Herbs for Women's Health with Ginny Kemp

Herbs for women's health with Ginny Kemp

Sebastian: Hello there. Welcome to the herbcast, the podcast from herbal reality, delving into the plant powered world of herbalism. So, do you know your echinacea from your erythrococcus, or your polyphenol from your polysaccharides? Whether you're a budding herbalist, an inquisitive health professional, or a botanical beginner, herbcast is here to inform and inspire you on your journey to integrating herbs in our everyday lives. So settle down, turn us up, and let's start today's episode of the herbal reality Herbcast.

Simon: So welcome, Ginny. This is a lovely opportunity to talk about something very special in the world of herbal medicine. Thank you for coming along to talk us through some real world experience of women's health and working with women in the practice. Tell us a little about yourself. Where did you come into this herbal world?

into the herbal world back in: 2007

Speaker D: And when you'd asked me about that.

Ginny: I thought, my guesstimate is that I see about 80% women, actually. So I do do a lot of women's health. And I went back through my clinic book for the last few weeks and.

Speaker D: I was spot on.

Ginny: So 80% of my, uh, patients are women?

Simon: Yes, because obviously I have a different angle on this one. Um, but, uh, I would say I have obviously more men in the practice because they probably orient a bit to a male practitioner. But it's 60%, I guess, in my case. But I'm obviously having to learn from scratch every time. So I'm grateful to hear some of your stories. Interestingly, the hides are another thing we have in common because it was the hides that brought me into herbal medicine, flesher hide, way back in the 70s. Um, and we would do some of our clinical training up there.

Speaker D: Fantastic.

Simon: Um, yeah, we have that in common also. So thank you. Thank you again for coming.

health following on from the: 2021

Simon: Well, I was always struck when I was growing up in this world how, uh, much what we are using, uh, is women's medicine. Um, and historically, in many cultures, it was the women that did this work, uh, because they were often the midwives and the duers as well. They were the ones who were involved in day to day health care, uh, by various circumstances. And so, um, we see, especially in some of the earlier societies, we see it was the women who were picking the remedies and they were picking them for their own needs as much as anybody else's. Absolutely m from the inside, so to speak. And so her, uh, for menstrual and menopausal and fertility problems are really thick on the ground, aren't they?

Ginny: Yeah, they've been an absolute staple. And of course, in so many cultures around the world now that still happens, doesn't it? Less so in ours.

Simon: Perhaps it's catching up. We just have to look at the membership of the herbal profession and it's reverting back to type.

Ginny: Yeah.

Simon: Anyway, um, I don't know, uh, we thought we might like to start with talking about one particular story, one patient, one presentation, and tease it out a bit and see what you've learned from that. And we can sort of put the questions backwards and forwards between us. Do you want to introduce, uh, your patient, um, and tell us her story?

Ginny: Yes. So I have picked a patient, ah, whose story to share with you today. The reason I have chosen this one is because I think it really demonstrates, um, how we work as herbalists. Um, and it was a typical case of somebody coming in with a particular presentation and seeking help for a particular, um, area of their health. And then actually when we had our consultation and opened that out, um, there are, as always, lots of, um, other things playing into that. And I think that the wonderful thing about being able to spend an hour with our patients and having the luxury of the time is that we have time to examine, um, all of that. So, um, Alice was a 36 year old lady that came to see me, um, some time ago. And she'd been referred by somebody that.

Speaker D: Had been to see me before, and.

