Menopause Symptoms -- Herbs No Help?

July 24, 2006 -- There's no proof any of the alternative or complementary herbal therapies used by women for menopausal symptoms help -- at least not in English-language scientific literature.

That's the conclusion of Oregon Health & Science University researcher Ann Nedrow, MD, and colleagues. Nedrow and colleagues looked in 1,432 studies for evidence any nonmedical treatment might work.

They found 70 studies that met scientific standards, but none that had evidence proving an alternative or complementary therapy relieves any symptom of menopause. This doesn't mean the therapies don't or can't work. It only means there's no proof they do.

"Lifestyle modification and mind-body techniques may have high safety profiles and result in additional health benefits," Nedrow and colleagues conclude. "Many alternative therapies used by menopausal women, such as massage, aromatherapy, yoga, and ayurvedic therapy, need to be studied in randomized, controlled trials," they say.

Types of Therapies

Nedrow and colleagues note five categories of alternative/complementary therapies:

• Biologically based therapies. These include botanicals, animal-derived products, fatty acids, vitamins, minerals, probiotics, diets, and functional foods.
• Mind-body therapies. These focus on the ways emotional, mental, social, spiritual, and behavioral factors affect health.
• Energy therapies. These try to make use of real energies, such as electromagnetic forces, or hypothetical energies, such as life-force energy.
• Manipulative and body-based therapies. These include chiropractic, osteopathy, massage, and other techniques.
• Whole medical systems. These involve medical systems outside Western medicine, such as traditional Chinese medicine and ayurvedic medicine.

The problem with most studies of these techniques, Nedrow and colleagues find, is they are small and have various methodological problems making their results difficult to reproduce. These problems include nonstandardized study populations, varying definitions of menopause, nonstandardized outcome measures, and nonstandardized biological therapies.

For example, one trial showed a benefit for a brand of black cohosh, as did earlier German studies. But other studies found no benefit -- and the various studies can't be compared directly.

The biggest problem, however, is the placebo effect, which is particularly strong for menopausal symptoms. In a study of hormone therapy for hot flashes, for example, half of the women getting fake treatment said their symptoms improved.

Nedrow and colleagues note that 42% of Americans used some kind of alternative medicine in the last year. Menopausal symptoms are one of the most common reasons for seeking these treatments. Yet 70% of menopausal women using them don't tell their doctors.

The researchers say more high-quality research is needed. Until then, they urge doctors to create an atmosphere in which menopausal women feel free to discuss any treatments they may be using.

Nedrow and colleagues report their findings in the July 24 issue of Archives of Internal Medicine.