A Physician’s View of Complementary & Alternative Medicine Therapies for Menopause

There’s an interesting study underway of 3300 women who are being followed as they progress through their menopause transition.  The multi ethnic Study of Women’s Health Across the Nation (SWAN) began in 1996 and is expected to be completed next month when participants have their final annual follow-up visit.  One aspect of the study involves how women cope with mid-life changes.  To date, almost half of the women in the study, aged 42-52 used some kind of complementary or alternative medical (CAM) treatment in the previous year.

Clearly, there is growing use of CAM treatments to ease menopausal symptoms, particularly for hot flashes and insomnia. But there’s still a lot of confusion about what really works.  Recently, I asked Dr. JoAnn Pinkerton, a gynocologist in private practice and Director of Mid Life Health at the University of Virginia in Charlottesville, VA., if there are non-hormonal treatment options that are worth trying, in her opionion.  She said that for women with mild menopausal symptoms, there are many options;

Dr. Pinkerton: There is some evidence to support paced breathing- deep, slow diaphragm breathing for 20 min three times a day, Lamaze like breathing during a hot flash, acupuncture and acupressure. Hyponosis, homeopathy and yoga are more difficult to test in a blinded fashion, but may have benefits. Over the counter products have also been evaluated. It is important to remember that placebo works on average 50 percent of the time in hot flash trials compare to estrogen which works up to 85-90 percent at reducing frequency and severity of hot flashes.

Wendy: What CAM treatments have you observed do NOT work?

Dr. Pinkerton: Products that are NOT better than placebo at relieving hot flashes include ginseng, evening primrose oil, dong quoi, red clover and licorice. Phytoestrogens and black cohosh have had mixed reports- some favorable; others no better than placebo. Phytoestrogens may have risks of estrogen stimulation on breast or uterus; black cohosh has had reports of liver toxicity.

Wendy: What guidance do you give your patients about hormone replacement therapy?

Dr. Pinkerton:  In 2007, the Women’s Health Initiative findings were reanalyzed based on years since menopause and age.  The good news is that for women under 60, and within 10 years of menopause, there was NO increase in heart events and mortality was less. There remains concern of a slight increase in breast cancer, among those using estrogen plus progestereone, as well as blood clots, stroke and gallstones. Fewer fractures and less colon cancer were found. Although only one estrogen/progesterone product was studied, it is currently felt that all estrogen and progesterone combinations including so-called bioidentical hormones carry the same potential risks.

Wendy: What about other non-hormonal treatments like anti-depressants?

Dr. Pinkerton: Two types of anti-depressants are being tested – the SSRIs such as Prozac, Paxil, and Zoloft, and the SSNRs such as low doses of Effexor. An anti-seizure medication, Gabapentin, has also been shown to be effective at 300 mg three times a day. All of these medications have side effects, have only been tested in limited trials and none are FDA- approved for relief of hot flashes. Also, none are as effective as estrogen or estrogen plus progesterone for women with a uterus.