Ginny: She was struggling with fertility. So she had come off the oral contraceptive pill, um, 14 months, ah, before, and, um, was still trying to conceive, um, and she'd also noticed that she was feeling quite tired over the last six months. So she was suffering with some fatigue. So obviously we spoke through her gynecological history. Um, she, um, was actually put on the contraceptive pill at the age of 14 and that was for, um, heavy and painful periods and she'd been on it ever since. So a really long time to, um, have those hormone controlled periods. And, um, when she stopped her pill, the periods came back fairly quickly. Um, she was having a regular cycle and she was doing ovulation sticks that showed, um, an lh, um, surge mid cycle that suggested she was ovulating. Um, but, um, she felt that the luteal phase of her cycle was a bit lacking and the periods that she was getting were really quite scant. She had a one day good bleed, but it faded off very quickly after a couple more and she was, um, experiencing a lot of pain. So she was in agony, so much pain that she was actually, um, sweating and, um, not able to get out of bed, um, some days. And particularly she was noticing that was aggravated when she was trying to open her bowels. Um, she'd already been down the route of having some investigations done, so she'd had an ultrasound and her, um, ovaries and fallopian tubes were patent. There didn't appear to be any problems with her uterus, although it was raised that she may have had a slightly thin endometrial lining on day 21, which was interesting and tied in with the sort of scant periods, um. Um, but she had been referred potentially for some endometriosis, um, investigation off the back of that. Um, her blood tests had all come back fine. So oestrogen, progesterone, lh and fsh levels, um, had been, um, normal, um, but she hadn't had her prolactin looked at that time. So we spoke a little bit more about the history of her periods and, um, things, um, and then a little bit more about her wider health. Um, she was struggling with ibs at the same time and every morning she was waking up with, um, severe cramps until she managed to evacuate her bowels, but she was constipated. So good old type one on the Bristol stool chart, so pelleted, um, and mucusy and really uncomfortable. But actually, other than that her digestive system was unremarkable. Um, we talked through diet, of course, and she'd got a fairly standard, um, high grain diet, so she was having cereals and pastries, um, for breakfast. She had a very busy job. It was quite stressful, very long hours, um, so it was a typical sort of grab food when you can so um, cereals and pastries. Um, she would have a sandwich for lunch and then her evening meal. A lot of red meat, um, a little bit of um, vegetable, um, and potatoes and things. Not very much fruit. So quite lacking in fiber. She tended to have sugar cravings as well.

Speaker D: Um.

Ginny: Um, she was also suffering with anxiety. And m every morning she was waking up feeling um, like she got a tight chest and she was short of breath. So quite marked anxiety symptoms. She was worrying particularly about her health, about her fertility, and um, about the pain that she gets around her period and dreading the next one coming along. Um, and also as I say, she was noticing particularly that she was feeling lethargic. But her sleep was actually very good. So she was getting a good sleep opportunity. She was allowing herself 9 hours in bed, which obviously is hugely important in terms of hormone regulation. Um, but I'd say sort of lots of stress there. Um, she had a history of depression in her 20s, but she felt that was more due to a situation that she was in at the time. Um, and the other thing of note was that she was getting headaches. They weren't necessarily tied into her menstrual cycle, um, but she was getting a couple of headaches every month and some um, urinary tract infections. And she was also suffering with thrush.

Speaker D: From time to time.

Ginny: So quite a few things came up in sort of various different systems she was already taking proceeds. So she was taking um, a um, preconception multivitamin. And actually when she came off the pill, ah, 14 months before, she had been diagnosed with a low thyroid. So she was taking um, fairly low dose thyroxin at the time. Um, so we had a good chat.

Speaker D: Through all of that.

Ginny: The rest of her health was really um, quite good, um, but it was just one of those cases that comes up where instantly you feel like there are various areas that her be fantastic for. And actually if we can get lots of those different things moving better then altogether that would improve things and improve her chances of success at conception.

Simon: So you were fairly okay that the cycles were in order, they were on time, they were doing what they should do. Apart from perhaps uh, towards the end.

Speaker D: Of the luteal phase, they appeared to be.

Ginny: She was having a pretty regular um, cycle. It was at 31 days. Um, I say she was doing ovulation sticks. So she was getting an Lh surge that suggested she was ovulating around day 15 each month. And she also was getting Mickel Schmert. So she felt some inflammation that she was getting some electrical sort of sensations around day 21, um, as well. But yet the first half of her cycle seemed okay. She didn't report any pain at that stage. Um, it was more sort of around the period. And actually after the period, I say apart from day 21, she was okay. But I think because of the, um, IBS type symptoms and the fatigue, um, and, um, the severe dysmenorrhea, she was waiting for investigation into potential endometriosis. And that was of consideration, um, when I was putting together herbal treatment plan.

Simon: So what was your first thoughts?

Ginny: Yes, well, we use the word pelvic congestion sometimes, don't we? It's a bit of an old term rather than necessarily anything sort of hard sciency. But that was my gut feeling. It was that there was a lot of congestion. Things weren't moving around there. We needed to get her digestive system going so that she was, um, getting rid of, uh, any excess oestrogen, um, and also to relieve this tension around that area. And obviously the sort of luteal phase, the scamp period, I really wanted to get something warming in there to encourage pelvic circulation, um, so that just to support the uterus itself. So the herb that sprung straight into my mind was of course, Angelica sinesis, um, dong kwai, um, which I think is a brilliant herb for lots of pelvic and gyne, um, conditions. Because it's anti inflammatory, I thought she was probably producing quite a lot of the series two prostaglandins. So trying to push down that antiinflammatory pathway, um, it also helps to encourage the pelvic circulation. And I found it very, um, useful in helping to, um, encourage a good bleed, as we might sometimes call it. But when there is scamp bleeding. But interesting with Angelica senences, I don't know if you find the same, but I also do use it in fibroids and things where actually we're trying to astringe and slow the bleed. But because it's a tonic and used alongside other astringent, it really is very helpful in that moderating, um, it's congestion.

