Ineffective or unsafe alternative treatments for perimenopause

Based on the latest research, some therapies are not recommended for perimenopausal symptoms, either because they are not effective or because they can cause dangerous effects. These include:

• Kava, a medicinal root used to calm anxiety, restlessness, sleeplessness, and stress-related symptoms, such as muscle tension or spasm. Despite its effectiveness, kava use is widely considered to be dangerous. The U.S. Food and Drug Administration (FDA) is currently investigating a link between kava supplements and liver toxicity. Reports of kava causing liver damage (some requiring liver transplant) have led to the recent removal of these products from shelves in Canada and parts of Europe.¹ Symptoms of serious liver disease include jaundice (yellowing of the skin or the whites of the eyes) and brown urine. Other symptoms of liver disease can include nausea, vomiting, light-colored stools, unusual tiredness, weakness, stomach or abdominal pain, and loss of appetite.²
• Evening primrose, a source of gamma-linolenic acid (GLA) that also contains anticoagulants. It has been recommended for premenstrual syndrome (PMS), weight loss, blood pressure control, breast pain, arthritis, multiple sclerosis, and hangovers. Recent studies have found that GLA is no better than a placebo for the treatment of hot flashes (both placebo and evening primrose were linked to a "significant improvement" in the number of nighttime hot flashes).³
• Dong quai, a type of angelica (see below) that has been used in traditional Chinese medicine for centuries, usually in combination with other medicinals. It is commonly used for treatment of irregular menstrual periods, PMS, cramps, fatigue, and "blood cleansing." Dong quai can be toxic. It has anticoagulant effects, may increase menstrual bleeding, and can cause a skin rash with sun exposure (photosensitivity). Dong quai should not be used during pregnancy.⁴ Claims that dong quai is a phytoestrogen or has estrogenlike effects are not supported by research. Women treated with dong quai for 12 weeks have shown no differences in perimenopausal symptom relief, estrogen-related effects, or hormone levels than those treated with placebo.³
• Dehydroepiandrosterone (DHEA). This supplement is currently being promoted for its antiaging properties, and many women are using it for menopausal symptoms. There is no scientific evidence to support benefits of DHEA. Adverse effects include yellowing of the skin (jaundice), elevated liver function tests, and increased cholesterol levels. Women who may become pregnant should not take DHEA because of possible adverse effects on the developing fetus.
• Angelica, which is commonly used for problems with gas, water retention, and regulation of menstruation and for induction of abortion. There is no scientific evidence to support benefits of its therapeutic uses. Serious side effects when taken in large doses include bleeding problems, skin rash, and mutations in a developing fetus.

Citations

1. Huntley AL, Ernst E (2003). A systematic review of herbal medicinal products for the treatment of menopausal symptoms. Menopause, 10(5): 465–476.

2. Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration (2002). Kava-containing dietary supplements may be associated with severe liver injury. FDA/CFSAN Consumer Advisory. Available online: http://www.cfsan.fda.gov/~dms/addskava.html.

3. American College of Obstetricians and Gynecologists (2001). Use of botanicals for management of menopausal symptoms. ACOG Practice Bulletin No. 28. Obstetrics and Gynecology, 97(6, Suppl): 1–11.

4. Dog TL, et al. (2001). An integrative approach to menopause. Alternative Therapies, 7(4): 45–55.