Complementary and Alternative Medicine for Menopausal Symptoms: A Review of Randomized, Controlled Trials
Publication: Annals of Internal Medicine
Volume 137, Number 10
Submit a Comment
Contributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.
Abstract
Background:
Women commonly use soy products, herbs, and other complementary and alternative medicine (CAM) therapies for menopausal symptoms. Randomized, controlled trials have evaluated the efficacy and short-term safety of these therapies.
Purpose:
To review randomized, controlled trials of CAM therapies for menopausal symptoms in order to better inform practice and guide future research.
Data Sources:
Searches of MEDLINE for articles published from January 1966 through March 2002, of the Alternative and Complementary Database (AMED) of the British Library for articles published from January 1985 through December 2000, and of the authors' own extensive files. Search terms were hot flash/flush, menopause, and climacteric, combined with phytoestrogens, alternative medicine, herbal medicine, traditional medicine, Traditional Chinese Medicine (TCM), Ayurveda, naturopathy, chiropractic, osteopathy, massage, yoga, relaxation therapy, homeopathy, aromatherapy, and therapeutic touch.
Study Selection:
29 randomized, controlled clinical trials of CAM therapies for hot flashes and other menopausal symptoms were identified; of these, 12 dealt with soy or soy extracts, 10 with herbs, and 7 with other CAM therapies.
Data Extraction:
Each author extracted information from half of the studies on the number of patients, study design, outcome measures, and results; the other author then checked these results.
Data Synthesis:
Soy seems to have modest benefit for hot flashes, but studies are not conclusive. Isoflavone preparations seem to be less effective than soy foods. Black cohosh may be effective for menopausal symptoms, especially hot flashes, but the lack of adequate long-term safety data (mainly on estrogenic stimulation of the breast or endometrium) precludes recommending long-term use. Single clinical trials have found that dong quai, evening primrose oil, a Chinese herb mixture, vitamin E, and acupuncture do not affect hot flashes; two trials have shown that red clover has no benefit for treating hot flashes.
Conclusions:
Black cohosh and foods that contain phytoestrogens show promise for the treatment of menopausal symptoms. Clinical trials do not support the use of other herbs or CAM therapies. Long-term safety data on individual isoflavones or isoflavone concentrates are not available.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Corney RH, Stanton R. A survey of 658 women who report symptoms of premenstrual syndrome. J Psychosom Res. 1991;35:471-82. [PMID: 1920178]
2.
MacLennan AH, Wilson DH, Taylor AW. Prevalence and cost of alternative medicine in Australia. Lancet. 1996;347:569-73. [PMID: 8596318]
3.
Himmel W, Schulte M, Kochen MM. Complementary medicine: are patients' expectations being met by their general practitioners? Br J Gen Pract. 1993;43:232-5. [PMID: 8373645]
4.
Avina RL, Schneiderman LJ. Why patients choose homeopathy. West J Med. 1978;128:366-9. [PMID: 664638]
5.
Hare ML. The emergence of an urban United States Chinese medicine. Med Anthropol Q. 1993;7:30-49.
6.
Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. . Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998;280:1569-75. [PMID: 9820257]
7.
Kronenberg F, O'Leary , Cobb J, McMahon D. Alternative medicine for menopausal problems: results of a survey [Abstract]. Menopause. 1994;1:171-2.
8.
Beal MW. Women's use of complementary and alternative therapies in reproductive health care. J Nurse Midwifery. 1998;43:224-34. [PMID: 9674352]
9.
Kronenberg F. Hot flashes: epidemiology and physiology. Ann N Y Acad Sci. 1990; 592:52-86; discussion 123-33. [ 2197954]
10.
Jacobson JS, Troxel AB, Evans J, Klaus L, Vahdat L, Kinne D, et al. . Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol. 2001;19:2739-45. [PMID: 11352967]
11.
Warnecke G. Beeinflussung Klimakterischer Beschwerden durch ein Phytotherapeutikum: Erfolgreiche Therapie mit Cimicifuga-Monoextrakt. Med Welt. 1985;36:871-4.
12.
Stoll W. [Phytopharmacon influences atrophic vaginal epithelium—double-blind study—Cimicifuga vs. estrogenic substances] [German]. Therapeutikon. 1987;1:23-31.
13.
Lehmann-Willenbrock E, Riedel HH. [Clinical and endocrinologic studies of the treatment of ovarian insufficiency manifestations following hysterectomy with intact adnexa]. Zentralbl Gynakol. 1988;110:611-8. [PMID: 2841818]
14.
Baber RJ, Templeman C, Morton T, Kelly GE, West L. Randomized placebo-controlled trial of an isoflavone supplement and menopausal symptoms in women. Climacteric. 1999;2:85-92. [PMID: 11910672]
15.
Knight DC, Howes JB, Eden JA. The effect of Promensil, an isoflavone extract, on menopausal symptoms. Climacteric. 1999;2:79-84. [PMID: 11910671]
16.
Hirata JD, Swiersz LM, Zell B, Small R, Ettinger B. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril. 1997;68:981-6. [PMID: 9418683]
17.