Simon: Isn'T it, that it is so appropriate for in whatever form it takes, particularly in the pelvic area. And that includes, as you said, um, things like fibroids and other pelvic symptoms.

Speaker D: Yeah, absolutely.

Ginny: Fantastic. And because it's also a gentle laxative as well, I thought it ticked that box in, helping to move things along, um, and also, uh, stability.

Speaker D: Um, so it was a really sort.

Ginny: Of top pick, um, to help, um, from all areas, really. Obviously. When we talk about the luteal phase, we often think about, um, vitex, agnes castus. So I gave her a good dose of one in one vitex. Um, I tend to mix that into the medicine for, um, ease and personally find it works just as well taken at any time of day. I know sometimes it's suggested that it's just taken in the morning. Um, but I popped that into the mix and that really was for, um, luteal phase support. So to encourage the progesterone side of things, um, the development of the uterine lining in that luteal phase. Um, and of course to ease premenstrual symptoms because she was finding that a week before her period, she was, um, feeling really quite mood, m swinging a little bit low. So to support the HPO axis, um, pop the vitex in there.

Simon: Do you consider vitamins and nutrients in that luteal phase at all?

Ginny: Um, generally, um, supplement wise, she was already taking proceed. And I put in some omega three fish oils, um, to help with that and to push it down to the prostaglandin three pathway. Um, other than that, I wouldn't use anything specific. Is there anything that you would recommend at that time?

Simon: Uh, they always cease to talk about various b vitamins at that stage of the cycle. And I don't know if the evidence is very strong and evening primrose oils and so on have often been as tight as the game. The evidence is a bit weak, I think.

Ginny: Yes, absolutely. Um, evening primrose oil. I tend to use, um, particularly for nostalgia. So, um, breast tenderness. Um, but yeah, b vitamins are often a top pick, um, when working with menstrual cycle, particularly premenstrual symptoms and anxiety. Um, and she was taking quite a good quality, um, preconception multivitamin that had some levels of b vitamins in there. Um, so that was sort of covered there, really. Um, I also put in some black cohosh. Now, they say you treat, um, choose herbs for people, not herbs for conditions. And I chose that from a sort of quite a traditional perspective. It's got its anti inflammatory properties to it. It's um, a sort of traditional spasmolytic and uterine tonic. And also because it can help with ovulation, I'll say the suggestion was that she was ovulating, um, but again with that scant, um, uterine lining, I thought if we put some semislfusure in just to help as a sort of traditional, um, uterine tonic. Um, and it's used sometimes to support ovulation. Alongside um, clomid. It's been reported to be quite useful in some studies there. Um, so that felt like a really good choice. So I popped some of that in.

Simon: Interestingly, uh, entry is also used in native American as a bowel remedy. So nice tie over there.

Ginny: Perfect. And we do, don't we notice sometimes that when you give it to patients they do report that their bowels are.

Speaker D: A little bit looser.

Ginny: Um, so yeah, in that mix, actually I only put ten mils in. Obviously we were trying to get the bowels going anyway. But um, I am sometimes a little bit cautious with that. Um, but I put some cramp bark in there as well to help, um, ease bowel tension. And obviously one of the key things we really wanted to ease was um, the period pain. That is menorah. And it was quite a spastic cramping pain. Um, and of course Fibop is quite good for anxiety as well.

Simon: Do you ever use fib pruneifolium?

Ginny: I was thinking about that when I put this together and I don't. It's not a herb that I um, stock in my dispensary. Um, and I was asking myself why that was. And I think it's because I find that Vibop has always worked quite well and I use that in lots of other conditions. But it did make me think that actually perhaps it's something that um, I should um, think about using. And I certainly remember in training that was the key one used for um, period pain.

Simon: I sometimes throw them both in together just to give a double whammy.

Ginny: And are there times when you use Vipproo on its own?

