Complementary Therapies For Menopausal Symptoms

Herbal medicines and various vitamin and mineral supplements are increasingly common form of alternative therapy. These products have great appeal to patients, the reality of which cannot be ignored. It is estimated that between 30% and 50% of women use complimentary therapies for menopausal symptoms although there is little evidence to support their effectiveness. Only products containing phytoestrogens, black cohosh or vitamin E have been studied in randomized controlled trials and the results of these trials are controversial.

Phytoestrogens or plant-derived estrogens are being increasingly promoted as the "natural" alternative to HRT. The lower prevalence of hot flushes in Asia and particularly in Japan, compared to that in Europe and North America, has been attributed to the traditional Asian diet rich in phytoestrogens, with an average daily content of up to 200 mg of isoflavones. Epidemiological studies also suggest that the incidence of certain diseases influenced by estrogens - cardiovascular disease, osteoporosis and breast cancer, for example - is lower in populations with a diet high in phytoestrogens.

Phytoestrogens are classified into three groups: isoflavones, lignans and coumestans. Of these three groups isoflavones (the main sources are soybeans, lentils, chickpeas) have been the most investigated.

It appears that dose of isoflavones of above 60mg per day has some efficacy in relieving hot flushes. Doses between 30 and 40 mg can reduce serum cholesterol level. It is also believed that isoflavones might have a weak impact on coronary heart disease and may also be protective for the breast.

Unfortunately only about 50 - 70% of adults are able to produce equol (a member of isoflavone family and an exclusive metabolic product of gut bacteria) and therefore can benefit from isoflavone intake.

Vitamin E in a daily dose of 800 IU was found to reduce hot flushes significantly in women with breast cancer. High doses of black cohosh also significantly reduce number of hot flushes in women with breast cancer. Although short term use of black cohosh seems to be safe it appears that higher doses can affect liver function and there was a case of acute liver damage that required liver transplant. Trials testing the effectiveness of dong quai, ginseng, evening primrose oil and wild yam creams failed to document any benefit over placebo.