrated – it can be used in a very simple way and be so effective”. Melinda suggests always trying to obtain loose-leaf herbal tea as it will be stronger and more potent than a herbal tea bag. In addition, she advises steeping it in your teapot for about 10 minutes to let the hot water extract the chemicals from the plants. G Baldwins and Co, established in 1844 by George Baldwin, is London’s oldest Apothecary and is recommended as a good source of loose-leaf herbal tea. Melinda emphasises that this is a really inexpensive and easy way of using herbal medicine.

 

How can Adaptogens help women in cancer treatment?

Adaptogens are a class of herbs that help our bodies ‘adapt’ to stress. Some Adaptogens can be beneficial for women who are either recovering from breast cancer or undergoing treatment, including Ashwagandha, Rhodiola, and Siberian Ginseng.

Ashwagandha

Studies have indicated that Ashwagandha (Withania somnifera) might have anti-proliferative properties and may assist in suppressing breast cancer recurrence (2). Ashwagandha promotes a sense of calmness and reduces anxiety, while also protecting against physiological and emotional stress. Additionally, it helps to improve sleep quality.

Rhodiola

Rhodiola (Rhodiola rosea) is prized for its ability to improve energy, mood, cognition, and mental focus and its cardio-protective and anti-cancer qualities (3,4). While there are no specific studies looking at interactions with Tamoxifen or aromatase inhibitors, a small-scale study in humans has shown that Rhodiola has the potential to affect specific liver enzymes which may decrease the clearance of certain drugs (5) an effect that has also been seen in laboratory tests (6). It’s possible that Rhodiola might increase the levels of Tamoxifen in your body, but whether this is beneficial or not remains uncertain.

Siberian Ginseng

If you’re feeling tired, Siberian Ginseng (Eleutherococcus senticosus) might help give you a boost of energy. It is also well known for improving mental focus, for its immunomodulatory actions, and for having antioxidant and anti-cancer properties (7). It’s important not to confuse it with Asian Ginseng (Panax ginseng), which is a different plant species and has so-called ‘phytoestrogenic’ properties. Again, it is advised to consult first with a trained medical herbalist to ensure there are no herb-drug interactions or side effects.

What is the controversy surrounding Herbal Phytoestrogens?

Women who have been diagnosed with breast cancer are often advised against consuming phytoestrogens. These are plant compounds that have a similar chemical structure to human oestrogen. To clarify, there are two types of oestrogen receptors: alpha and beta receptors. When we talk about hormone-receptive breast cancer, we mainly refer to the alpha receptors that play a role in driving the cancer.

A growing body of research shows that beta receptors may have an anti-proliferative effect, meaning they reduce cancer growth and slow down the alpha receptors. The beta receptors were only discovered as recently as 1996, so research in this field is relatively new.

Interactions with common cancer drugs

Drugs like Tamoxifen target the alpha receptors by suppressing their activity. Initially, it was believed that herbal phytoestrogens stimulated the alpha receptors, potentially increasing the risk of breast cancer recurrence. However, according to Melinda, current research is debunking this theory. Specifically, new studies are showing that phytoestrogens have a higher affinity for binding to beta receptors, meaning that they may be beneficial for women recovering from breast cancer and reduce recurrence (8).

Phytoestrogen or PhytoSERM?

The name ‘phytoestrogens’ may be misleading – while they do have an oestrogenic effect, Melinda agrees with researchers who recommend that they should be renamed PhytoSERMs – Selective Estrogen Receptor Modulators. These so-called phytoestrogens include Sage (Salvia officinalis), Red Clover (Trifolium pratense), and Wild Yam (Dioscorea villosa). At the moment patients will generally receive a hard “no” from oncologists as to whether these herbal medicines are safe to use in cancer treatment. However, there are ground-breaking research trials in this area being undertaken which may change the shape of this conversation.

New PhytoSERM Research Trials

Dr. Roberta Brinton, Ph.D., an internationally recognised leader in Alzheimer’s research, has received substantial funding of $7.6 million to research PhytoSERMs (9). She is studying isolated components of Soy and Red Clover. Examining their impact on the female brain, and their ability to relieve symptoms such as hot flushes. In addition, she says they may also have the potential to reduce breast cancer risk (10). Furthermore, Dr. Brinton hopes that in future this may be offered as a safer alternative to traditional hormone therapy. Therefore, these clinical trials are generating a lot of excitement and the scientific community eagerly awaits the outcomes. 

Is the herbal medicine Black Cohosh safe for women with breast cancer?

Black Cohosh (Actaea racemosa) is a popular and effective herbal medicine for menopause. It was first used by the indigenous North Americans. Originally thought of as a so-called ‘phytoestrogen’, we now understand that it works on neurotransmitter pathways in the brain. It helps calm hot flushes and improves mood and sleep – and doesn’t adversely affect oestrogen-sensitive pathways (11).