Simon: Yes, uh, I do see it as very focused on the womb. So, Jilly, what else was in the brew? We got the viburnum, uh, in there.

Speaker D: We did, yeah. The next herb that I put in there was chamomile as an anti inflammatory calm minative. So really working on the digestive system. Um, and um, that morning anxiety, I find it really useful in helping. Quite often I use it alongside um, black core hound, belota niagara for that and sort of the vagus nerve. But on this occasion m. I put, uh, just the chamomile in alongside, um, some ginger. Again, lovely warming digestures.

Simon: It was Fred Fletcher high that reminded me that metricaria comes from the latin matrix, which is womb.

Speaker D: There you go.

Simon: Uh, so it's again another clearly identified as a women's remedy once upon a time.

Speaker D: Yes. That will be why I use it by the bucket load. So I popped that in there alongside some ginger, um, for several reasons there. So obviously, pelvic circulation, anti inflammatory, sort of warming to get things moving. Um, and obviously, that often helps with palatability, because we know that a lot of the women's health herbs don't taste very nice.

Simon: They don't, do they? I think. Is it some of the saponins that can taste quite lousy?

Speaker D: Yes, absolutely. Um, and, um, I put a little bit of valerian in there as well, which personally, I love the taste of. I know not everybody's keen, but I always think that lifts it a little. Um, and again, that was to work, really, alongside the chamomile, um, on the acute anxiety that she was suffering in the morning and to help with the bowels, and also possibly just to have a go at the, um, easing the headaches that she was suffering with as well. Um, so that was the main mix that I gave her. I also gave her a pre menstrual mix of ginger and cramp bark, uh, to start 48 hours before the onset of her period.

Simon: Okay.

Speaker D: I gave her take two to four meals three times a day from 48 hours before, and then when her period started to continue at that dose, or she could increase it to every 3 hours if she felt that she needed to.

Simon: So what happened?

Speaker D: Well, she also made some good dietary changes because obviously there were some bits there, and I think that will have helped enormously in sort of how she got on. So she was eating a lot of red meat, so we reduced the red meat. We went a little bit more Mediterranean diet wise. So, uh, more fish, plenty of fresh fruit and veg. A good old tablespoon of flaxseed, um, on her breakfast in the morning to help encourage her bowels.

Simon: And also linseed also has its own benefits for the women's metabolism as well.

Speaker D: Yes, absolutely. Um, I encouraged her to split them if she could, because obviously, all's the better if time allowed. And obviously, if you're sort of looking for that action, that's particularly important, of course, isn't it? Um, but she was happy. She embraced the dietary changes that we made. Also, in my experience, in thinking along the lines of endometriosis, I found a lot of patients there in the dietary changes have benefited from taking gluten out, um, especially when the diet is quite so high in gluten and when the.

Simon: Bowels are also involved.

Speaker D: Yes, absolutely. Because irritating to the digestive system. Um, and I tend to suggest that as a temporary measure, take it out, see what difference it makes, and then look at trying to put it back in and usually at a lower level because I think it's um, not a bad thing to um, have little bits of, but obviously we have a lot of it. And particularly her diet was quite high in that we talked about dairy and just trying to go for organic if she could and not having too much of that. Again. Um, and I also suggested kafir, which obviously is dairy, but from a microbiome probiotic perspective, again, looking at bowel health, inflammation, immune regulation, you see there's a thyroid issue in there as well. So potentially that autoimmune link. M so she did all of that and um, she also took some high strength fish oils. So again to try and reduce the inflammatory prostaglandins. She was very compliant, um, and as a result I think she really um, felt the benefit. So I asked her to come back and see me four weeks later.

Simon: Where was she in the cycle when you started this treatment?

Speaker D: When I saw her again four weeks later, she was day 26. So she was quite late on in the luteal phase. Um, but interestingly something sort of kicked in really quite quickly. Obviously she was taking the um, cramp bark and ginger mix as well. Um, but I saw her after four weeks when she was day 26 again. Um, she had not had any of the bowel pain when she was opening her bowels, her bowels were soft and regular. Um, her uh, energy level was better already. Um, she wasn't waking up in the morning with those sort of acute anxiety symptoms. So the sort of chest pains, um, shortness of breath, um, and digestive upset. She'd um, obviously had a bleed but it was quite soon after I saw her. Um, it was a four day bleed so she had felt already that it was better. And actually she hadn't had any pain to start with. Um, she got 30 minutes of pain on day four, so normally she'd have quite acute pain on day one so it had really shortened it and pushed it to slightly later on in the bleed. She'd had her usual Michelsmertz ovulation and she still had that sort of electrical feeling in day 21. Um, and she hadn't had any headaches so she was really pleased. Um, and I think it's um, brilliant when after four weeks you can see a good improvement because it spurs on with all of the taking of the unpleasant things, um, and the dietary changes.

