Menopause

Research

Herbal treatments in Menopause
Complementary and alternative medicine
HRT - Hormone Replacement Therapy
Acupuncture and Menopause



Herbal treatments in Menopause


Herbal product use and menopause symptom relief in primary care patients: a MetroNet study.

Womens Health (Larchmt). 2003 Sep;12(7):633-41. Dailey RK, Neale AV, Northrup J, West P, Schwartz KL. Division of Practice-based Research, Department of Family Medicine, Wayne State University, Detroit, Michigan 48201, USA. rdailey@med.wayne.edu

OBJECTIVES:
The four study objectives were to determine (1) the prevalence of use of four herbal product types promoted to reduce menopause symptoms (phytoestrogens, St. John's wort, Ginkgo biloba, and ginseng) among primary care patients approaching or in menopause, (2) the extent to which women who use these types of herbal products report menopause-related symptoms compared with herbal product nonusers, (3) the frequency of reported symptom reduction after use, and (4) if use was disclosed to their physicians.
METHODS:
A cross-section of ethnically diverse women 40-55 years of age (35.5% African American, 60.2% Caucasian) who were recruited from eight primary care centers in Michigan to complete a self-report survey. The questionnaire included demographic items, health history, recent use of four herbal product types purported to relieve menopause symptoms and perception of symptom improvement, and interest in additional herbal product information.
RESULTS:
Of 397 women, 24.9% reported taking, in the previous 6 months, at least one of the four study herbs. Herbal product use did not vary by patient demographics or health characteristics. Herbal product users reported more menopause symptoms than nonusers, and 68% of the users said that the herbs improved their symptoms; 56.4% said that their physician was aware of their herbal product use.
CONCLUSIONS:
Primary care patients experiencing common menopausal symptoms are likely to use herbal products that are purported to provide menopause symptom relief, and many believe that these products improve their menopausal symptoms. Healthcare providers should be aware of patient's positive attitude, use patterns, and lack of disclosure of use of herbal medicines. Inquiry of herbal product use is another way for physicians to learn about patient self-medication of bothersome symptoms.

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Clinical study on relationship between memory quotient, estrogen and Chinese nourishing kidney herbs in perimenopausal women]

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2002 Jul;22(7):494-5. Clinical study on relationship between memory quotient, estrogen and Chinese nourishing kidney herbs in perimenopausal women]. Jing SY, Wei MJ. Obstetric and Gynecological Hospital of Fudan University, Shanghai 200011.

OBJECTIVE:
To explore the memory quotient and hormone level in women with perimenopausal syndrome and healthy women in perimenopausal period, and the effect of estrogen and Chinese nourishing Kidney herbs (CNKH) on memory.
METHODS:
Fifty-six women of perimenopausal syndrome were treated with estrogen (n = 24) and CNKH (n = 32) respectively. The changes of memory and estrogen level before and after treatment were determined and compared with those in healthy women.
RESULTS:
The memory quotient (MQ) and estrogen level increased and follicule-stimulating hormone (FSH) level decreased significantly after treatment in both groups (P less than 0.01), these parameters approached to those in healthy women. The difference of therapeutic effect between the two treated group was insignificant (P > 0.05).
CONCLUSION:
The decrease of memory is related to the lowering of estrogen level, CNKH could improve the brain function and enhance memory.

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The Search for Alternative Therapies for Menopausal Women: Estrogenic Effects of Herbs

Karen M. Prestwood. Center on Aging, University of Connecticut Health Center Farmington, Connecticut 06030-5215 Address all correspondence and requests for reprints to: Karen M. Prestwood, M.D., Associate Professor Medicine, Center on Aging, University of Connecticut Health Center, Farmington, Connecticut 06030-5215. E-mail: prestwood@nso1.uchc.edu. .

Approximately 1 yr ago, millions of women awoke to newspaper headlines questioning the safety of hormone replacement therapy (HRT), a treatment that many women were taking to relieve menopausal symptoms and to prevent heart disease and osteoporosis. The Women's Health Initiative (WHI) Study reported increased risk of cardiovascular disease, breast cancer, stroke, and thromboembolic disease with conjugated equine estrogen plus medroxyprogesterone acetate (HRT) compared with placebo, and that component of the study was halted (1). Meanwhile, the arm of the study examining the benefits and risks of estrogen alone vs. placebo continued and is still ongoing. Since the original report alerting us to the risks of HRT, the WHI study group has also demonstrated that quality of life (2) and cognition (3) are no better in the HRT group than the placebo group. The benefits of HRT from WHI were reduced incidence of hip fracture and colon cancer as well as relief of menopausal symptoms (1). Many previous studies demonstrated the beneficial effect of estrogen replacement therapy/HRT on bone density, but this was the first large randomized trial to confirm that HRT reduced hip fracture. Recent studies suggested that lower doses of estrogen and progesterone than used in WHI were effective in preventing bone loss and reducing hot flashes in postmenopausal women, even those in the early menopause (4, 5, 6). In older women, ultra low-dose estrogen (one fourth of the usual dose) reduced bone resorption to the same degree as usual dose estrogen in a short-term study (7). The ultra low-dose (0.25 mg/d) estrogen also increased bone mineral density and decreased bone turnover in older women over 3 yr with few adverse events (8). Overall, these data suggest that lowering the dose of estrogen and progesterone may reduce menopausal symptoms and enhance bone health without increasing adverse effects as seen in WHI.