Melinda is an advocate of potentially using Black Cohosh with breast cancer patients. Moreover, she believes that up-to-date research (12) is not reflected in the current medical guidelines.

The Current Guidance for Herbal Medicine and Cancer Treatment

Current medical guidance advises against taking Black Cohosh if you’ve had breast cancer or are undergoing endocrine therapy. Melinda, however, highlights that clinical studies have been done looking at the use of Black Cohosh alongside Tamoxifen. These studies found that Black Cohosh enhanced the activity of Tamoxifen and reduced menopausal symptoms such as joint aches, night sweats, hot flushes, and low mood (13,14). With this debate in mind, there are calls for additional well-designed clinical studies. Which needs to evaluate the efficacy and safety of using the herbal medicine – Black Cohosh – while undergoing treatment.

 

Differing Views

Some oncologists may not agree with incorporating herbal remedies like Black Cohosh into cancer treatment, while others are more open-minded. In fact, it’s not unusual for women to receive conflicting guidance from different doctors, even within the same hospital. As a result, it can be quite challenging for patients to navigate through this. Therefore, having a medical herbalist who engages in scientific discussions with specialists and presents them with the latest evidence for review can be incredibly helpful in such cases.

 

What To Consider When Buying Herbal Medicine Over The Counter?

Is important to seek a trusted and reliable source when purchasing herbal medicines. Especially if you are taking medication, so you don’t put your treatment at risk. Melinda points out that many products that are advertised either do not work or do not contain the plants that are described. A medical herbalist will prescribe practitioner-grade medicines from their own dispensary. Furthermore, she recommends that if you are buying supplements in a health food shop or online, to look out for the THR logo: Traditional Herbal Registration. This will ensure that the medicine has gone through a registration process and is a reliable quality product.

 

What is a Medical Herbalist?

A medical herbalist is highly trained to work with plant medicines and botanical extracts that include all the chemical constituents that make up a plant. Medicinal plants often have long traditional uses that are backed up by modern scientific research and clinical trials.  Melinda describes herbal medicine as “Always being with us; plants were here before humans existed and we have evolved alongside them. Our bodies know exactly what to do with these plant medicines; they are fundamental to our health and well-being.”

How Do I Choose A Medical Herbalist?

Some people might want to consider seeing a medical herbalist who can look at your specific case. In addition, liaise with your medical team if necessary and put together a treatment plan, including a herbal medicine prescription tailored to you. The National Institute of Medical Herbalists is the main governing body for herbal practitioners in the UK. Specifically, the “Find a Herbalist” section of the website enables you to find a highly trained, registered practitioner in your area. The College of Practitioners of Phytotherapy (CPP) is also a highly regulated source. 

The Role of a Medical Herbalist

A medical herbalist can support women going through perimenopause and menopause with herbal medicine. This includes women who have undergone surgical or chemical menopause. One of their goals is to help women undergoing long-term cancer treatment to continue taking their medication for as long as possible and alleviate the debilitating side effects caused by endocrine therapy, which often results in women discontinuing their medication. Overall, “The aim is to stay on the drugs, keep cancer at bay, and help women to feel better while in recovery.” 

 

What can you expect from a typical consultation?

A typical consultation lasts approximately 60-90 minutes and your concerns are closely listened to. The safety of the prescribed treatment is ensured by gathering a comprehensive medical history, including medication details. Additionally, areas like diet, sleep, and digestion are thoroughly discussed. If needed, collaboration with specialists like gynaecologists, oncologists, breast cancer teams, or pharmacists is established. These conversations are often backed by research papers to enhance the effectiveness of the treatment. Finally, a herbal medicine prescription is formulated consisting of various herbs targeting specific symptoms.

Taking a Holistic Approach

Frequently, there is a tendency to want a “magic silver bullet” to fix everything. However, as Melinda highlights, it’s generally not just one thing that works and it’s not “one size fits all”. Overall, it’s best to take a holistic approach that focuses on individualised and personalised medicine. Each person is unique with different health needs. In addition, varying factors such as side effects and contraindications need to be taken into account.

Open Communication is Key in Herbal Medicine and Cancer Care

It is not uncommon for women to hide what they are taking from their oncologist or medical team due to confusion about what is appropriate and safe to take. Melinda proposes that a more collaborative approach is viable with a medical herbalist. She explains that women should not feel like they need to conceal information. Or go outside of what the treatment protocol is. Instead, she advocates for all practitioners involved to discuss and come to an agreement regarding the safe use of herbal medicine. Moreover, medical herbalists can work alongside other practitioners who are part of your care.

References:

1. Posadzki P, Lee MS, Moon TW, Choi TY, Park TY, Ernst E. (2013). Prevalence of complementary and alternative medicine (CAM) use by menopausal women: a systematic review of surveys. Maturitas. 75(1), 34-43. https://doi.org/10.1016/j.maturitas.2013.02.005.

