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St. John’s wort for perimenopause/menopause symptoms

Perimenopause and menopausal symptoms can include hot flashes/nightsweats, insomnia, anxiety, depression, cognitive changes, decline in sexual desire, and skin and mucus atrophy including the eyes, mouth, vulva, vagina and our general skin thinning, wrinkling and drying. That list might seem long enough, but there can be others. The good news is that not all women experience problematic symptoms, and if they do, often they are not long in duration. However, there are women who experience moderate to severe symptoms and/or long-standing symptoms. One study pointed out that the average length of hot flashes/nightsweats is about 7 years.

St. John’s wort is most well-known for its antidepressant effects. More recent clinical studies have found that SJW with black cohosh may be useful for symptoms in perimenopausal and menopausal women. The singular effect of St. John’s wort was studied for hot flashes in one perimenopausal women study and in one menopausal women study– both showing effectiveness

The purpose of the current randomized, double-blind, placebo-controlled study was to evaluate the effect of SJW on menopausal symptoms, hot flashes, and depression. Menopausal women (n = 80, aged 45-60) participated in this study conducted at six health centers in Iran. Women in the study had at least two menopausal symptoms. Study participants received 330 mg of St John’s Wort (SJW) three times per day or placebo for eight weeks. Standard menopause research scales were used at baseline and every two weeks including the Kupperman Index (KI) and the Hamilton Depression Rating Scale.

There were no significant differences between the SJW and the placebo groups in the frequency of hot flashes or in KI score at baseline and week two. However, at week 4 through week 8, the SJW group had a significant reduction in hot flashes and KI score compared with the placebo group. In addition, there were no significant differences between groups in the intensity of hot flashes at baseline and week 2. At week 4 through week 8, there were no participants in the SJW group with severe hot flashes, while the placebo group had 31-43% of participants with severe hot flashes.

Upon study entry, the intensity of depression was similar in both groups. Then, at eight weeks, 80% of the SJW group did not have depression and 20% reported mild depression. In the placebo group, only 5.7% had no depression and 80% had mild depression.

Commentary: From this study, it’s a fair conclusion that SJW significantly improved both the frequency and severity of hot flashes, general menopausal symptoms, and mild to moderate depression. I would be more comfortable if the study was at least 12 weeks. This study is consistent with other positive studies for mild to moderate depression, and at least one other study in perimenopausal women and one study in menopausal women, using SJW for hot flashes in menopausal women. Given that hot flashes and mood changes such as depression are a common perimenopause/menopause experience, I would have SJW as a top choice in addressing both of these symptoms. And don’t forget about those two SJW/black cohosh studies as well.

Reference: Eatemadnia A, Ansari S, Abedi P, Najar S. St. John’s Wort Reduces Menopausal Symptoms and Improves Depression in Post-menopausal Women with Mild to Moderate Depression The effect of Hypericum perforatum on postmenopausal symptoms and depression: A randomized controlled trial. Complement Ther Med. August 2019;45:109-113.

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