NIH Conference Looks at Treatments for Menopausal Symptoms
Menopause is a natural process for women as they age. (It can also occur if a woman has certain major treatments that affect her ovaries.) There are symptoms that can occur with menopause, such as hot flashes, night sweats, vaginal dryness, and sleep problems. However, many women go through menopause with no or few symptoms, or feel that their symptoms are not troubling enough that they need to seek medical treatment. For others, symptoms can be severe and affect quality of life.
For several decades, menopausal hormone therapy, consisting of estrogen alone or combined with progestin, has been the leading conventional treatment for menopausal symptoms. However, recent studies have identified increased risks for serious health problems among women taking hormone therapy. This is one reason that many women and their health care providers have become interested in CAM treatments for menopausal symptoms.
To review what is known about managing these symptoms, NCCAM and some other components of NIH cosponsored a March 2005 conference in Bethesda, Maryland. An independent panel of experts assessed the state-of-the-science on this topic and areas where further research is needed. To obtain the full report, see below.
The panel observed that menopause is a normal, healthy part of a woman's life and should not be viewed as a disease. Also, some symptoms currently viewed as being menopausal might not be caused by menopause, but by aging in general and/or life changes.
The panel's review of CAM therapies focused mainly on botanicals (therapies from plants and plant products), some of which are thought to act like a weak estrogen. Black cohosh and soy extracts are among the most frequently studied, especially for hot flashes. But Tieraona Low Dog, M.D., who is a member of NCCAM's National Advisory Council for Complementary and Alternative Medicine, noted that clinical trials have not been rigorous enough to determine the effectiveness of these therapies. Also, more basic information is needed on black cohosh, soy extracts, and other supplements, including their chemical components, how they are processed by the body, optimal doses, and side effects. Scientists are especially concerned about effects on the liver and on hormone-sensitive tissues such as those in the breast and uterus.
There is not much evidence on CAM therapies for menopausal symptoms, and the evidence that is available is not strong. The panel commented on other CAM therapies as follows:
- Kava: Effective in reducing anxiety, but there is insufficient evidence about effectiveness for hot flashes. Kava can be damaging to the liver, and the U.S. Food and Drug Administration has issued a warning about this.
- Red clover leaf: Believed to function as a weak estrogen, but studies have not found it effective for hot flashes.
- Dong quai root: Does not appear to be effective for hot flashes. Dong quai interacts with the drug warfarin, which could cause bleeding problems.
- Ginseng root: May be helpful for certain quality-of-life concerns, such as well-being, mood, and sleep, but does not appear to affect hot flashes.
- Exercise, health education, and paced respiration (a technique of slow, deep breathing): May be important for future investigation. Side effects are rare, and a few small studies have shown some benefits. However, these three therapies are not considered proven for menopausal symptoms.
NCCAM is continuing research on CAM therapies for menopausal symptoms. For example, researchers will study botanicals, looking especially at standardization (ensuring chemical consistency), characterization (better understanding of what's in the therapies), and best dosages. This information will be useful in future clinical trials. Also, NCCAM is sponsoring an initiative to develop improved measures of hot flashes; these are expected to be useful in future studies of CAM therapies.
For the conference report, see www.consensus.nih.gov/ta/025/025MenopauseINTROpostconf.htm, call 1-888-644-2667, or write the NIH Consensus Program Information Center, P.O. Box 2577, Kensington, MD 20891.
