New Guidelines Discuss Botanical Alternatives to Hormone Replacement Therapy for Relieving Menopausal Symptoms (dateline June 5, 2001)

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.

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.

Additional Resources and References

• The May 31, 2001 American College of Obstetricians and Gynecologists (ACOG) news release, "It’s ‘Buyer Beware’ with Alternative Botanical Treatments for Menopausal Symptoms, Says ACOG," is available at http://www.acog.org. Contact the ACOG for more information on the new guidelines entitled "Use of Botanicals for Management of Menopausal Symptoms.
• To learn more about menopause, please visit http://www.imaginis.com/womenshealth/menopause.asp
• To learn more about hormone replacement therapy, please visit http://www.imaginis.com/breasthealth/hrt.asp