Given the positive effects of lower dose estrogen, it is plausible and logical to look for substances that have less affinity for the estrogen receptor than estradiol in the hope of identifying herbs or nutritional supplements that reduce menopausal symptoms and, perhaps, benefit bone without the adverse effects associated with HRT. The study published by Oerter Klein et al. (9) in this issue of JCEM describes a technique to examine the bioactivity of estrogen in various herbs known to have some effect on menopausal symptoms. The assay was developed originally to assess low levels of estradiol in children and postmenopausal women and was modified for this study. The assay provides information related to estradiol equivalents per microgram of herb and so allows the reader to directly compare estrogenic activity of different herbs. Some interesting findings came from the study: fo-ti, a Chinese herb, has similar estrogenic activity as soy (1/300 the potency of estradiol); and the aglycone form of soy had an even higher estrogen activity than soy. The estrogenic activity of soy, red clover, and licorice has been reported previously and is confirmed in this study. Black cohosh, chaste berry, and dong quai, herbs that have been used for menopausal symptoms, did not have any estrogenic activity by this assay or in previous studies (10, 11, 12, 13). Clinical studies on the effectiveness of black cohosh and soy to reduce menopausal symptoms have been mostly positive, whereas studies of red clover and don quai have been negative (14, 15, 16). Soy and black cohosh can be recommended to postmenopausal women to ameliorate menopausal symptoms (14, 17), however, the long-term risks and benefits of these agents in postmenopausal women are not yet known. Furthermore, data regarding the effect of soy on breast health are conflicting, with most studies demonstrating an antiestrogenic effect and some studies an estrogenic effect (18, 19). Longer term studies are currently under way to examine the benefits of soy and black cohosh in postmenopausal women.

Fo-ti, also known as He Shou Wu, is a Chinese herbal medicine used as a secondary adaptogen. It is used in combination with other herbs to treat symptoms of chronic disease such as general weakness, poor appetite, fatigue, and weight loss; it is also used to darken hair color. Chinese herbs are typically administered in combination to maximize benefit and to minimize adverse effects; the herbs balance the human system and each other. To date, there have not been any reports of fo-ti being used for the alleviation of menopausal symptoms or prevention of osteoporosis. In traditional Chinese medicine (TCM), the kidneys are believed to be the foundation of life. As such, the right kidney (energetically Yang) provides the spark to the organs to do their jobs effectively and the Yin kidney provides fluids necessary to cool the body and provide lubrication to joints as well as promote vaginal fluids, intestinal fluids, and stomach fluids. Menopausal symptoms, from the TCM point of view, are often related to a kidney Yin deficiency. One of the TCM uses of fo-ti is to tonify (or strengthen) the kidney, thus building Yin (20). From a TCM standpoint, then, this herb may be of benefit to postmenopausal women. Thus, potential mechanisms of action related to the use of fo-ti in postmenopausal women exist in both TCM and Western medical systems.

With the new information reported in this issue of JCEM, relating to the estrogenic activity of fo-ti, clinical studies will likely be initiated to examine its role in postmenopausal women. However, because fo-ti has been traditionally used in combination with other herbs, it is unclear whether its use as a single agent will be beneficial or whether any potential side effects will become more prominent. In the case of fo-ti, those side effects are diarrhea and digestive problems. As we begin to screen and test herbs for potential estrogenic effects, it seems prudent to look at the traditional uses of herbs in China and other cultures and to take advantage of thousands of years of experience with herbs. By integrating ancient knowledge with modern technology, we may find several options to reduce the effects of estrogen deficiency on postmenopausal women. The study by Oerter Klein et al. (9) is one method of assessing estrogenic activity of herbs and has provided new information about fo-ti. Further research is required to fully elucidate the benefits and risks of fo-ti used as a single agent or in combination with other herbs in postmenopausal women.