Simon: Because so often I find it takes three cycles to turn some of these things around. Uh, I often project that to avoid disappointment and the first one doesn't behave itself and sometimes I even say the first cycle is going to be different because we're still shaking things around a bit. Uh, but you may not expect it to be wonderful, but you hit gold there.

Speaker D: Yeah, but as you know, sometimes that can happen in the first cycle and then you get the next couple of cycles aren't as good. And so, uh, I'm exactly the same, I tend to say sort of a good three months. And we'd agreed, ah, a three month preconception plan. So I had complete free rein on the herbs that I used as well. And so of course, we had that conversation, said, that's brilliant. You'd only had your herbs for a couple of days at the time of your period, but obviously the rest of the improvements you'd noticed throughout the month were great. Um, she was due for some repeat thyroid tests and a few other blood tests were in the pipeline. So I gave her six weeks worth of medicine, um, in the plan that she'd have for a couple of more periods again before we saw each other again. Um, and so we got together again six weeks later. So that was ten weeks after the onset of treatment, so still in our sort of preconception treatment phase. And she'd had another sort of really manageable period again, four day bleed, and she felt that she was getting a much better bleed and a good bleed for three or four days rather than at one day, and then a little bit scant. Um, much more manageable. She was using the cramp bark and ginger and taking it more frequently during the day as and when she needed to. Um, she felt like her anxiety was under really good control. Work stress was an issue, so she'd had a couple of episodes of anxiety, but she felt like they were much more controlled and shorter lived. She'd had some blood tests, so they were interesting. Testosterone, sex hormone, biling, globulin were all normal. Prolactin was normal, but interestingly, it was slightly towards the top of the normal range. And as you know, as herbalists, we always like to look at the blood tests and when things come back as normal and just see where they sit. Um, so I thought that was interesting. Obviously, from the Vitex perspective, we don't know what her, um, prolactin levels were like before she started, but I just, um, made a mental note that they were sort of top of the normal range because we can use vitex to help lower, sort of higher levels of prolactin. Um, her thyroid function was still slightly low, so she'd just had her dose increased slightly to 75 micrograms. And she had been referred on to, um, fertility clinic and again for endometrial investigation. But she was feeling really positive and, um, really good now. She hadn't had two periods since I had Latina, she'd just had the one. So she was due to have a period around that time. So rather than prescribe, um, another course of the same treatment, um, we agreed that she's got a little bit left to see how that period went and then I could prescribe some more medicine accordingly and we can move on to medicine, um, to take while she's trying to conceive, um, but in this occasion, happily, two days later, she messaged to say that she had got a positive pregnancy test and was already pregnant, which is fantastic news.

Simon: It is. So what do you think was going on to, uh, prevent her being pregnant? What was the fertility issue as far as you could work out?

Speaker D: Well, I think it comes down to that sort of pelvic congestion thing. Sometimes patients come in asking for fertility support and you can take a case history and everything can seem to be exactly as it should. Um, and that can be particularly tricky, um, in this case, when somebody comes in and there are several areas, particularly around the pelvic area, that you think actually we can optimize that. And often that's what it is, isn't it? It's rebalancing and optimizing. All of the tests that she'd had had come back as normal. There's the element of, um, stress in there and calming the stress, um, encouraging elimination through the bowels, relieving and the.

Simon: Bowels improved along with other things and all this, did they?

Speaker D: Yes, absolutely. Fairly quickly, yeah.

Simon: In the old days, when women's health books were written by men, there was a famous gynecologist who said that he was. Always got confused between bowel and womb symptoms, that they were often very difficult to untangle, which I suppose a bloke could get away with saying, but, um, there is a, uh, confluence, isn't there, that they do share similar, um, apart from the geography, they share similar behavior characteristics. So if you can get one working often you ease up on the other.

Speaker D: Yes, absolutely. Can include bladder as well. Often, um, this patient had been getting urinary traction. She didn't have any during the course of, um, her treatment.

Simon: Was there any thrush around in your story?

