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Evid Based Nurs 10:14 doi:10.1136/ebn.10.1.14
  • Treatment

Review: sparse good quality evidence supports the use of alternative therapies for menopausal symptoms


 
 Q Are complementary and alternative therapies effective for menopausal symptoms?

METHODS

GraphicData sources:

Medline, PsycINFO, Cochrane Library (to March 2005), AMED, MANTIS, reference lists, experts, and websites.

GraphicStudy selection and assessment:

randomised, placebo controlled trials and meta-analyses that evaluated alternative therapies (categorised by the National Center for Complementary and Alternative Medicine) in perimenopausal and postmenopausal women (including those with breast cancer). 70 randomised controlled trials (RCTs) met the selection criteria: 48 assessed biologically based therapies (including 31 of phytoestrogens), 9 assessed mind-body therapies, 1 assessed manipulative therapy, 2 assessed energy therapies, and 10 assessed whole medical systems. Methodological quality of most RCTs was fair or poor.

GraphicOutcomes:

improvement in menopausal symptoms (eg, hot flashes, sleep disturbance, vaginal dryness, urinary frequency or incontinence, depression, anxiety, and sexual dysfunction), quality of life, and cognitive function.

MAIN RESULTS

A few RCTs showed more improvement with treatment than with placebo for hot flashes, other menopausal symptoms, and cognitive functioning (table), but the evidence was inconsistent.

CONCLUSION

There is insufficient good quality evidence to support the use of complementary and alternative therapies for menopausal symptoms.

Commentary

  1. M Kay Libbus, RN, DrPH
  1. Sinclair School of Nursing, University of Missouri, Columbia
 Missouri, USA

      Treatment of menopause as a medical disorder rather than a normal life passage, coupled with the unfortunate effects of many prescription drugs, has led to the popularity of certain plant substances and other untested interventions that purport to relieve menopausal symptoms. The review by Nedrow et al not only examined the usual phytoestrogens but also evaluated other alternative therapies. It showed that, although some positive results have been reported, there is not yet sufficient good quality, consistent evidence to support recommending these therapies to postmenopausal women. In addition, it should be noted that “natural” therapies are not without risk of toxicities, drug interactions, possible carcinogenic effects, and other unknown adverse effects, an important issue addressed only briefly in the review.

      The fair-to-poor quality of the studies included in the review is representative of a perhaps unreasonable push by the healthcare community, and a growing population of ageing women and their significant others, to find quick and easy solutions to inevitable, but negatively viewed, changes. Healthcare providers should not recommend these alternative therapies to patients before researchers have had time to evaluate them in rigorous trials; this will avoid the widespread use of ineffective or possibly harmful treatments. Future research must focus on the safety of alternate therapies, as well as their efficacy.

      Perhaps a more holistic and realistic response to the menopause “question” is for healthcare providers to talk to women, understand their concerns and attitudes, give them honest information and advice about available options and risk-benefit ratios, and tailor therapies for serious or seemingly intolerable symptoms using the safest options available.1

      References

      Complementary or alternative therapies v placebo for menopausal symptoms

      
 
 Q Are complementary and alternative therapies effective for menopausal symptoms?

      Footnotes

      • For correspondence: Dr A Nedrow, Oregon Health and Science University, Portland, OR, USA. nedrowa{at}ohsu.edu

      • Sources of funding: National Institutes of Health and Portland Veterans Affairs Medical Center Women’s Health Fellowship.

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