2. Vashi, R., Patel, B. M., & Goyal, R. K. (2021). Keeping abreast about ashwagandha in breast cancer. Journal of Ethnopharmacology269, 113759. https://doi.org/10.1016/j.jep.2020.113759

3. Panossian, A., Wikman, G., & Sarris, J. (2010). Rosenroot (Rhodiola rosea): Traditional use, chemical composition, pharmacology and clinical efficacy. Phytomedicine17(7), 481–493. https://doi.org/10.1016/j.phymed.2010.02.002

4. Pu, W., Zhang, M., Bai, R., Sun, L., Li, W., Yu, Y., Zhang, Y., Song, L., Wang, Z., Peng, Y., Shui, H., Zhou, K., & Li, T. (2020). Anti-inflammatory effects of Rhodiola rosea L.: A review. Biomedicine & Pharmacotherapy121, 109552. https://doi.org/10.1016/j.biopha.2019.109552

5. Thu OK, Spigset O, Nilsen OG, Hellum B (2006). Effect of commercial Rhodiola rosea on CYP enzyme activity in humans. Eur J Clin Pharmacol. 72(3), 295-300. https://doi.org/ 10.1007/s00228-015-1988-7.

6. Ole Kristian Thu, Odd Georg Nilsen & Bent Hellum (2016) In vitro inhibition of cytochrome P-450 activities and quantification of constituents in a selection of commercial Rhodiola rosea products, Pharmaceutical Biology, 54 (12), 3249-3256, https;//doi.org/ 10.1080/13880209.2016.1223145

7. Davydov, M., & Krikorian, A. D. (2000). Eleutherococcus senticosus (Rupr. & Maxim.) Maxim. (Araliaceae) as an adaptogen: a closer look. Journal of Ethnopharmacology72(3), 345–393. https://doi.org/10.1016/s0378-8741(00)00181-1

8. Mauny, A., Faure, S., & Derbré, S. (2022). Phytoestrogens and Breast Cancer: Should French Recommendations Evolve? Cancers14(24), 6163. https://doi.org/10.3390/cancers14246163

9. Brinton, R. (2022, December 23). PhytoSERM to Prevent Menopause Associated Decline in Brain Metabolism and Cognition – Full Text View – ClinicalTrials.gov. Clinicaltrials.gov. https://classic.clinicaltrials.gov/ct2/show/NCT05664477

10. Wichner, D. (2023, November 10). Tucson Tech: Startup developing supplement to ease menopausal hot flashes. Arizona Daily Star. https://tucson.com/news/local/subscriber/tucson-medical-startup-university-of-arizona/article_0d422df8-7e94-11ee-b63f-f75185114024.html

11. Wuttke, W., Jarry, H., Haunschild, J., Stecher, G., Schuh, M., & Seidlova-Wuttke, D. (2014). The non-estrogenic alternative for the treatment of climacteric complaints: Black cohosh (Cimicifuga or Actaea racemosa). The Journal of Steroid Biochemistry and Molecular Biology139, 302–310. https://doi.org/10.1016/j.jsbmb.2013.02.007

12. Castelo-Branco, C., Gambacciani, M., Cano, A., Minkin, M. J., Rachoń, D., Ruan, X., Beer, A.-M. ., Schnitker, J., Henneicke-von Zepelin, H.-H. ., & Pickartz, S. (2020). Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms – an update on the evidence. Climacteric24(2), 1–11. https://doi.org/10.1080/13697137.2020.1820477

13. Ruan, X., Mueck, A. O., Beer, A.-M. ., Naser, B., & Pickartz, S. (2019). Benefit–risk profile of black cohosh (isopropanolic Cimicifuga racemosa extract) with and without St John’s wort in breast cancer patients. Climacteric22(4), 339–347. https://doi.org/10.1080/13697137.2018.1551346

14. Rostock, M., Fischer, J., Mumm, A., Stammwitz, U., Saller, R., & Bartsch, H. H. (2011). Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints – a prospective observational study. Gynecological Endocrinology: The Official Journal of the International Society of Gynecological Endocrinology27(10), 844–848. https://doi.org/10.3109/09513590.2010.538097

Melinda McDougall, MSc, MNIMH is a registered medical herbalist specialising in menopause and is the former Vice President of the National Institute of Medical Herbalists

https://www.melindamcdougall.com/

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Disclaimer: The information provided in this article is for informational purposes only and should not be considered as a substitute for medical advice. Always consult your doctor, oncologist, or medical team.

Menopause and Cancer are not affiliated with any product or service mentioned or linked.

Written by Bettina Alderton, MSc Psych, BSc (Hons)

Last updated January 2024

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