Speaker D: Not when I was seeing her, but in the case history, she said when she off and she got sort of Uti and thresh together. So that could have been due to.

Simon: Again, that speaks to congestion itself, doesn't it?

Speaker D: Yeah, absolutely. So it was really pleasing. But as you say, um, some cases respond really quickly, others often do take longer. And um, obviously read agreed that she wasn't going to try and get pregnant for three months. But uh, sometimes people can't wait. But a really lovely story and I say quite a good one at just showing the bits that you can put together and how uh, we do function as a whole being and looking at all of those different elements can be enough to.

Simon: Indeed I do sometimes think that we've unwittingly or otherwise added to the human population by the number of uh, our patients who have struggled with being pregnant, who have become pregnant after herbal treatment. So it does happen, doesn't it?

Speaker D: Absolutely, yes, but a really lovely way to do it. And also I hope that the changes that we've made um, will also help her, uh, health moving forward as well because that anxiety, um, and digestion, even when you're not trying to conceive, is uh, not something that you necessarily want to continue living with.

Simon: So take us through what happens next. I mean not necessarily with this patient, uh, but uh, generally when your patients become pregnant, what do you do? Do you sort of stand by? Uh, presumably we don't go barching in there with big boots on, but no.

Speaker D: It entirely depends on the patient and also what's gone before. So in patients that have a history of miscarriage, often that comes around 10, 12, 13 weeks.

Simon: Where would you start with that sort of case? Someone who's lost babies before, um, when do you start? There's an obvious point. And what sort of approach do you bring to such cases?

Speaker D: Again, it depends on the case history. So again, ideally that three month period where we put a pause on trying to conceive and actually optimize gynecological health. Um, again taking that case history and looking at areas obviously with miscarriage, often it's unidentified as to why that might be. So again, work with that individual patient on optimizing their health and just increasing chances of conception. And then we work incredibly carefully when patients are pregnant. I do tend to use vitex in the uM, first few months and in patients before that I've worked with. You've have recurrent miscarriages. I would use quite simple herbs, say vitex, chamomile or ginger. Um, up through to about 16 weeks. Especially if they have lost um, babies at around the twelve week mark when the decenter starts to take over.

Simon: Yeah, we always try to get through the first three months without interference. Don't we? Um, there's another, uh, native, one or two, couple native british remedies that sometimes are used, uh, for this situation. Alcamilla being one. Um, very gentle. Um, belota has been used, uh, um, very gentle preventative of. And the viburnums again, um, later. As closest to the end of the first trimester as you can get.

Speaker D: Yeah, absolutely. And we always work incredibly carefully, as I say, patients. Some patients. This particular patient had some morning sickness, so had, um, some support for the first few weeks, but then felt like she was away and wanted to do it on her own. So, um, didn't have any other herbs during pregnancy. Sometimes people will have a mix early on and then come back for something simple like some raspberry leaf as a participator in the last few weeks of pregnancy, um, which I do quite often give, but, yeah, I generally try not to treat in pregnancy unless there's a reason.

Simon: Absolutely, yeah. Do you get involved much in the later stages of pregnancy with some of your patients? Um, you don't do a doula job?

Speaker D: I don't do a doula job, no. I do have some raspberry leaf if you'd like it. And then please tell me when your baby arrives. And I did have a, um, lovely one arrived this week of a little girl that was born. And it's just such a lovely feeling, isn't it? You just think that's absolutely amazing, the healthy arrival. And, um, this particular patient went on to have a baby boy, which was wonderful.

Simon: Uh, why don't we go through, um, the cycle a bit further then? So a, uh, new baby's arrived, um. Uh, issues around nurturing, breastfeeding, lactation, uh, baby's health in general over those first weeks. Um. What's your experience in working in that area?

Speaker D: Yeah, to be honest, I don't have that many patients coming back in with their babies. I've seen a few over the years, um, perhaps more with, um, colic problems. Um, and again, when patients are breastfeeding, I work very carefully, probably, um, if obviously they're breastfeeding through, um, herb teas for mum or tinctures for mum, things like chamomile and fennel, um, as sort of gentle, carminative, perhaps a bit of meadowsweet, um, if there's reflux.

Simon: Yeah. Yesterday I had a patient who was, um, two months old who was still being fed, obviously by her mother, and we decided and she had very bad eczema and it wasn't food related because she'd been through all that. So we decided that we would treat the mother and then, uh, get, uh, the herbs passively, so to speak, uh, through the mother's mill. Uh, but spices often come up in that context as well, as you mentioned, fennel. But other spices also step up in those postnatal weeks as a way of treating the baby through the mother because he can sometimes settle the bowel and settle the gut and help with other digestive upsets and as well as building strength.