Chenoy R, Hussain S, Tayob Y, O'Brien PM, Moss MY, Morse PF. Effect of oral gamolenic acid from evening primrose oil on menopausal flushing. BMJ. 1994;308:501-3. [PMID: 8136666]
18.
Wiklund IK, Mattsson LA, Lindgren R, Limoni C. Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Swedish Alternative Medicine Group. Int J Clin Pharmacol Res. 1999;19:89-99. [PMID: 10761538]
19.
Davis SR, Briganti EM, Chen RQ, Dalais FS, Bailey M, Burger HG. The effects of Chinese medicinal herbs on postmenopausal vasomotor symptoms of Australian women. A randomised controlled trial. Med J Aust. 2001;174:68-71. [PMID: 11245505]
20.
Jarry H, Harnischfeger G, Duker E. [The endocrine effects of constituents of Cimicifuga racemosa. 2. In vitro binding of constituents to estrogen receptors] [German]. Planta Med. 1985; August:316-9. [ 4070446]
21.
Struck D, Tegtmeier M, Harnischfeger G. Flavones in extracts of Cimicifuga racemosa. Planta Med. 1997; 289-90.
22.
Kennelly EJ, Baggett S, Nuntanakom P, Ososki AL, Mori SA, Duke J, et al. . Analysis of thirteen populations of black cohosh for formononetin. Phytomedicine. 2002;9:461-7. [PMID: 12222669]
23.
McCoy J, Kelly W. Survey of Cimicifuga racemosa for phytoestrogenic flavonoids [Abstract]. Proceedings of the 212th American Chemical Society National Meeting, Orlando, FL. 25–29 August 1996.
24.
Foster S, Tyler VE. Tyler's Honest Herbal. 4th ed. New York: Haworth Pr; 1999.
25.
Zava DT, Dollbaum CM, Blen M. Estrogen and progestin bioactivity of foods, herbs, and spices. Proc Soc Exp Biol Med. 1998;217:369-78. [PMID: 9492350]
26.
Amato P, Christophe S, Mellon PL. Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause. 2002;9:145-50. [PMID: 11875334]
27.
Fugh-Berman A. Herb-drug interactions. Lancet. 2000;355:134-8. [PMID: 10675182]
28.
Greenspan EM. Ginseng and vaginal bleeding [Letter]. JAMA. 1983;249:2018. [PMID: 6834589]
29.
Punnonen R, Lukola A. Oestrogen-like effect of ginseng. Br Med J. 1980;281:1110. [PMID: 7191760]
30.
Hopkins MP, Androff L, Benninghoff AS. Ginseng face cream and unexplained vaginal bleeding. Am J Obstet Gynecol. 1988;159:1121-2. [PMID: 3189445]
31.
Thompson LU, Robb P, Serraino M, Cheung F. Mammalian lignan production from various foods. Nutr Cancer. 1991;16:43-52. [PMID: 1656395]
32.
Lock M, Kaufert P, Gilbert P. Cultural construction of the menopausal syndrome: the Japanese case. Maturitas. 1988;10:317-32. [PMID: 3265758]
33.
Adlercreutz H, Hämäläinen E, Gorbach S, Goldin B. Dietary phyto-oestrogens and the menopause in Japan [Letter]. Lancet. 1992;339:1233. [PMID: 1349965]
34.
Van Patten CL, Olivotto IA, Chambers GK, Gelmon KA, Hislop TG, Templeton E, et al. . Effect of soy phytoestrogens on hot flashes in postmenopausal women with breast cancer: a randomized, controlled clinical trial. J Clin Oncol. 2002;20:1449-55. [PMID: 11896091]
35.
Han KK, Soares JM Jr, Haidar MA, de Lima GR, Baracat EC. Benefits of soy isoflavone therapeutic regimen on menopausal symptoms. Obstet Gynecol. 2002;99:389-94. [PMID: 11864664]
36.
St Germain A, Peterson CT, Robinson JG, Alekel DL. Isoflavone-rich or isoflavone-poor soy protein does not reduce menopausal symptoms during 24 weeks of treatment. Menopause. 2001;8:17-26. [PMID: 11201510]
37.
Scambia G, Mango D, Signorile PG, Anselmi Angeli RA, Palena C, Gallo D, et al. . Clinical effects of a standardized soy extract in postmenopausal women: a pilot study. Menopause. 2000;7:105-11. [PMID: 10746892]
38.
Quella SK, Loprinzi CL, Barton DL, Knost JA, Sloan JA, LaVasseur BI, et al. . Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: A North Central Cancer Treatment Group Trial. J Clin Oncol. 2000;18:1068-74. [PMID: 10694559]
39.
Upmalis DH, Lobo R, Bradley L, Warren M, Cone FL, Lamia CA. Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study. Menopause. 2000;7:236-42. [PMID: 10914616]
40.
Washburn S, Burke GL, Morgan T, Anthony M. Effect of soy protein supplementation on serum lipoproteins, blood pressure, and menopausal symptoms in perimenopausal women. Menopause. 1999;6:7-13. [PMID: 10100174]
41.
