Alternative Medicine and Menopause

It is estimated that Americans spend close to 27 billion dollars on alternative medicine each year. The highest rates of use occur in the 35-64 age groups. Given the interest in overall health at the time of menopause it is perhaps not surprising that an estimated 30 % of menopausal women use alternative therapies for both symptoms of menopause and theoretical long term health benefits.

Many women feel that the use of botanically derived compounds represents a more "natural" approach to menopause. A natural approach to menopause would include an interest in good nutrition, exercise and behavioral approaches such as stress reduction to staying healthy. Commonly used botanical products include Soy products, black cohosh, evening primrose, Dong Quai, St. John’s Wort, ginseng and Mexican and wild yam. Some products contain a mixture of various botanically derived compounds.

Phytoestrogens are compounds made by plants that have weak estrogenic activity when consumed by humans. There are three groups of phytoestrogens: isoflavones found in soy, garbanzo and other legumes, ligans which are a part of the cell wall of plants and are commonly consumed as oils such as flaxseed oil and coumestans found in red clover, sunflower seeds and bean sprouts. A lifetime of a diet high in these foods is thought to be protective against developing cancers and cardiovascular disease. Altering the diet at middle age to incorporate more phytoestrogens may not have a similar benefit. It is important to keep in mind that no single compound chemically isolated from these products has the same benefit as eating the original food product.

Consumption of phytoestrogens is safe and potentially beneficial to health in the amounts typically consumed in food products. However there is concern that the consumption of extremely high amounts of these compounds in dietary supplements may be potentially harmful, especially in women with or at risk for estrogen dependent cancers such as breast or uterine cancer.

In regards to easing hot flushes associated with menopause, soy protein will have beneficial effects in some women. In one study women given a soy protein supplement had a 45% reduction in hot flushes compared to 30% of women given a placebo. Black cohosh may also have a positive effect on easing the hot flushes, insomnia and mood disturbances that may occur during menopause. However there is no data on its safety when used for more than 6 months. In fact, traditional cultures and the German compendium of herbal remedies only recommend its use for 6 months. Ginseng, Dong Quai and evening primrose oil have not been shown to have any effect on reducing the severity of hot flushes in controlled studies.

Another popular "treatment" for menopausal symptoms is extracts from wild and Mexican yams. The steroid hormones found in yams are supposed to restore "hormonal balance." The steroids found in yams are not in a form that humans can use and we have no mechanism to convert the particular steroid found in the yams to a useable hormone. There are some creams sold as yam extracts that actually contain synthetic progestins.

Because dietary supplements are not classified as drugs the manufacturers do not have to provide any data to support health claims. There is no regulatory agency that assures the efficacy or safety of these compounds. It is left to the individual manufacturer. These products may be safe and effective or may be contaminated or adulterated. Some have none of the purported active ingredients. For example a study by the American Botanical Council found that the majority of ginseng products they examined had little or no ginseng and many had been adulterated with caffeine.

So what advice do I give women who ask about supplements or "natural" treatments for menopausal symptoms? A healthy diet, incorporating different types of fruits and vegetables and unprocessed food, along with regular exercise is very important. Soy food products can be helpful for some women plagued by hot flushes as can black cohosh. However when it comes to supplements I am reminded of the segment on a local news show "buyer beware." The term "natural" used to describe these pills is no more than a marketing tool. It is not a guarantee of efficacy or safety. Supplements do contain substances that can interact with medications and should be discussed with your physician.