Speaker D: Um, and which are your favorite ones to use? What would you put in the tea?

Simon: Uh, well, I got a handful of favorites. Cardamom always keep stepping up as, ah, a strengthening one. Um, the cinnamons, gingers, of course, um, coriander. Um, uh, what's the other ones? Brazily turmeric, of course. But I don't give that as a tincture. It's because it's far too yellow.

Speaker D: Yes, well, how about Fenny, Greek?

Simon: Uh, I haven't actually found a way of using it apart from suggesting that someone goes and gets a supplement. Have you got it in your practice?

Speaker D: Well, no, but when I had my own children for my second daughter, I then tried some fenugreek tea to encourage lactation. And I've never recommended to anybody since because I struggled to drink it so much.

Simon: I think you have to take it as a capsule of some sort because you need the bulk, don't you?

Speaker D: Absolutely. I think you might be sitting in the cupboard downstairs in my kitchen somewhere feeling very left out. Uh, but we're incredibly lucky to work in women's house, aren't we? And seeing women of all ages with all different health conditions, um, young girls, when they're starting out on their menstrual journey and their HPO access is just establishing itself. Um, and I love working with them, particularly because young people are already adapting so often just that gentle nudge of herbal medicine to help with things like period pain.

Simon: Yeah. Yes, indeed. So, shall we move along the women's health path a little further? Um, so, um, gone through pregnancy, childbirth, um, uh, as women get older, they often find that their cycles begin to shift pre menopause, don't they? There's this, uh, um, perimenopause that we call it, um, which can go on, seem to go on for a long time. I've always felt that it shouldn't. Um, and, um, that someone who's suffering in their 40s with perimenopausal symptoms needs some strong support. Um, what's your experience?

Speaker D: Yes, absolutely. A lot of my patients, ah, are between the ages of 30 and 75. And now in my practice I have women that I have seen through their thirty s and now into their forty s. And you really get in tune with menstrual journey. And absolutely, we're talking about perimenopause now, whereas 20 years ago we didn't. And there's a huge, um, issue with the sort of slow development of perimenopausal symptoms and how disruptive they can be. And absolutely, herbs can be fantastic for, um, support. And one of the big things that people notice, um, and often comment on specifically after having children is that premenstrual aggravation. So that week before the period where they can't bear their children and their partners, um, and they can't go but work and they can't focus and perhaps they're getting night sweats just that week before the period. And of course we've got some lovely herbs, um, that can really help to balance that out. Obviously vitex, one of them, the use of nerveines at that time of the month, um, and including some liver support and actually really quite gentle touch with herbs can make a huge difference to that. Um, I'm now 42, Simon. So quite a lot of my friends are entering that perimenopausal phase and they all know, um, my favorite herbs and I'm dishing it out as appropriate, really. Um, it is a shame. And I'm a big believer in sleep and a champion of sleep. And when patients come in, we always talk in depth about sleep quality, sleep quantity, making sure we give ourselves enough time to switch down before bed, and that we're actually in bed for long enough to get a good solid, ideally 8 hours sleep a night, because that makes such a huge difference on cardiovascular system, hormone regulation, appetite regulation, immune system. It ties in just to so much. And that sort of premenstrual fatigue, nervous system dysregulation can be hugely disrupted by not sleeping well. Um, and often people have got a lot on their minds. So, um, a herbal sleep mix I give out very regularly to my perimenopausal and menopausal women. Um, one of the brilliant things about it is that they take it every night to start with and then they start forgetting to take it and you think, brilliant, jump down to it.

Simon: One of the things I always look for in this time is congestion, the bit that we picked up from before. Um, and obviously as we get older, sitting in chairs and working at the desks so much, we tend to get pelvic congestion simply by our, uh, bad habits. And I do put a lot of focus on simple exercises, upside down bicycling, that sort of thing. That will open, uh, up the circulation to the pelvic area and just get that moving a bit more. Because congestion is so often a precedent for, uh, an uncomfortable menopause.

Speaker D: Yeah, absolutely. And do you recommend that for men and women alike?

Simon: Yes, because blokes have their own problems, as we know. Not quite in the same way, but, yeah, congestion, no agenda, boundaries. It affects us all. The chair has got a lot to answer for, hasn't it?