Albertazzi P, Pansini F, Bonaccorsi G, Zanotti L, Forini E, De Aloysio D. The effect of dietary soy supplementation on hot flushes. Obstet Gynecol. 1998;91:6-11. [PMID: 9464712]
42.
Dalais FS, Rice GE, Wahlqvist ML, Grehan M, Murkies AL, Medley G, et al. . Effects of dietary phytoestrogens in postmenopausal women. Climacteric. 1998;1:124-9. [PMID: 11907915]
43.
Brzezinski A, Adlercreutz H, Shaoul R, Rosler A, Shmueli A, Tanos V, et al. . Short-term effect of phytoestrogen-rich diet on postmenopausal women. Menopause. 1997;4:89-94.
44.
Murkies AL, Lombard C, Strauss BJ, Wilcox G, Burger HG, Morton MS. Dietary flour supplementation decreases post-menopausal hot flushes: effect of soy and wheat. Maturitas. 1995;21:189-95. [PMID: 7616867]
45.
Baird DD, Umbach DM, Lansdell L, Hughes CL, Setchell KD, Weinberg CR, et al. . Dietary intervention study to assess estrogenicity of dietary soy among postmenopausal women. J Clin Endocrinol Metab. 1995;80:1685-90. [PMID: 7745019]
46.
Blatt MH, Wiesbader H, Kupperman HS. Vitamin E and climacteric syndrome. Arch Intern Med. 1953;91:792-6.
47.
Barton DL, Loprinzi CL, Quella SK, Sloan JA, Veeder MH, Egner JR, et al. . Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. J Clin Oncol. 1998;16:495-500. [PMID: 9469333]
48.
Wyon Y, Lindgren R, Lundeberg T, Hammar M. Effects of acupuncture on climacteric vasomotor symptoms, quality of life, and urinary excretion of neuropeptides among postmenopausal women. Menopause. 1995;2:3-12.
49.
Ernst E, White A. Life-threatening adverse reactions after acupuncture? A systematic review. Pain. 1997;71:123-6. [PMID: 9211472]
50.
Freedman RR, Woodward S. Behavioral treatment of menopausal hot flushes: evaluation by ambulatory monitoring. Am J Obstet Gynecol. 1992;167:436-9. [PMID: 1497048]
51.
Freedman RR, Woodward S, Brown B, Javaid JI, Pandey GN. Biochemical and thermoregulatory effects of behavioral treatment for menopausal hot flashes. Menopause. 1995;2:211-8.
52.
Irvin JH, Domar AD, Clark C, Zuttermeister PC, Friedman R. The effects of relaxation response training on menopausal symptoms. J Psychosom Obstet Gynaecol. 1996;17:202-7. [PMID: 8997686]
53.
Lee JR. Natural Progesterone: The Multiple Roles of a Remarkable Hormone. Sebastopol, CA: BLL Publishing; 1993.
54.
Komesaroff PA, Black CV, Cable V, Sudhir K. Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women. Climacteric. 2001;4:144-50. [PMID: 11428178]
55.
Leonetti HB, Longo S, Anasti JN. Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstet Gynecol. 1999;94:225-8. [PMID: 10432132]
56.
Cooper A, Spencer C, Whitehead MI, Ross D, Barnard GJ, Collins WP. Systemic absorption of progesterone from Progest cream in postmenopausal women [Letter]. Lancet. 1998;351:1255-6. [PMID: 9643756]
57.
Wren BG, McFarland K, Edwards L. Micronised transdermal progesterone and endometrial response [Letter]. Lancet. 1999;354:1447-8. [PMID: 10543679]
58.
Lewis JG, McGill H, Patton VM, Elder PA. Caution on the use of saliva measurements to monitor absorption of progesterone from transdermal creams in postmenopausal women. Maturitas. 2002;41:1-6. [PMID: 11809337]
Information & Authors
Information
Published In
Annals of Internal Medicine
Volume 137 • Number 10 • 19 November 2002
Pages: 805 - 813
History
Published online: 19 November 2002
Published in issue: 19 November 2002
Keywords
Copyright
© 2002 American College of Physicians.
Authors
Metrics & Citations
Metrics
Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
Download article citation data for:
Complementary and Alternative Medicine for Menopausal Symptoms: A Review of Randomized, Controlled Trials. Ann Intern Med.2002;137:805-813. [Epub 19 November 2002]. doi:10.7326/0003-4819-137-10-200211190-00009
Complementary and Alternative Medicine for Menopausal Symptoms: A Review of Randomized, Controlled Trials. Ann Intern Med.2002;137:805-813. [Epub 19 November 2002]. doi:10.7326/0003-4819-137-10-200211190-00009
View More
Login Options:
Purchase
You will be redirected to acponline.org to sign-in to Annals to complete your purchase.
Access to EPUBs and PDFs for FREE Annals content requires users to be registered and logged in. A subscription is not required. You can create a free account below or from the following link. You will be redirected to acponline.org to create an account that will provide access to Annals. If you are accessing the Free Annals content via your institution's access, registration is not required.
Create your Free Account
You will be redirected to acponline.org to create an account that will provide access to Annals.
Comments
0 Comments