References
1. Writing Group for the Women's Health Initiative Investigators 2002 Risk and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA 288:321-333[Abstract/Free Full Text]
2. Hays J, Ockene JK, Brunner RL, Kotchen JM, Manson JE, Patterson RE, Aragaki AK, Shumaker SA, Brzyski RG, LaCroix AZ, Granek IA, Valanis BG, Women's Health Initiative Investigators 2003 Effects of estrogen plus progestin on health-related quality of life. N Engl J Med 348:1839-1854[Abstract/Free Full Text]
3. Shumaker SA, Legault C, Thal L, Wallace RB, Ockene JK, Hendrix SL, Jones 3rd BN, Assaf AR, Jackson RD, Kotchen JM, Wassertheil-Smoller S, Wactawski-Wende J, WHIMS Investigators 2003 Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women. JAMA 289:2651-2662[Abstract/Free Full Text]
4. Lindsay R, Gallagher JC, Kleerekoper M, Pickar JH 2002 Effects of lower doses of conjugated equine estrogens with and without medroxyprogesterone acetate on bone in early postmenopausal women. JAMA 287:2668-2676[Abstract/Free Full Text]
5. Recker RR, Davies KM, Dowd RM, Heaney R 1999 The effect of low dose continuous estrogen and progesterone therapy with calcium and vitamin D on bone in elderly women: a randomized controlled trial. Ann Intern Med 130:897-904[Abstract/Free Full Text]
6. Utian WH, Shoupe D, Bachmann G, Pinkerton JV, Pickar JH 2001 Relief of vasomotor symptoms and vaginal atrophy with lower doses of conjugated equine estrogens and medroxyprogesterone acetate. Fertil Steril 75:1065-1075[CrossRef][Medline]
7. Prestwood KM, Kenny AM, Unson C, Kulldorff M 2000 The effect of low dose micronized 17ß-estradiol on bone turnover, sex hormones and side effects in older women: a randomized, double-blind placebo-controlled study. J Clin Endocrinol Metab 85:4462-4469[Abstract/Free Full Text]
8. Prestwood KM, Kenny AM, Kleppinger A, Kulldorff M 2003 Ultra low-dose micronized 17ß-estradiol and bone density and bone metabolism. JAMA 290:1042-1048[Abstract/Free Full Text]
9. Klein KO, Janfaza M, Wong JA, Chang RJ 2003 Estrogen bioactivity in fo-ti and other herbs used for their estrogen-like effects as determined by a recombinant cell bioassay. J Clin Endocrinol Metab 88: 4077-4079
10. Liu J, Burdette JE, Xu H, Gu C, van Breemen RB, Bhat KP, Booth N, Constantinou AI, Pezzuto JM, Fong HH, Farnsworth NR, Bolton JL 2001 Evaluation of estrogenic activity of plant extracts for the potential treatments of menopausal symptoms. J Agric Food Chem 49:2472-2479[CrossRef][Medline]
11. Tham DM, Gardner CD, Haskell WL 1998 Potential health benefits of dietary phytoestrogens: a review of the clinical, epidemiological, and mechanistic evidence. J Clin Endocrinol Metab 83:2223-2235[Abstract/Free Full Text]
12. Kuiper GG, Lemmen JG, Carlsson B, Corton JC, Safe SH, Van der Saag PT, Van der Burg B, Gustafsson J 1998 Interaction of estrogenic chemicals and phytoestrogens with estrogen receptor ß. Endocrinology 139:4252-4263[Abstract/Free Full Text]
13. Zierau O, Bodinet C, Kolba S, Wulf M, Vollmer G 2002 Antiestrogenic activities of Cimicifuga racemosa extracts. J Steroid Biochem Mol Biol 8-:125-130
14. Kronenberg F, Fugh-Berman A 2002 Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Int Med 137:805-813[Abstract/Free Full Text]
15. Tice JA, Ettinger B, Ensrud K, Wallace R, Blackwell T, Cummings SR 2003 Phytoestrogen supplements for the treatment of hot flashes: the Isoflavone Clover Extract (ICE) study. JAMA 290:207-214[Abstract/Free Full Text]
16. Burke GL, Legault C, Anthony M, Bland DR, Morgan TM, Naughton MJ, Leggett K, Washburn SA, Vitolins MZ 2003 Soy protein and isoflavone effects on vasomotor symptoms in peri- and post menopausal women: the Soy Estrogen Alternative Study. Menopause 10:147-153[Medline]
17. Dog TL, Powell KL, Weisman SM 2003 Critical evaluation of the safety of Cimicifuga racemosa in menopause symptom relief. Menopause 10:299-313[Medline]
18. Peeters PHM, Keinan-Boker L, van der Schouw YT, Grobbee DE 2003 Phytoestrogens and breast cancer risk. Breast Cancer Res Treat 77:171-183[CrossRef][Medline]
19. Aldercreutz H 2003 Phytoestrogens and breast cancer. J Steroid Biochem Mol Biol 83:113-118[CrossRef]
20. Molony D, Molony MMP 1998 Complete guide to Chinese herbal medicine: how to treat illness and maintain wellness with Chinese herbs. New York: Berkley Books; 40, 60-61, 150-151
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Complementary and alternative medicine


Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials.

