Exploring natural alternatives to HRT after cancer
Hands up, ladies, if your libido isn’t what it was before you were diagnosed with cancer. It really isn’t surprising, given that the stress of the diagnosis will have an impact on your sex drive. But there’s also the effect of surgery, particularly in the case of breast cancer patients, who may understandably feel that their sexuality has been damaged by it and that they’re less attractive. On top of that, chemo and radiation can cause vaginal atrophy, which can cause sex to be painful or uncomfortable. If you’re on Selective Estrogen Receptor Modulator (SERM) medication like Tamoxifen, that can cause hot flashes, vaginal dryness and loss of libido too.
Medical solutions
Pre-menopausal women are sometimes prescribed medications to boost their sex drive:
One of these is Flibanserin (Addiyi), which is a tablet you take once daily at bedtime. It can cause nausea, dizziness, fatigue and low blood pressure. If you drink alcohol or take Fluconazole, commonly used to treat vaginal thrush infections, it can make the side effects even worse (1).
Another is Bremelanotide (Vyleesi), an injection you give yourself in the thigh or the stomach just before sex. Common side effects include headache, flushing, vomiting and a reaction at the injection site. Some women feel nauseous but this usually happens after the first injection with less of a reaction with subsequent ones (1).
Neither of these is a particularly attractive proposition, is it?
If you’re post-menopausal, doctors usually prescribe hormone replacement therapy (HRT). That can be problematic if you’ve had cancer because the treatment increases your chances of subsequent cancers. Hormone replacement therapy increases your risk of breast cancer in particular, can cause endometrial cancer with some therapies, not to mention increasing cardiovascular risks. Most doctors wouldn’t recommend HRT to someone who’s had cancer.
Herbs that can improve your life
Luckily, there are a few herbs that can help.
Ashwagandha (Withania somnifera)
In a double-blind randomised controlled trial (RCT), 50 women aged 21-50 suffering from Female Sexual Dysfunction (FSD) tested Ashwagandha over 8 weeks. After 4 weeks of using it, they had a significant improvement in lubrication, arousal, orgasm and satisfaction, but no improvement in pain. All of that happened without any adverse side effects (2).
Another RCT studied women aged 18-50 with no hormonal disturbances and suffering FSD who took 300 mg of Ashwagandha twice daily for 8 weeks. Like the other study, there was a significant improvement in lubrication, arousal, orgasm and satisfaction. In this study, pain was reduced too. Side effects were minor and included some nausea and drowsiness (3).
Ashwagandha has all sorts of other benefits for cancer patients, which I covered in an earlier blog article and I highly recommend it to you if you’re able to take it.
The normal dose for Ashwagandha is 300 mg taken twice daily.
At doses of up to 1250 mg daily, it is considered to be safe to use for up to 6 months (4).
You may experience some digestive upsets with its use: vomiting, diarrhoea or upset stomach. If this happens, stop using it.
If you have or are recovering from a blood cancer, you shouldn’t use Ashwagandha, as its effects on the bone marrow could increase your cancer’s growth.
Women who are pregnant or breastfeeding shouldn’t use it because of its hormonal effects. It could potentially cause miscarriage and the hormonal effects could pass into a suckling infant.
Take care if you are taking anti-diabetic medication, as it could increase its effects.
Don’t use it if you are taking immunosuppressants, as it’s likely to reduce their effects.
If you are on thyroid medication, consult your doctor before using it.
Stop taking Ashwagandha before any surgery that requires a general anaesthetic because its sedative effects could increase the effects of the anaesthetic.
Ginseng (Panax ginseng)
There are quite a few varieties of ginseng and all of them contain different constituents with different actions. Here I’m talking about Red Korean Ginseng, also known as Panax gingseng.
Ginseng is an adaptogen, which means that it helps to balance stress, boosts energy and generally acts as a tonic. But it also has a reputation for helping with sexual problems.
A double blinded RCT on 59 post-menopausal women aged 45-60 with FSD tested 500 mg of ginseng twice daily for 4 weeks. The group that received the ginseng had a significant improvement in arousal, lubrication, orgasm, satisfaction and pain (5).
In another double blinded RCT of post-menopausal women, they took 1 g of ginseng 3 times daily. It significantly improved arousal for them (6).
Unfortunately, ginseng does have an effect on oestrogen and progesterone, so it isn’t suitable for you if you have or have had a hormonal cancer (7).
It can cause insomnia because of its energy-boosting effects. If you choose to take it, it’s best taken earlier in the day so that its effects have dwindled by bedtime.
Theoretically, ginseng could increase your risk of hypoglycaemia if you’re taking anti-diabetes drugs (8).
