From AMA news letter
Introduction
GPs play an important role in educating and empowering menopausal women to be active participants in their health. A key part of this includes understanding the non-pharmacological options women turn to if they self-medicate for menopausal symptoms.1
There are varying estimates regarding the use of complementary and alternative medicines (CAM) in menopausal women. An Australian survey involving over 850 women found 82.5% of menopausal women used CAM; 67% used nutrition (dietary supplements and healthy eating), 56% used phytoestrogens and 41% used herbal therapies (evening primrose oil, Vitamin E, ginseng or red clover).1
An examination of the evidence base for selected complementary therapies is described below. Current evidence has shown that oestrogen therapy with or without progesterone is the most effective therapy for menopause-related vasomotor symptoms (VMS) and their potential consequences which can include disturbed sleep, irritability, difficulty concentrating and subsequent reduced quality of life.2
Phytoestrogens
Phytoestrogens are plant-derived substances that include isoflavones and lignans. Isoflavones can be sourced from soy, chickpeas or red clover and have oestrogenic properties.3 Lignans can be found in seeds such as flaxseed, whole cereals, vegetables, legumes and fruit.3
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Black Cohosh
Black cohosh (Actaea racemosa, also known as cimicifuga racemosa) is a plant found in North America and is commonly used to treat menopausal symptoms. There is conflicting evidence regarding the efficacy of black cohosh.3 Preparations vary in dose and potency therefore making it difficult to establish efficacy.7
The long term safety of black cohosh has not yet been established, however there have been reports of hepatic failure.4 It is thought to possess oestrogenic properties and therefore should be avoided in women with a history of breast cancer.5 Isolated cases of hepatitis, thrombosis and hypertension have been reported around the world however there is little evidence linking these side effects directly to black cohosh.8 There have been reports of idiosyncratic liver failure and all black cohosh products sold in Australia now carry a warning to this effect.7
Wild yam as a natural progesterone cream
Well-controlled studies of the safety and efficacy of wild yam for menopausal symptoms are limited. One small double blind, placebo-controlled, crossover study (23 women) examined the effect of wild yam topical cream for 6 months. The study suggests that short-term treatment with topical wild yam extract in women suffering from menopausal symptoms is free of side-effects, but appears to have little effect on menopausal symptoms.9 Wild yam contains a sterol that cannot be transformed into progesterone in the body, and as such should not be used as the progesterone component of HRT because of failure to protect against oestrogen-induced endometrial hyperplasia.4
Evening primrose oil
Evening primrose oil is high in gamma-linolenic and linolenic acid and is used by some women to relieve symptoms such as hot flushes. Despite wide use, there is little evidence that proves it to be efficacious.3
St John’s Wort
St John’s Wort (Hypericum perforatum) has been proven to be effective in mild-to-moderate depression in women who are both peri- and premenopausal, however there is little evidence for its role in relieving VMS.3
Despite its efficacy in relieving some forms of depression, St John’s Wort should be used with caution as it interacts with a wide range of medication. For example, it can decrease plasma concentrations of cyclosporine, midazolam, tacrolimus, amitriptyline, digoxin, indinavir, warfarin and theophylline. When used concomitantly with oral contraceptives it may lead to contraceptive failure or breakthrough bleeding.3
Diet and supplements
There is very limited evidence for vitamin E, C and minerals such as selenium having any benefit on menopausal symptoms.3
