Complementary and alternative therapies show little benefit in treating menopause symptoms
Insufficient evidence exists to support the use of complementary and alternative therapies to relieve menopause-related symptoms, according to a review article in the July 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Twenty-five million women will go through menopause in the next decade, and many of them will experience hot flashes, night sweats, vaginal dryness, sleep problems and other associated symptoms. Approximately 40 percent of women seek medical help for these complaints, according to background information in the article. After the Women's Health Initiative, a large clinical trial of hormone therapy, was halted because of an increased risk of breast cancer, many physicians and patients began to seek other options for menopausal symptoms.
Anne Nedrow, M.D., Oregon Evidence-based Practice Center and Oregon Health and Science University, Portland, and colleagues reviewed 70 previous studies of alternative and complementary therapies for menopause-related symptoms. Forty-eight of the studies examined vitamins, proteins, complete diets or other biologically based treatments; nine focused on mind-body therapies, including meditation and guided imagery; one studied osteopathic manipulation, a body-based therapy; two looked at the energy-based treatments reflexology and magnet therapy; and 10 assessed whole medical systems, such as traditional Chinese medicine or ayurvedic medicine (a traditional therapy from India that includes yoga and dietary modifications).
Although some of the individual studies suggested benefits for certain therapies, the overall quality and quantity of data was not sufficient to recommend any of the treatments, the authors write. The 48 studies of biologically based treatments had mixed results. For example, of 15 fair- or good-quality studies of the soy-derived compounds known as phytoestrogens, only four suggested the supplements provided a benefit in relieving menopause symptoms. In the four qualifying studies of black cohosh, the root of a native North American shrub, one large study showed an overall improvement in several symptoms, while three did not show any benefit for hot flashes. The studies of energy, mind-body and other types of therapies suggested few benefits for these treatments for menopause-related symptoms.
Many of the studies had a large placebo effect, meaning that even women who were not assigned to receive active therapy still reported improvement in their symptoms. "The large placebo effect is consistent with preexisting work of menopausal hormonal therapies," the authors write. "A study of estrogen compared with placebo reported a 50 percent improvement in frequency of hot flashes in the placebo group. The placebo effect likely plays an important role in the expanding number of dietary supplements marketed to menopausal women."
Because many women are using alternative and complementary therapies to treat their symptoms, often without telling their physicians, additional rigorous studies are needed to identify which of these treatments are safe and effective, the authors write. In the meantime, "the most important thing that the health professionals can do for symptomatic menopausal women is to encourage open communication that allows patients to disclose treatments they are using," they conclude. "Women value partnership, choice and shared decision making. Because there is no universal menopausal presentation or treatment, it is essential that health care professionals provide accurate information and options for midlife women." (Arch Intern Med. 2006;166:1453-1465. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was funded in part by the Oregon Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality, Rockville, Md. Additional support came from the National Institutes of Health and the Portland Veterans Affairs Medical Center Women's Health Fellowship. The NIH Office of Medical Applications of Research funded this research through the Agency for Healthcare Research and Quality Evidence-based Practice Centers Program for the NIH-sponsored State of the Science Conference on Managing Menopause-related Symptoms. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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