Celery seed (Apium graveolens)
Who would have expected that the humble celery seed would be an aphrodisiac? But a double blind RCT has proven that to be the case. In a fairly small group of pre-menopausal women (80), half were given 500 mg of celery seed 3 times daily for 6 weeks. After just 3 weeks, the results showed that the celery seed was significantly more effective at improving arousal, lubrication and pain than the placebo. But even after 6 weeks, satisfaction and orgasm measurements hadn’t improved. There weren’t any serious side effects reported and nobody dropped out of the study because of them (9).
Animal studies have proved that celery seed increases testosterone levels, which probably explains how it works. It also contains flavonoids, which have a mild phyto-oestrogenic effect (9). You might want to discuss using it with your oncologist if you have a hormonal cancer. Aside from this, celery seed is considered very safe.
Because of its effects on testosterone, celery seed will not be a good option for post-menopausal women. Testosterone increases the risk of hormone-sensitive cancers in post-menopausal women (13).
There is a theoretical concern that celery seed could reduce the effects of levothyroxine (10).
Celery seed has a mild diuretic effect, which could increase levels of lithium (10).
Maca (Lepidium meyenii, L. peruvianum)
Most herbs associated with aphrodisiacs for women don’t help when they’re taking SSRI (selective serotonin reuptake inhibitor) anti-depressant drugs. Maca is an exception.
Two small studies have shown that taking 1.5 g of maca twice a day for 12 weeks improves loss of libido induced by SSRI drugs (11).
Another study on post-menopausal women proved that this wasn’t because of any oestrogenic effect, but maca did reduce the psychological effects and sexual dysfunction caused by menopause (11).
Tribulus (Tribulus terrestris)
Tribulus has been used in folk medicine for thousands of years in India, Pakistan, Sudan and China to treat a wide variety of conditions, including to boost libido both in men and women.
A review of a number of studies found evidence that it was effective for improving sexual satisfaction, pain, desire, lubrication and ability to reach orgasm in both pre-menopausal and post-menopausal women. It does this by increasing testosterone levels. Testosterone is known to be connected with women’s sexual drive as well as men’s (12).
This review also found evidence that testosterone is helpful in fighting breast and ovarian cancer because it counterbalances the stimulatory effects of oestrogen (12). This is certainly true for pre-menopausal women but the story is a bit different in post-menopausal women. That’s because older women tend to convert the testosterone to oestrogen and this has been shown to increase the risk of hormone-sensitive cancers in healthy women (13). So Tribulus is not going to be advisable in post-menopausal women and particularly those with hormone-sensitive cancers.
The dosage used in the studies was 250 mg 3 times daily for 3 months. It seems to be well tolerated, with only rare side effects (14).
If you take antidiabetic medication, Tribulus could increase your risk of hypoglycaemia (14).
Theoretically, if you take Tribulus together with drugs for hypertension (high blood pressure), it could increase their effects and you could get low blood pressure (14).
Again theoretically, Tribulus could increase the effects of lithium (14).
Lemon balm (Melissa officinalis)
You may remember my previous article on lemon balm with all the benefits of it wrapped up in a wonderful tasting herb that can be used to make tea as well as used in cooking.
In a small double blind RCT of 89 women between 18 and 50 suffering from reduced sexual desire, 1 g of an extract of lemon balm was given twice daily for 4 weeks. By the end of the study, those taking the lemon balm had significant improvements in desire, arousal, lubrication, orgasm, satisfaction and pain (15). This study didn’t mention whether any of the women were post-menopausal. It doesn’t have any oestrogenic effects or raise testosterone levels, so it should be suitable for both pre- and post-menopausal women.
The extract in this study was made by making an infusion that was then concentrated. To make an infusion, you pour 600 ml of boiling water over 30 g of dried lemon balm and brew it for at least 10 minutes to extract the useful constituents. Drink 200 ml of the tea and save the rest to warm up later the same day. Make a fresh batch every day.
It’s unwise to take lemon balm if you’re drinking alcohol or taking sedatives, as it’s likely to increase the sedative effects (16).
In animals, it increases the effects of barbiturates (16).
Glaucoma patients have reported increased eye pressures after taking lemon balm (16), so if you have glaucoma ask your health professional to monitor your eye pressures if you’re taking lemon balm.
Lemon balm could theoretically reduce the effects of thyroid replacement medication (16). If you’re taking thyroid replacement medication, ask your health professional to monitor your hormone levels.
In vitro studies suggest that lemon balm could interact with SSRIs, drugs used for depression (16), so you shouldn’t use lemon balm with them.
At high doses (900 mg a day or more), lemon balm could make it dangerous for you to drive or operate machinery (16).
There isn’t enough information on its use during pregnancy or breastfeeding, so I suggest you avoid it.
