MENOPAUSE
AND COMPLEMENTARY AND ALTERNATIVE MEDICINE
Menopause
is the permanent end of a woman's menstrual periods. Menopause
can occur naturally or be caused by surgery, chemotherapy, or
radiation. Many women use complementary and alternative medicine
(CAM) for menopausal symptoms.
This fact
sheet is based on findings from a 2005 National Institutes of
Health (NIH) State-of-the-Science conference on the management
of menopause-related symptoms. To find out more about topics
and resources mentioned in this fact sheet, see For More Information.
Key
Points
Some
symptoms commonly seen as menopausal may be related to aging
in general.
Menopause
is a normal part of aging and should not be viewed as a disease.
There
is very little high-quality scientific evidence about the
effectiveness and long-term safety of CAM therapies for menopausal
symptoms. More research is needed.
Tell
your health care providers about any complementary and alternative
practices you use. Give them a full picture of what you do
to manage your health. This will help ensure coordinated and
safe care.
About
Menopause
A woman
is said to have completed natural menopause when she has not
had a period for 12 consecutive months. For American women,
this typically happens at around age 51 or 52. Menopause occurs
immediately if the uterus or both ovaries are surgically removed,
or if the ovaries are damaged in cancer treatment with radiation
therapy or certain drugs.
Common
Symptoms During the Menopausal Transition
Some symptoms
that women experience are related to menopause and decreased
activity of the ovaries. Others may be related to aging in general.
Scientific
evidence of a link to menopause is strongest for the following
symptoms:
Hot flashes
and night sweats (also called vasomotor symptoms, because
they involve the expansion of the blood vessels)
Sleep
difficulties
Vaginal
dryness, which can lead to painful intercourse and other sexual
problems.
It is not
certain whether the following symptoms are due to menopause,
other factors that can come with aging, or a combination of
menopause and these factors:
Problems
in thinking or in remembering things
Urinary
incontinence
Physical
complaints, such as tiredness and stiff or painful joints
Changes
in mood, such as depression, anxiety, and/or irritability.
The expert
panel assembled for the NIH State-of-the-Science conference
noted that menopause is a normal part of women's aging and advised
that menopause should not be "medicalized" (or viewed as a disease).
Hormone
Replacement for Menopausal Symptoms
For decades,
hormone replacement therapy (HRT)—more recently known as menopausal
hormone therapy (MHT)—was conventional medicine's main treatment
for menopausal symptoms. In 2002, findings from a large study
called the Women's Health Initiative raised serious concerns
about the long-term safety of MHT. These concerns are one reason
that many women are turning to CAM therapies.
What
the Science Says About CAM Therapies for Menopausal Symptoms
The NIH
State-of-the-Science conference panel discussed the evidence
on several CAM therapies:
Six botanicals—black
cohosh, dong quai root, ginseng, kava, red clover, and soy
DHEA
(dehydroepiandrosterone), a dietary supplement.
Very little
well-designed research has been done on CAM therapies for menopausal
symptoms. A small number of studies have been published, but
they have had limitations (such as the way the research was
done or treatment periods that may not have been long enough).
As a result, the findings from these studies are not strong
enough for scientists to draw any conclusions. Also, many studies
of botanicals have not used a standardized product (i.e., one
that is chemically consistent). The National Center for Complementary
and Alternative Medicine (NCCAM) is sponsoring a number of studies
on botanicals using products that are both well characterized
(i.e., their ingredients have been carefully studied) and well
standardized and on other CAM therapies that have shown possible
promise for reducing menopausal symptoms.
Because
CAM products used for menopausal symptoms can have side effects
and can interact with other botanicals or supplements or with
drugs, research in this area is addressing safety as well as
efficacy. Some findings from this research are highlighted below.
Botanicals
Black
cohosh
(Actaea racemosa, Cimicifuga racemosa). This herb
has received more scientific attention for its possible effects
on menopausal symptoms than have other botanicals. Studies
of its effectiveness in reducing hot flashes have had mixed
results. A study funded by NCCAM and the National Institute
on Aging found that black cohosh, whether used alone or with
other botanicals, failed to relieve hot flashes and night
sweats in postmenopausal women or those approaching menopause.
Other research suggests that black cohosh does not act like
estrogen, as once was thought. Black cohosh has had a good
safety record over a number of years. Some concerns have been
raised about whether it may cause liver problems, but an association
has not been proven.
