The role of complementary and alternative medicine in management of menopausal symptoms

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Complementary and alternative medicine use in the United States

The use of CAM is prevalent and increasing within the United States. Telephone surveys of adults conducted in 1991 (N = 1539) and 1997 (N = 2055) revealed that the use of 1 of 16 CAM therapies during the prior year increased from 33.8% to 42.1% [2]. The most commonly used therapies in 1997 were as follows: relaxation techniques (16.3%), herbal medicine (12.1%), massage (11.1%), and chiropractic (11.0%). Women used CAM more frequently than men (48.9% versus 37.8%), and CAM use was most frequent in

Complementary and Alternative Medicine use by midlife women

Other studies have examined CAM use in midlife women and for the treatment of menopausal symptoms. The SWAN found that 48.5% of a multiethnic cohort of women reported using a CAM therapy during the preceding 12 months [3]. This population was pre- or perimenopausal at baseline. Herbal use was 16.9% and ranged from 8% in Hispanic women to 27.6% and 25.8% in Japanese American and Chinese American women. In addition, 18.6% of white women and 14.9% of African American women reported the use of

Design issues related to complementary and alternative medicine studies

There are several specific issues related to study design in trials examining the efficacy of CAM therapies for the treatment of menopausal symptoms. These design issues are worth keeping in mind when evaluating and comparing CAM studies. Areas impacting results and scientific rigor include the following: (1) the placebo effect and adequacy of the control, (2) the type and quality of the botanical product under study, (3) the characteristics of the patient population being examined, and (4) the

Soy foods, soy protein, and soy isoflavones

Soy foods or products are popular proposed therapies for menopausal symptoms. The initial interest in soy developed because of reports suggesting that Asian women (with higher dietary soy intake) experienced fewer vasomotor symptoms [13]. In the SWAN, African American women reported hot flashes most frequently (45.6%), with Japanese American women reporting them least frequently (17.6%) [14]. Although phytoestrogen intake has been hypothesized as an underlying mechanism for these differences,

Red clover extracts

Five studies have examined red clover extracts containing isoflavones. Two earlier studies examined 51 and 37 postmenopausal women, respectively, and used the red clover product Promensil [35], [36]. Both studies found no difference between groups in frequency of hot flashes. There have been three recent RCTs on the use of red clover. Two small-scale studies (N = 30 in each) found a significant reduction in hot flashes [37], [38]. One study randomized 30 postmenopausal women who experienced more

Black cohosh

Black cohosh (Cimicifuga racemosa) is an herb that has been promoted for treatment of menopausal symptoms. Herbal extracts are derived from the root and rhizome, and most studies have used the commercial product Remifemin. Several trials have been published on black cohosh; however, several of these publications were either open label or did not include a placebo or inactive control. There are three randomized, placebo-controlled trials [40], [41], [42]. One study of 80 women using the black

Other botanical complementary and alternative medicine therapies

There are about 10 other RCTs of various herbs and supplements in addition to the studies on soy, red clover, and black cohosh [43], [44], [45], [46], [47], [48], [49], [50], [51], [52]. A study of 71 postmenopausal women randomized to dong quai or placebo for 6 months found no difference between groups in Kupperman index or number of hot flashes [43]. Similarly, studies of evening primrose oil (N = 56; duration of 6 mo) and ginseng (N = 384; duration of 14 wk) found no significant advantage of

Nonbotanical complementary and alternative medicine therapies

Two acupuncture trials recently have been published. One trial was a randomized, single-blind, controlled design examining the effects of electroacupuncture on psychologic distress in postmenopausal women [56]. The treatment group received acupuncture needles placed at specific points chosen as potentially relevant to vasomotor symptoms. The needles were introduced in a manner to evoke the DeQi sensation and then attached to an electrical stimulator. The control needles were placed

Mind–body techniques

Several small-scale trials have suggested the efficacy of mind–body techniques for reduction of menopausal symptoms in several patient populations. No recent trials (published since 2002) were identified. Nevertheless, the reported trials all have shown benefits in reducing menopausal symptoms. The trials face the challenge of appropriate choice of a “placebo” group, however. Germaine and Freedman [62] and Freedman and Woodward [63] have demonstrated a benefit of paced respirations for hot

Summary

CAM therapies are widely used by women in the United States for reduction of vasomotor symptoms. The scientific rigor of studies of CAM therapies has been improving, with more reports of randomized, double-blind, placebo-controlled trials. The number of subjects enrolled, inclusion criteria, and outcomes measured have varied widely, however, making it difficult to compare among studies. The soy studies have compared very different products (soy food versus isoflavone extracts of differing

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