Alternative Medicine a Mixed Bag for Menopause

Review of studies finds some may relieve hot flashes

MONDAY, Nov. 18, 2002 (HealthDayNews) -- Last summer, menopausal women were stunned by the news that the risks of hormone therapy probably outweighed its benefits.

Since then, women have been searching for other ways to manage menopausal symptoms, and new research now offers hope for some alternative therapies, at least for controlling hot flashes.

In a review of almost 30 randomized, controlled clinical trials for alternative treatments for hot flashes, researchers from George Washington University and Columbia University found that black cohosh and foods that contain phytoestrogens, such as soy, may help.

But, they add, some other well-known alternatives -- vitamin E, red clover, evening primrose oil and dong quai -- were not effective.

Dr. Mary Hardy, medical director of the integrative medicine program at Cedars-Sinai Medical Center in Los Angeles, says it's important for women to know there are choices available to them.

"The first discussion you need to have with your doctor or health-care provider is if you need to be on estrogen," she explains. If you don't want to be on estrogen or you're not a good candidate because of your family or personal health history, she says, "there are still choices -- good choices -- out there."

When it comes to the bothersome symptoms of menopause, she adds, "You're not doomed to hell forever."

Hormone therapy or not, women apparently aren't willing to put up with their menopause symptoms. In a study conducted before the hormone therapy news, the North American Menopause Society found that 25 percent of women had used relaxation therapy, such as meditation or yoga, to relieve their symptoms. Another 10 percent have tried plant estrogens, while 9 percent have tried herbal remedies.

In the current study, appearing in tomorrow's issue of the Annals of Internal Medicine, the researchers looked at the results of 29 other studies. Twelve of them used soy or soy extracts, 10 used herbs, and seven used other alternative therapies such as acupuncture or behavioral therapy.

The authors conclude there appears to be some evidence that black cohosh and phytoestrogens are effective in reducing hot flashes, but no studies have been done to look at the long-term safety of these products.

Three out of four studies on black cohosh found it was beneficial for treating hot flashes, according to the study. Hardy says black cohosh, an herb traditionally used by Native Americans to treat gynecological conditions, may also be effective at relieving some of the other symptoms of menopause.

Dr. Ray Sahelian, author of several books on herbal supplements, says black cohosh seems to be safe and new research has even shown it may have some antioxidant properties. Neither Hardy nor Sahelian were involved with the current research.

Many plant foods, such as flaxseed, soy and other beans, clover and alfalfa, contain phytoestrogens. These are plant estrogens that include isoflavones, lignans and coumestans. They may act like estrogen in the body. The researchers looked at 12 studies, some of them on soy and others on isoflavone extracts, and found less than half of them showed positive effects on hot flashes after more than six weeks of treatment.

Since soy foods have been a staple in Asian diets for many years, the authors say they can be presumed safe. However, no long-term data exists on the safety of the often high-dose isoflavone extracts.

The researchers also looked at vitamin E therapy, acupuncture, behavioral therapy and wild yam and progesterone cream. They found that none of these treatments were more effective than placebos, though the authors acknowledge these studies were small.

They point out that while some therapies may be useful, there is little scientific data available and more research must be done into alternative therapies.

Sahelian agrees that double-blind, controlled trials are lacking, but says he now treats menopausal symptoms with alternative therapies first.

"When we compare the potential risk from synthetic progestin to alternative treatments, I am totally leaning toward using herbal medicine at this point," he says. If a patient of his has severe hot flashes, he says he would use low doses of estrogen only for a short period of time.

Hardy says she is also "trying to minimize hormonal interventions" for her patients, and uses a variety of alternative treatments, including black cohosh, phytoestrogens, evening primrose oil, fish oil, vitamin E, wild yam topical cream, yoga and acupuncture.

What To Do

For more information on using alternative therapies for menopause symptoms, read this from the National Institutes of Health, the Mayo Clinic, or the North American Menopause Society.

SOURCES: Mary Hardy, M.D., medical director, integrative medicine program, Cedars-Sinai Medical Center, Los Angeles; Ray Sahelian, M.D., author, Mind Boosters: A Guide to Natural Supplements that Enhance Your Mind, Memory and Mood, Marina Del Ray, Calif.; Nov. 19, 2002, Annals of Internal Medicine
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