Dong
quai (Angelica sinensis). Only one randomized
clinical study of dong quai has been done. The researchers
did not find it to be useful in reducing hot flashes. Dong
quai is known to interact with, and increase the activity
in the body of, the blood-thinning medicine warfarin. This
can lead to bleeding complications in women who take this
medicine.
Ginseng
(Panax ginseng or Panax quinquefolius). The panel
concluded that ginseng may help with some menopausal symptoms,
such as mood symptoms and sleep disturbances, and with one's
overall sense of well-being. However, it has not been found
helpful for hot flashes.
Kava
(Piper methysticum). Kava may decrease anxiety, but
there is no evidence that it decreases hot flashes. It is
important to note that kava has been associated with liver
disease. The FDA has issued a warning to patients and providers
about kava because of its potential to damage the liver.
Red
clover (Trifolium pratense). The panel reported
that five controlled studies found no consistent or conclusive
evidence that red clover leaf extract reduces hot flashes.
Clinical studies in women report few side effects, and no
serious health problems have been discussed in the literature.
However, there are some cautions. Some studies have raised
concerns that red clover, which contains phytoestrogens, might
have harmful effects on hormone-sensitive tissue (for example,
in the breast and uterus). (See box below for more information
on phytoestrogens.)
Soy.
The scientific literature includes both positive and negative
results on soy extracts for hot flashes. When taken for short
periods of time, soy extracts appear to have few if any serious
side effects. However, long-term use of soy extracts has been
associated with thickening of the lining of the uterus.
About
Phytoestrogens
Some
botanical products, such as soy and red clover, contain estrogen-like
compounds called phytoestrogens. Plants rich in phytoestrogens
may help relieve some symptoms of menopause. However, it is
uncertain whether this relief comes from phytoestrogens or from
other compounds in the plant. Much remains to be learned about
these plant products, including exactly how they work in the
human body. Doctors caution that certain women need to be particularly
careful about using phytoestrogens, especially:
Women
who have had or are at increased risk for diseases or conditions
that are affected by hormones, such as breast, uterine,
or ovarian cancer; endometriosis; or uterine fibroids
Women
who are taking drugs that increase estrogen levels in the
body, such as birth control pills; MHT; or a type of cancer
drug called selective estrogen receptor modulators (SERMs),
such as tamoxifen.
DHEA
DHEA is
a naturally occurring substance that is changed in the body
to the hormones estrogen and testosterone. It is also manufactured
and sold as a dietary supplement. A few small studies have suggested
that DHEA might possibly have some benefit for hot flashes and
decreased sexual arousal, although small randomized controlled
trials have shown no benefit. Because levels of natural DHEA
in the body decline with age, some people believe that taking
a DHEA supplement can help treat or prevent conditions related
to aging; however, there is no good scientific evidence to support
this notion.
Concerns
have been raised about whether DHEA is safe and effective. Its
long-term effects, risks, and benefits have not been well studied,
and scientists are not certain whether it might increase the
risk for breast or prostate cancer. Before using DHEA for any
purpose, people should talk to their health care provider about
potential benefits and risks.
If
You Are Considering CAM for Menopausal Symptoms
Although
there is very little scientific evidence to support the effectiveness
of CAM therapies for menopausal symptoms, it is possible that
some CAM therapies may provide some relief to women during the
menopausal transition. Here are two important points to keep
in mind if you are considering these therapies:
Tell
your health care providers about any complementary and alternative
practices you use. Give them a full picture of what you do
to manage your health. This will help ensure coordinated and
safe care.
"Natural"
does not automatically mean "safe." As noted earlier, botanical
and other dietary supplements can interact with each other
and with prescription and over-the-counter drugs, affecting
how the body reacts. Supplements can pose other safety issues
as well. Some have been found to be contaminated, contain
unlabeled ingredients, or have different amounts of ingredients
than are listed on the label.
Women who
are looking for alternatives to MHT should be aware that CAM
therapies are not their only option. Certain lifestyle changes
can contribute to healthy aging, including during the menopausal
transition. For example, quitting smoking, eating a healthy
diet, and exercising regularly have been shown to reduce the
risks of heart disease and osteoporosis. The NIH State-of-the-Science
conference report (see "Selected References") discusses several
commonly used non-CAM interventions for relief of menopause-related
symptoms.