It has very few side effects, apart from rare cases of allergic reactions and wheezing. It might increase your appetite. But for most people it’s a very safe herb.
Conclusion
I hope that at least one of these herbs will help you if you’re currently suffering from a lack of sexual desire. If one doesn’t help you, try another.
If you find any of them useful, I’m sure that other readers would appreciate it if you would leave a comment below to let other people know.
There are so many side effects that can affect us during and after cancer treatment. You can find many more remedies for counteracting them in my book and you can find links to all the online stores you can buy it, in both paperback and ebook formats, by clicking the ‘Buy the Book’ button below.
References
Mayo Clinic. Low sex drive in women. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/low-sex-drive-in-women/diagnosis-treatment/drc-20374561. Published February 24, 2022. Accessed March 14, 2023.
Dongre S, Langade D, Bhattacharyya S. Efficacy and safety of ashwagandha (Withania somnifera) root extract in improving sexual function in women: A pilot study. BioMed Research International. 2015;2015:284154. doi:10.1155/2015/284154
Ajgaonkar A, Jain M, Debnath K. Efficacy and safety of ashwagandha (Withania somnifera) root extract for improvement of sexual health in healthy women: A prospective, randomized, placebo-controlled study. Cureus. 2022;14(10):e30787. doi:10.7759/cureus.30787
Natural Medicines Database. Natural Medicines - Login. Natural Medicines Database. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=960#interactionsWithDrugs. Published 2022. Accessed 2023.
Ghorbani Z, Mirghafourvand M, Charandabi SM-A, Javadzadeh Y. The effect of ginseng on sexual dysfunction in menopausal women: A double-blind, randomized, controlled trial. Complementary Therapies in Medicine. 2019;45:57-64. doi:10.1016/j.ctim.2019.05.015
Oh K-J, Chae M-J, Lee H-S, Hong H-D, Park K. Effects of Korean red ginseng on sexual arousal in menopausal women: Placebo-controlled, double-blind crossover clinical study. The Journal of Sexual Medicine. 2010;7(4 (Pt 1):1469-1477. doi:10.1111/j.1743-6109.2009.01700.x
Cho JY, Park W, Lee SK, Ahn W, Lee YJ. Ginsenoside-RB1 from Panax ginseng C.A. Meyer activates estrogen receptor-α and -β, independent of ligand binding. The Journal of Clinical Endocrinology & Metabolism. 2004;89(7):3510-3515. doi:10.1210/jc.2003-031823
Natural Medicines Database. Panax ginseng. Natural medicines database. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1000#interactionsWithDrugs. Published March 27, 2022. Accessed March 15, 2023.
Hessami K, Rahnavard T, Hosseinkhani A, et al. Treatment of women's sexual dysfunction using apium graveolens L. fruit (celery seed): A double-blind, randomized, placebo-controlled clinical trial. Journal of Ethnopharmacology. 2021;264:113400. doi:10.1016/j.jep.2020.113400
Natural Medicines Database. Celery. Natural medicines database. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx. Published November 18, 2021. Accessed March 16, 2023.
Prescott H, Khan I. Medicinal plants/herbal supplements as female aphrodisiacs: Does any evidence exist to support their inclusion or potential in the treatment of FSD? Journal of Ethnopharmacology. 2020;251:112464. doi:10.1016/j.jep.2019.112464
Ghanbari A, Akhshi N, Nedaei SE, et al. Tribulus terrestris and Female Reproductive System Health: A comprehensive review. Phytomedicine. 2021;84:153462. doi:10.1016/j.phymed.2021.153462
Tin Tin S, Reeves GK, Key TJ. Endogenous hormones and risk of invasive breast cancer in pre- and post-menopausal women: Findings from the UK Biobank. British Journal of Cancer. 2021;125:126-134. doi:10.1038/s41416-021-01392-z
Natural Medicines Database. Tribulus. Natural medicines database. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx. Published November 7, 2022. Accessed March 16, 2023.
Darvish-Mofrad-Kashani Z, Emaratkar E, Hashem-Dabaghian F, Emadi F, Raisi F, Aliasl J, Kamalinejad M, Hasheminejad SA, Eftekhar T, Zafarghandi N. Effect of Melissa officinalis (Lemon balm) on Sexual Dysfunction in Women: A Double- blind, Randomized, Placebo-controlled Study. Iranian Journal of Pharmaceutical Research. 2018 Winter;17(Suppl):89-100. PMID: 29796033; PMCID: PMC5958328.
Brendler T, Gruenwald J, Kligler B, et al. Catherine Ulbricht, PharmD, MBA(C), column editor, Lemon Balm (Melissa Officinalis L.). Journal of Herbal Pharmacotherapy. 2005;5(4):71-114. doi:10.1080/j157v05n04_08
