What alternative treatments for menopause have been scientifically studied?
The alternative treatments for menopause that have been studied in well-designed trials include phytoestrogens (plant estrogens, isoflavones), black cohosh, and vitamin E.
Isoflavones are chemical compounds found in soy and other plants (such as chick peas and lentils) that are phytoestrogens, or plant-derived estrogens. Red clover is another source of isoflavones that has been used by some women in an attempt to relieve hot flashes. Isoflavones have a chemical structure that is similar to the estrogens naturally produced by the body, but their effectiveness as an estrogen has been estimated to be much lower than true estrogens.
Some studies have shown that these compounds may help relieve hot flashes and other symptoms of menopause. In particular, women who have had breast cancer and do not want to take hormone therapy (HT) with estrogen sometimes use soy products for relief of menopausal symptoms. However, some phytoestrogens can actually have anti-estrogenic properties in certain situations, and the overall risks of these preparations have not yet been determined. There is some concern because of the fact that these products are selective estrogen receptor modulators (SERMs), that phytoestrogens may stimulate breast cancer growth or limit the antitumor effects of tamoxifen (Nolvadex). Data are conflicting in this regard, and it is important for women to understand that the long-term risks and potential effects of phytoestrogens have not been fully characterized. For example, researchers have shown that long-term use of phytoestrogens in postmenopausal women led to an increase in endometrial hyperplasia (overgrowth of the tissues lining the uterus) which can be a precursor to cancer.
There is a perception among many women that plant estrogens are "natural" remedies and therefore safer than HT, but their safety has never been proven scientifically. Further research is needed to fully characterize the safety and potential risks of phytoestrogens.
Black cohosh is an herbal preparation that has been popular in Europe for hot flash relief. This herb is becoming more popular in the U.S., and the North American Menopause Society does support the short-term use of black cohosh for treating menopausal symptoms. The recommended use is up to six months because of its relatively low incidence of side effects. Some studies have shown that black cohosh can reduce hot flashes, but most of the studies have not been considered to be rigorous enough in their design to firmly prove any benefit. The Herbal Alternatives for Menopause Trial (HALT) study, a one-year study described below, failed to establish any benefit of black cohosh in the treatment of hot flashes. There have also not been scientific studies done to establish the long-term benefits and safety of this product. Research is ongoing to further determine the effectiveness and safety of black cohosh. There is some concern about the potential estrogenic effect of black cohosh on the breast, and it is not recommended as a safe therapy for women with breast cancer or who are at high risk for breast cancer.
The Herbal Alternatives for Menopause Trial (HALT) was a one-year study carried out with 351 peri- or postmenopausal women experiencing hot flashes and other symptoms of menopause. The women were randomly assigned to receive one of five treatments: black cohosh alone, a multibotanical regimen that included black cohosh (and other herbal ingredients such as ginseng and dong quai), the multibotanical regimen plus dietary soy counseling, conjugated estrogen 0.625 mg (with or without medroxyprogesterone acetate), or placebo. After one year of therapy, conjugated estrogen reduced hot flashes more than placebo, but there was no significant reduction in the frequency or severity of hot flashes with black cohosh or with any of the herbal interventions when compared to placebo at any of the follow-up times.
Some women report that vitamin E supplements can provide relief from mild hot flashes, but scientific studies are lacking to prove the effectiveness of vitamin E in relieving hot flashes. Taking a dosage greater than 400 international units (IU) of Vitamin E may not be safe, since some studies have suggested that greater dosages may be associated with cardiovascular disease risk.
Other alternative therapies
There are many supplements and substances, including ginseng; licorice; evening primrose oil; dong quai; chasteberry; and wild yam, that have been advertised as "natural" treatments for menopause. Scientific studies have not been performed to prove the safety and effectiveness of these products, although the HALT study (see black cohosh, previously) showed that ginseng and dong quai were no more effective than placebo in the treatment of hot flashes.
The North American Menopause Society recommends that women try behavioral modifications such as attempting to keep the core body temperature cooler to help relieve hot flashes. Other modifications include regular exercise, yoga and meditation. Several studies have failed to prove a beneficial effect of exercise on hot flashes, possibly because exercise raises core body temperature and may, in fact, trigger hot flashes. Still, regular exercise has important benefits in the prevention of obesity, cardiovascular disease, diabetes, and other conditions.
Relaxation therapy and stress management interventions do not appear to be effective in the management of hot flashes, according to scientific studies. However, these interventions may be beneficial for women in maintaining overall health, physical well-being, and emotional well-being during the menopausal transition.