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Alternative therapies for the symptoms of menopause

Note: This report represents information on this subject as of December 1996.

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Over the next decade, an average of 10,000 Americans will reach age 50 each day.1 Corresponding numbers of women of the baby boom generation will experience menopause. Not surprisingly, then, issues related to menopause have become increasingly visible in the popular press. Alternative therapies for the treatment of menopausal symptoms receive extensive coverage in popular magazines and books,2,3 despite lack of scientific evidence of their efficacy. 

Along with the explosion of self-help books and articles on menopause, the alternative health care industry has grown significantly. This industry has responded enthusiastically to women's desire to experience "natural menopause" through the use of natural methods such as vitamin supplements,
herbal remedies, exercise, and change in diet as alternatives to hormonal treatment. 

Several studies suggest that Americans make extensive use of alternative therapies. Based on telephone interviews conducted with 1539 adults between January and March, 1991, Eisenberg et al4 concluded that 1 in 3 (34%) respondents had used at least 1 unconventional therapy in the previous year. The authors defined alternative therapy practices as one of the following: relaxation techniques, chiropractic, massage, imagery, spiritual healing, commercial weight-loss programs, lifestyle diets (e.g. macrobiotics), herbal therapies, megavitamin therapy, self-help groups, energy healing, biofeedback, hypnosis, homeopathy, acupuncture, folk remedies, exercise, and prayer.4 

A study of adult members of the North California Kaiser Permanente Medical Care Program reached similar conclusions.5 The sample population of this study included 2000 adult health plan members who were mailed questionnaires in 1993. Approximately 18% of those surveyed had used an alternative therapy in a 1-year period. Respondents who reported pain were twice as likely to have used alternative therapies as those who did not report pain.5 

The popularity of alternative therapies among the general population, combined with the growing attention devoted to menopause and its treatment, suggest that physicians should be familiar with and inquire about use of alternative therapies when caring for perimenopausal women.6 

Alternative therapies for menopause 

Advocates of alternative therapies seek to provide menopausal women with tools that empower them to overcome discomfort and to improve their quality of life while their bodies undergo "self-healing." Alternative therapies are based in a holistic approach, focusing on emotional and physical well-being rather than specific symptoms.3 Therapies recommended by alternative practitioners are intended to relieve the physical and emotional discomfort sometimes associated with menopause, including hot flashes, night sweats, memory loss, uncomfortable skin sensations, anxiety, and subjective stress.3 There is a growing expectation by women that these symptoms can be treated, or at least managed, in contrast to the historical assumption that the symptoms of menopause were inevitable and had to be tolerated. 

The following alternative therapies will be considered in this report: 

  • vitamin supplements
  • dietary practices and exercise
  • homeopathy
  • herbal medicine
  • visualization, hypnosis, and relaxation techniques. 

These treatments are reviewed because they are the ones most frequently cited in the popular literature on menopause. The therapies may be combined, depending on the individual's symptoms.7 

Vitamins 

Vitamins are consumed as dietary supplements and as therapeutic agents.8 Eisenberg et al4 reported that 2% of their sample population had used megavitamin therapy over the course of the study period. Vitamin supplements are prescribed, usually along with dietary changes and exercise, to improve quality of life and relieve discomfort from hot flashes, night sweats, and vaginal and bladder atrophy.9 Alternative medicine therapists recommend vitamins A, B, C and D to reduce excessive menstrual bleeding. Magnesium is said to help women who suffer from menopause-related insomnia by reducing anxiety and fostering calm. Potassium is purported to reduce fatigue and muscular weakness. Alternative medicine therapists also recommend vitamin E to reduce hot flashes, as well as anxiety and mood swings.3 

Calcium is often recommended by physicians to minimize loss of bone density and to prevent osteoporosis.6 However, there have been no scientific studies examining the potential therapeutic effects of vitamins or other dietary supplements on menopausal symptoms. Only anecdotal support exists for their use in alleviating menopausal discomfort. 

Dietary practice and exercise 

A low-fat diet and regular exercise are recommended by alternative medicine therapists to improve general physical and emotional well-being.2 In the Kaiser Permanente study, 4.9% of the sample population reported that they follow a special diet for some medical purpose.5 Eisenberg et al4 reported that 4% of the surveyed population practiced a "lifestyle diet" at some time in one year. 

Specific dietary practices promoted by alternative medicine therapists for menopausal women include avoiding foods believed to contribute to symptoms, such as hot flashes. These include caffeine-containing foods, sugar, salt, and alcohol.3 Alternative medicine therapists recommend foods such as beans, whole grains, fruits, and vegetables.  2 Whole grains, which are high in fiber, are said to help regulate estrogen levels. Soy products, such as tofu, are believed by practitioners to have estrogenic properties.3 Regular exercise is espoused to reduce sleeplessness; to normalize hormone levels, thereby minimizing hot flashes; and to promote emotional well-being. Alternative medicine therapists also recommend yoga to "energize the entire female reproductive tract," improve circulation, and relieve hot flashes.10 

Scientific research has linked diet and exercise with the prevention of heart disease, diabetes mellitus, and other chronic illnesses.11 There has been a call for investigation of the role of dietary practices and exercise in relieving menopausal symptoms;6 no studies have yet been done. 

