So what did I do? First I suggested shatavari (Asparagus racemosa), alongside black cohosh (Cimicfuga racemosa). Black cohosh was accepted by the substitute supervisor (SS), but shatavari was not. Black cohosh is a selective modulator of oestrogen receptors, able to protect bone mass but not stimulate growth of the uterus or breasts, so it is a safe alternative to oestrogen replacement. Shatavari apparently only works if a woman still has some eggs left, good for perimenopausal but not postmenopausal women. I eventually replaced this with rehmannia (Rehmannia glutinosa) extract, as this is an adrenal tonic and the adrenal glands are responsible for almost all of a postmenopausal woman's sex hormones.
|Tribulus terrestris. Source: JM Garg|
I had also advised this patient to eat regularly, and I learnt today that caloric restriction of at least 50% can increase sex hormone binding globulin, which may be contributing to her weight gain. Depending on her results, this saga may continue as the treatment of menopausal weight gain is considerably overlooked for something that so many people want to address.