Speaker D: It has. And especially in the last few years, people aren't even commuting to work anymore, a lot of the time. So the step count has really significantly decreased. And general exercise.

Simon: Yeah. So heading into the change itself, uh, what's your star performers in your experience?

Speaker D: Um, I love adaptogens and I think that is one of our brilliant things. And I give talks on the menopause to people and that's what I champion, because we've got our hormone modulating herbs, but we're all about helping women adapt to the change in their body around menopause. Um, and it's a physiological stress and often at that time of their lives, there's a lot else going on as well. They might have children at home, grandpa, parents to look after. Um, there's work, there's a huge pull. And, um, you get it, I'm sure as well. Patients come in and their menopausal symptoms are massively worsened when they are stressed or going into a work meeting. Um, so definitely, um, adaptogens alongside hormone modulators. What's your favorite adaptogen, Simon?

Simon: Well, the story I often tell is that when you're in reproductive life, you've got two sets of steroid producing glands, your adrenal cortex and your ovaries. Um, and menopause is about half of the team heading off to the hills, so it's down to your adrenals after that. And so you're quite right, the adaptogens are working on the adrenal front to basically step up the gap that they now need to fill once the ovaries are gone. So, uh, it's anything that works at that level. And of course, we have our own, um, mostly chinese, um, adaptogenic tonics that fit in here. Romania, I find often helpful here. Uh, you've already mentioned Angelica, uh, synensis, which comes back into its own. Uh, we have, um, uh, the wythanias, uh, the sisyphus and so on, all supporting your earlier idea of sleep support as well. Um, so there's a range of them out there. I mean, we've got so many adaptogens, we could give siberian ginseng.

Speaker D: I think withania is probably the one that I use most because of that sleep disturbance. Um, and also shizandra. I love the shizandra. It's one of those herbs when you're dispensing that I really bond with. So when I smell it, I think, yeah, brilliant. Antioxidant liver support. So in terms of hormone metabolism, um, energy levels, which often need so much attention around that time, um, it's a real uplift adaptogen. So depending on the patient, if they're sort of really exhausted, then it would be with ania and sort of other times, probably shazandra and vizipus. Yes, I tend to use that in sleep mixes, mostly versus menopause picks up on your earlier point alongside things like hops.

Simon: Yes. Hops are very strong women's remedy, aren't they? Yes. And on the, um, theme of strength, sometimes women fear the menopause as a time when everything's going to go downhill. And I always point to those women that live in Mediterranean countries, usually up hillsides and villages where you wouldn't want to brush with them. They're as strong as oxes and they have shown that you can really get your strength more than back. You can be stronger after a change, if the change has been managed well enough.

Speaker D: Absolutely. And in many, uh, cultures, sort of postmenopausal women are highly regarded because of their experience and they're celebrated because they've had their children and they've moved on and it's considered an amazing phase of life. And it would be so lovely to get more of that attitude in the UK.

Simon: Back to the perfect.

Ginny: And, you know, we are talking about.

Speaker D: Women'S health more and we are talking about the menopause, but you're absolutely right. I have really found in the last couple of years it is an instilled fear of the menopause amongst people, um, and how it does need to be medicalized, and that's really quite splitting. And actually, so many patients that don't take HRT because they don't want to, and it's fine, it's every woman's choice, but they're absolutely thriving. Um, and I love sitting down with them and looking at how they can look after themselves in that phase of life. And obviously, at that point, we're looking at cardiovascular system health as well, bone health, um, and things like recurrent urinary tract infections that often plague women. Post menopausally as well. And there's so much there that we can offer as herbalists in helping to break that cycle of recurrent urinary tract infections.

Simon: Yeah, I, uh, think it's clear to me that herbal medicine has so much to offer women in ways it's almost perfectly designed to support particular hormonal related and women related health. It's so non medicalized, so supportive, so has the capacity to make, once come out, balanced and stronger.

Speaker D: Absolutely, yeah. And it is, it's that adaptogen and that rebalancing and just letting your body. Yeah. In a really healthy way.

Simon: Yeah. So thank you, Jenny. This has been really lovely to go through the life cycle of women's health in this, really. I hope people have found this really helpful in their practice. Uh, and to have your experience shared is really lovely. So thank you for joining us. Um, and good luck with the rest of your practices.

Speaker D: Thank you. Simon, it's been an absolute pleasure to talk to you. Thank you for inviting me.

Simon: Thank you.

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