Homeopathic remedies 

Homeopathy is an alternative therapy based on the "laws of similars" that "like can cure like."12 It rests on the premise that the human body can heal itself and, like other "natural" treatments, is intended to "assist nature rather than bludgeon her."12 

Homeopathy uses extremely diluted botanical and animal products that are intended to reduce the targeted symptoms in order to alleviate discomfort or illness. The Kaiser Permanente study determined that 4.4% of surveyed members used herbal medicine or homeopathy. Of the patients who used homeopathy, 19.1% utilized the therapy to treat pain and 7.4% for gynecological problems.5 Eisenberg et al4 reported a 1% utilization of homeopathy over 1 year. 

Homeopathic remedies are recommended by alternative medicine therapists as "natural" treatments for menopausal symptoms. Sulphur tablets have been prescribed for sleeplessness, and phosphorus compounds for excessive bleeding, thirst, and uterine fibroids.13 No scientific evaluations have been made of the efficacy of homeopathy to relieve menopausal symptoms. 

Herbal medicine 

Alternative medicine therapists recommend herbal medicine to women as a complement to a diet high in beans, whole grains, fruits, and vegetables.14 Eisenberg et al4 reported that of the population surveyed, 3% reported using some form of herbal medicine during 1990. Herbalists believe that phytoestrogen plants, containing a natural source of estrogen, can be used as an estrogen substitute to reduce menopausal symptoms such as hot flashes and night sweats.14 In this theory, plants containing phytosterols provide hormone precursors, allowing the individual to achieve appropriate hormone levels. Plants such as chamomile, primrose, valerian root, and skullcap are recommended as calming agents to reduce anxiety, nervousness, and sleeplessness. Ginseng, ginger, and dandelion root are suggested to improve energy levels and reduce fatigue.14 

Because no scientific studies have been performed, there is no scientific support for the therapeutic value of herbal medicine to reduce menopausal symptoms. 

Visualization, hypnosis, and relaxation techniques

Visualization, hypnosis, and relaxation techniques are all based on the premise of "mind over body." They are promoted as methods to gain control over one's physiology, including physical discomfort and emotional anxiety. 

The Kaiser Permanente study reported that 2.6% of the sample population used imagery and visualization and 5.7% practiced relaxation techniques.5 Eisenberg et al4 reported that 13% of the sample population used relaxation techniques, while 4% used imagery and spiritual healing and 1% used hypnosis. 

These practices are said to alleviate anxiety and moodiness associated with menopause.3 Relaxation techniques such as deep abdominal breathing and meditation are recommended by alternative medicine therapists to calm the body.15 Alternative medicine therapists also suggest visualization exercises to enhance body image and reduce irritability.15 Hypnosis is prescribed by alternative medicine therapists to overcome menopausal symptoms such as hot flashes and anxiety.  3 

There are no scientific studies validating the efficacy of these techniques for the treatment of menopause-related symptoms. 

Implications for physicians 

Clinical evaluation of the efficacy of the specific alternative therapies considered above has been minimal. Of the regimens reviewed here, the approaches having been most carefully researched are biofeedback and visualization. None of these studies, however, have examined the applications of these techniques to relief of menopause-related discomfort. Given the complete lack of scientific research, the potential benefit of alternative therapies for the treatment of menopause must be classified as unknown. No conclusions can be drawn about safety, efficacy, or potential interactions between alternative therapies and prescribed medical treatments. 

Physicians may therefore be tempted to disregard alternative therapies as potentially relevant when caring for patients. It is nevertheless important for physicians to inquire routinely about patients' use of alternative therapies for several reasons. Patients may not realize that they can talk to their physician about the discomfort they are experiencing, or they may be reluctant to tell their physician about the alternative therapies they use. When the physician acknowledges that alternative therapies are used by many people to relieve menopausal symptoms, a message is sent that the physician cares about the patient's quality of life and the things she does to feel better. 

There are several dimensions of menopausal symptoms that include the patient's well being and quality of life as well as clinical concerns of menopause such as the prevention of osteoporosis and heart disease. Therefore, it is critical that physicians address these important concerns with their patients. 

Initiating a discussion about alternative therapies is best done in a nonjudgmental, nonpunitive manner. The ensuing conversation presents an opportunity to educate the patient about other possible options for symptom relief. Sensitive, open communication between patients and physicians fosters a collaborative relationship, within which treatment decisions can be made. 
There are a number of possibilities with regard to the safety and efficacy of alternative therapies for treatment of medical conditions, including: 

  • the therapy is safe and effective
  • the therapy is safe but ineffective
  • the therapy is effective but unsafe
  • the therapy is neither effective nor safe.

