NEW YORK—Many common gynecologic conditions including urinary tract infections, menstrual cramps, vaginitis and interstitial cystitis can be easily and effectively managed with readily available botanical medicines, said Marcey Shapiro, MD, at Columbia University’s 8th annual course on Botanical Medicines in Modern Clinical Practice.

Dr. Shapiro, who practiced as a clinical herbalist before becoming a primary care physician, reviewed the clinical applications of herbs like Uva Ursi, Black Haw, Dong Quai, Chickweed, Cleavers, and Cranberry. But she stressed that herbs are not quick-fix panaceas: they tend to work more slowly than pharmaceuticals, and they typically require more frequent dosing. Efficacy will depend in large part on each patient’s willingness to engage in her own care.

For relatively minor but chronic gynecologic problems, she believes herbs offer advantages over drugs. “Preparing herbs encourages patients and their loved ones to actively participate in their own healing process. You will start to attract the kind of patients to your practice who will do proactive things to enhance their own health.”

Further, herbs tend to be less expensive than pharmaceuticals. “Many (synthetic) pharmaceuticals are derived from petroleum which is not a renewable resource. Plant-based medicines, especially if grown organically, are indefinitely sustainable and inexpensive to produce in terms of the real costs to the planet.”

The following are several of Dr. Shapiro’s favorite herbs for women’s health:

Black Haw (Viburnum prunifolium) and Cramp Bark (Viburnum opulus): These closely related herbs are native to North America, and have been used by Native Americans for centuries. Until the Flexner era in the 1920s, Black Haw was a common remedy for menstrual cramps. Though there are no clinical trials of either herb, they are widely used by midwives to prevent miscarriages.

Dr. Shapiro has found Black Haw, taken as a tincture alone or in combination with Cramp Bark, to be an excellent antispasmodic for treating menstrual cramps. It also has bactericidal and fungicidal effects, making it a good choice for women who have concurrent vaginitis. Be aware though, that these plants contain coumarin, meaning they should not be used long-term, and should be avoided in women on warfarin. They also contain valerianic acid, which can be sedating in some patients.

In most cases, mild menstrual cramps can be managed using a standardized tincture of Black Haw or a combination Black Haw and Cramp Bark, at a dose between 1 and 5 cc, every 4–6 hours.

Dong Quai (Angelica sinensis): “This is the preeminent Chinese herb for gynecological complaints, and you find it in 70%–80% of all gynecologic formulas in Chinese medicine, including those used for pregnancy,” said Dr. Shapiro, adding that without comprehensive training in Chinese herbal medicine, one probably should not use this herb to treat pregnant women. For non-pregnant women, though, it is quite safe.

In Chinese medicine, Dong Quai root is considered a uterine tonic, but like many tonic herbs, it has seemingly paradoxical, polyvalent effects. The alcohol-soluble components have a relaxing effect on the uterine wall, making alcohol-based Dong Quai tinctures a good therapy for menstrual cramps. On the other hand, the water-soluble compounds tend to be uterine muscle stimulants, so a Dong Quai decoction or tea is effective for conditions requiring increased uterine muscle tone.

In Chinese culture, Dong Quai is often used in soups. A portion of a root is simply boiled in chicken stock, and often given to people with mild anemias and poor circulation. Though it is a mild circulatory stimulant, it does not increase the work of the heart or the heart rate. This makes it a very useful herb for post-surgical convalescence.

Dr. Shapiro has found Dong Quai effective in managing menorrhagia, but only when taken during the first half of the menstrual cycle. “I recommend it only during the first 10 days of the cycle.” It is not particularly useful for post-menopausal women, and those who experience a lot of hot flashes should avoid Dong Quai as well as licorice and ginseng, as all three can actually increase frequency of flashes.

Her preferred mode of delivery is via standardized tinctures, given at a dose of 1–5 cc, several times per day. As with all herbs, you need to tailor the dosage to the patient’s response. “Some people will be very sensitive to a certain herb, and need only small doses, even a couple of drops. Others need very large doses. You have to see what works for each individual patient.”

	A cranberry harvest in New Jersey, and (inset) a coastal Washington cranberry bog. Unsweetened cranberry extract is an effective treatment for urinary tract infections. Photos by Keith Weller, courtesy of USDA Agricultural Research Service.

Cranberry (Vaccinium macrocarpon): This is arguably the penultimate plant medicine for urinary tract infections. It is extremely safe, and there is solid evidence that it prevents adherence of bacteria to the bladder wall. It is particularly effective against E. coli, and 60% of the known E. coli strains are sensitive to components in cranberries.

When patients come in complaining of UTI-like symptoms, Dr. Shapiro almost always does a urine culture, to determine if symptoms are in fact due to bacterial infections, and to identify the specific pathogen. “I then give my patients the choice of herbal therapy or antibiotics. Between 60% and 70% of them choose herbs, and they almost always work, obviating the need for antibiotics.” She uses cranberry in capsule form, two capsules, four times daily, or a concentrate of cranberry, 2 ounces dissolved in 8 ounces of water, and drunk every 2–3 hours.

She has found that goldenrod tincture is a useful adjunct in combination with cranberry capsules, provided a patient is not allergic to goldenrod or related plants.

It is essential to advise patients against using sweetened cranberry products. “Unsweetened is essential. Any kind of sweetener will diminish the antibacterial effect.”