NCCAM
Research on CAM for Menopausal Symptoms
NCCAM supports
a number of studies on CAM treatments (such as botanicals and
mind-body practices) for menopausal symptoms, as do some of
the other institutes and centers at NIH. Recent examples of
NCCAM-funded projects include:
An initiative
to improve measures of hot flashes, which is expected to add
to the understanding of hot flashes and to aid future clinical
studies
A study
of whether black cohosh can help with the anxiety that may
be experienced as a symptom of menopause
A study
to identify botanicals from Central America that have been
used by the native population for menopausal symptoms and
to develop and test standardized extracts from these plants
Several
studies looking at the effect of acupuncture on the recurrence
and severity of hot flashes in postmenopausal women and others
who may suffer from hot flashes, such as men being treated
for prostate cancer
A study
to determine the effects of mindfulness-based stress reduction
(a type of meditation) on hot flashes in menopausal women
A study
to understand how soy supplements might affect hot flashes
and night sweats.
In addition,
NCCAM and other NIH components are cofunding an initiative to
establish a network of research centers looking at potential
new treatments for menopausal symptoms.
National
Institute on Aging. Pills, Patches, and Shots: Can Hormones
Prevent Aging? January 2007. National Institute on
Aging Web site. Accessed on May 1, 2007.
National
Institutes of Health. NIH State-of-the-Science Conference
Statement on Management of Menopause-Related Symptoms.
March 21-23, 2005. National
Institutes of Health Web site (PDF). Accessed on
May 1, 2007.
Newton KM,
Reed SD, LaCroix AZ, et al. Treatment of vasomotor symptoms
of menopause with black cohosh, multibotanicals, soy, hormone
therapy, or placebo. Annals of Internal Medicine. 2006;145(12):869-879.
For
More Information
NCCAM
Clearinghouse
The NCCAM
Clearinghouse provides information on CAM and NCCAM, including
publications and searches of Federal databases of scientific
and medical literature. The Clearinghouse does not provide medical
advice, treatment recommendations, or referrals to practitioners.
Toll-free
in the U.S.: 1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site: nccam.nih.gov
E-mail:
PubMed®
A service
of the National Library of Medicine (NLM), PubMed contains publication
information and (in most cases) brief summaries of articles
from scientific and medical journals. CAM on PubMed, developed
jointly by NCCAM and NLM, is a subset of the PubMed system and
focuses on the topic of CAM.
ClinicalTrials.gov
is a database of information on federally and privately supported
clinical trials (research studies in people) for a wide range
of diseases and conditions. It is sponsored by the National
Institutes of Health and the U.S. Food and Drug Administration.
Sources
for information on conventional care, including MHT:
National
Institute on Aging (NIA)
NIA is the
NIH institute that focuses on supporting and conducting high-quality
research on aging processes, age-related diseases, and special
problems and needs of the aged. NIA publications include Hormones and Menopause:
Tips from the National Institute on Aging.
National
Women's Health Information Center (NWHIC)
NWHIC, a
service of the Office of Women's Health in the U.S. Department
of Health and Human Services (HHS), provides information to
help advance women's health research, services, and public and
health professional education. NWHIC coordinates the efforts
of all HHS agencies and offices involved in women's health.
NHLBI is
the NIH institute that focuses on diseases of the heart, blood
vessels, lungs, and blood, and sleep disorders. It is also the
administrator of the NIH Women's Health Initiative research
program.
National
Institute of Arthritis and Musculoskeletal and Skin Diseases
(NIAMS)
NIAMS supports
research into the causes, treatment, and prevention of arthritis
and musculoskeletal and skin diseases; the training of scientists;
and the sharing of research-based information.
This
publication is not copyrighted and is in the public domain.
Duplication is encouraged.
NCCAM has provided this material for your
information. It is not intended to substitute for the
medical expertise and advice of your primary health care
provider. We encourage you to discuss any decisions about
treatment or care with your health care provider. The
mention of any product, service, or therapy is not an
endorsement by NCCAM.
NCCAM has provided this material for your information.
It is not intended to substitute for the medical expertise
and advice of your primary health care provider. We encourage
you to discuss any decisions about treatment or care with
your health care provider. The mention of any product, service,
or therapy is not an endorsement by NCCAM.