An additional possibility is that use of an alternative therapy approach may compromise the effect of a prescribed treatment. The efficacy of alternative therapies for the treatment of menopausal symptoms can only be determined through carefully controlled clinical trails. In the absence of information about efficacy, physicians must counsel patients based on clinical judgments about safety. 

In some cases, an alternative therapy may be potentially dangerous. A classic example of this possibility is excessive intake of Vitamin A or Vitamin D, which can result in hypervitaminosis. In such cases, patients should be educated about the risk they are incurring and should be encouraged to explore other ways to help themselves feel better. In other cases, the physician may be unsure about a treatment's safety and should then engage the patient in a discussion about possible treatment-related problems they may be experiencing. When in doubt, other options for relieving stress and discomfort should be reviewed. 

In most cases, an alternative therapeutic practice will be judged by the physician to be benign. Although the physician should educate the patient about the lack of scientific information about their practice, a patient's right to do things she experiences as beneficial should be affirmed provided that it is not at the expense of a more effective therapy. On-going communication about the patient's quality of life, level of physical comfort, and self-care practices underscores the physician's interest in the patient as a whole person. Such communication strengthens the physician's ability to provide comprehensive, coordinated care and reinforces the patient's responsibility to be open with her physician about concerns she may have. 

It is likely that patients will continue to use alternative therapies to treat a variety of problems, including menopausal symptoms. Because they are common, such practices should be acknowledged within conventional medical practice, until such time as empirical evidence is available about their use in patient care. 

Recommendations

The following statements, recommended by the Council on Scientific Affairs, were adopted by the AMA House of Delegates as AMA policy at the 1996 AMA Interim Meeting. 

  1. Although many patients use alternative therapies to treat the symptoms of menopause, there is very little scientific evidence about the safety or efficacy of most of these therapies. In some cases, use of alternative therapies by patients may delay use of conventional therapies proven to have benefit for disease prevention in addition to relief of symptoms. The Council on Scientific Affairs of the AMA cannot recommend the use of unproven alternative therapies for the treatment of the symptoms of menopause.
  2. Physicians should routinely learn about and ask patients about their use of alternative therapies and educate them about the level of scientific information available about the therapy they are using, as well as conventional alternatives.
  3. Physicians should inquire about the presence of unpleasant or uncomfortable symptoms among patients in the perimenopausal stage of development. In this way, the physician can assist the patient in gaining relief while providing an opportunity to discuss the importance of preventing menopause-related disease processes.

References 

1.  US News and World Report. Dec 25, 1995/Jan 1, 1996:28.
2. Ojeda L.  Menopause Without Medicine. Alameda, Calif: Hunter House Inc.; 1995. 
3. Ito D.  Without Estrogen: Natural Remedies for Menopause and Beyond. New York: Crown Trade Paperbacks; 1994. 
4. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Devlance TL. Unconventional medicine in the United States: prevalence, costs, and patterns of use.  N Engl J Med. 1993;328:246-252. 
5. Gordon NP. Use of alternative therapies by adult HMO members to treat health problems: results of a 1993 member health survey. American Public Health Association Conference. Oct 31, 1995. 
6. Ravinker VA. Diet, exercise, and lifestyle in preparation for menopause.  Obstet Gynecol Clin North Am. 1993;20: 365-378. 
7. Seven principles of alternative medicine. In:  Menopause: Alternative Therapies. Washington, DC: National Women's Health Network; 1995:19. 
8. Council on Scientific Affairs. Vitamin preparations as dietary supplements and as therapeutic agents.  JAMA. 1987;257:1929-1936. 
9. Vitamins, minerals and essential fatty acids. In:  Menopause: Alternative Therapies. Washington, DC: National Women's Health Network; 1995:106-121. 
10. Yoga for menopause. In:  Menopause: Alternative Therapies. Washington, DC: National Women's Health Network; 1995:128-154. 
11. US Public Health Service.  The Clinician's Handbook of Preventive Services. Alexandra, VA.: International Medical Publishing, Inc.; 1994:88-96. 
12. Homeopathy at menopause. In:  Menopause: Alternative Therapies. Washington, DC: National Women's Health Network; 1995:36-39. 
13. Homeopathic remedies. In:  Menopause: Alternative Therapies. Washington, DC: National Women's Health Network; 1995:124-127. 
14. Herbs for menopause. In:  Menopause: Alternative Therapies. Washington, DC: National Women's Health Network; 1995:83-87. 
15. Menopause stress reduction. In:  Menopause: Alternative Therapies. Washington, DC: National Women's Health Network; 1995:62-79.

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Last updated: Sep 25, 2007
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