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Because more women than ever before are using non-traditional
medicines, such as herbal remedies, the American College of Obstetricians and
Gynecologists (ACOG) has issued new practice guidelines concerning botanical therapies for
menopausal symptoms. While the guidelines were written for physicians, their focus is the
millions of women who may be considering alternatives to hormone
replacement therapy (HRT) for relieving hot flashes, vaginal dryness, and other
symptoms associated with menopause. The
guidelines discuss which alternative therapies are effective and which ones are not.
Non-traditional medicines have become increasingly popular in recent years. According
to the National Institutes of Health’s National Center for Alternative and
Complementary Medicine (NCCAM), Americans spent more than $27 billion on alternative or
complementary therapies in 1997. Alternative medicines include vitamins and minerals,
herbs, mind/body exercises (such as meditation), aromatherapy, and many more.
The new ACOG practice bulletin is entitled "Use of Botanicals for Management of
Menopausal Symptoms." The guidelines were developed because an increasing number of
women are searching for alternatives to hormone replacement therapy (HRT) to alleviate
menopausal symptoms. Research also shows that many women do not discuss the use of
over-the-counter botanical products with their physicians. However, because these products
are unregulated by the U.S. Food and Drug Administration (FDA), the ACOG believes that
consumers cannot be certain of their actual content or effectiveness.
Furthermore, "fewer than one in three menopausal women choose traditional HRT, due
to a lack of confidence in its benefits, fear of increased risk of breast cancer, and/or its side effects," according to
an ACOG news release. "Many women perceive ‘natural’ treatments as safe and
effective despite the lack of adequate scientific studies proving either."
The new ACOG guidelines are meant to help physicians advise their patients on which
botanical treatments may be most effective at relieving menopausal symptoms. According to
the ACOG, research on all natural remedies is limited. However, taking into account the
limited number of studies available, the ACOG finds that soy
products seem to provide the best short-term treatment (two years or less) for menopausal
symptoms such as hot flashes and night sweats, compared to other botanical remedies. This
may be due to the fact that many soy foods are rich in phytoestrogens, natural chemicals
that act like weak estrogen (a hormone that has been found to be effective for alleviating
menopausal symptoms). However, consuming large amounts of soy may be harmful for breast
cancer patients, survivors, or those at high risk for the disease. This is because some
research suggests that soy may stimulate the growth of estrogen-dependent breast cancer
cells.
The herb black cohosh may also be helpful for a period of six months or less for
treating menopausal symptoms, according to the ACOG. However, other therapies, such as
wild and Mexican yam and the Chinese herb Dong Quai do not appear to be beneficial for
treating menopausal symptoms. Furthermore, there is some research to suggest that Dong
Quai may increase the risk of skin cancer if women who consume the herb spend time in the
sun.
Summary of ACOG Guidelines |
| Soy |
May be effective at
relieving menopausal symptoms for two years or less. Safe in dietary amounts. Large
amounts may be harmful for women who have or have had breast cancer or other women. |
| Black Cohosh |
May be effective at
relieving menopausal symptoms for six months or less. |
| Wild and Mexican
Yam |
Not expected to be
effective at relieving menopausal symptoms. |
| Dong Quai |
Not expected to be
effective at relieving menopausal symptoms. Potentially toxic. May increase risk for skin
cancer. |
Hormone
replacement therapy (HRT) is the most commonly prescribed method of treating
menopausal symptoms. HRT is synthetic estrogen and progesterone (called progestin)
designed to "replace" a woman’s depleting hormone levels. Research has also
shown that HRT may also help prevent osteoporosis (weakening bones), heart disease, short-term memory loss, depression and
other diseases in post-menopausal women.
While HRT can provide many benefits, there is also conflicting evidence that HRT
increases the risk of breast cancer, especially when taken longer than five years. Other
negative effects of HRT that deter some women from using the treatment include bloating
and vaginal bleeding. Taking estrogen alone can increase the risk of endometrial cancer
(cancer of the uterine lining) in women who have not had their uteruses removed. However,
using combination HRT (estrogen plus progestin) counteracts this risk.
Because each woman’s medical situation is different, all women should talk to
their physicians about how best to treat menopausal symptoms, if treatment is necessary.
New research shows that special low-dose formulas of HRT may be as effective as regular
formulas but with fewer side effects (such as bloating). However, the increased risk of
breast cancer may still be associated with long-term use of low-dose HRT.
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