Kronenberg F, Fugh-Berman A. Rosenthal Center for Complementary and Alternative Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, Box 75, New York, NY 10032, USA.

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.
CONLUSONS:
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.

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HRT - Hormone Replacement Therapy


Postmenopausal hormone replacement: historical perspectives and current concerns.

White JP, Schilling JS. Family Nurse Practitioner Graduate Program, Slippery Rock University of Pennsylvania, USA.

Despite continuing evidence of its value, hormone replacement (HR) therapy is used by only a minority of postmenopausal women. Some of this reluctance may stem from concerns about the medicalization of menopause and the labeling of menopause as a state of failure or disease that needs to be treated. These concerns are understandable given the impact of previous efforts to apply erroneous biological models to women's physiology, often to their detriment. Some may assert that current attempts to describe menopause as a state of estrogen deficiency are as wrong as previous explanations that the backing up of menstrual blood required purging and bleeding. However, there is an abundance of research attesting to the value of HR in decreasing such menopausal symptoms as hot flashes and insomnia and in preventing chronic problems, including urogenital atrophy and osteoporosis. In addition, recent research suggests that estrogen may have positive effects on cognition. Questions about HR and breast cancer remain, and several studies have found a small increase in breast cancer among long-term estrogen users. The recent introduction of selective estrogen response modifiers may further increase the safety of HR therapy. Many women worried about breast cancer and other possible estrogenic effects of HR are seeking approaches they consider more natural to managing menopause, turning to such untested remedies as soy supplements and herbs. While awaiting rigorous trials, clinicians can help patients understand the consequences of relying on therapies that have unknown long-term safety and effectiveness.

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Acupuncture


A comparison of acupuncture and oral estradiol treatment of vasomotor symptoms in postmenopausal women.

Wyon Y, Wijma K, Nedstrand E, Hammar M. Faculty of Health Sciences, University Hospital, Linkoping, Sweden.

OBJECTIVE:
To compare the effects of electro-acupuncture with oral estradiol and superficial needle insertion on hot flushes in postmenopausal women. MATERIAL AND METHODS: Forty-five postmenopausal women with vasomotor symptoms were randomized to electro-acupuncture, superficial needle insertion or oral estradiol treatment during 12 weeks, with 6 months' follow-up. The number and severity of flushes were registered daily and the Kupperman index and a general estimate of climacteric symptoms were completed before, during and after therapy. RESULTS: In the electro-acupuncture group, the mean number of flushes/24 h decreased from 7.3 to 3.5 (ANOVA, p < 0.001). Eleven of the 15 women had at least a 50% decrease in number of flushes (with a mean decrease of 82%). Superficial needle insertion decreased the number of flushes/24 h from 8.1 to 3.8 (p < 0.001). In seven out of 13 women, the number of flushes decreased by at least 50% (mean decrease 83%). In the estrogen group, the number of flushes decreased from 8.4 to 0.8 (p < 0.001). The decrease in number of flushes persisted during the 24-week follow-up period in all treatment groups. The Kupperman index and the general climacteric symptom score decreased, and remained unchanged 24 weeks after treatment in all groups (p < 0.001). Electro-acupuncture decreased the number of flushes/24 h significantly over time, but not to the same extent as the estrogen treatment. No significant difference in effect was found between electro-acupuncture and the superficial needle insertion. CONCLUSION: We suggest that acupuncture is a viable alternative treatment of vasomotor symptoms in postmenopausal women and cannot recommend superficial needle insertion as an inactive control treatment.

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Can acupuncture ease the symptoms of menopause?

Cohen SM, Rousseau ME, Carey BL. University of Pittsburgh, 440 Victoria Bldg, 3500 Victoria St, Pittsburgh, PA 15261, USA. cohensu@pitt.edu

In a randomized, 2-group clinical study, acupuncture was used for the relief of menopausal hot flushes, sleep disturbances, and mood changes. The experimental acupuncture treatment consisted of specific acupuncture body points related to menopausal symptoms. The comparison acupuncture treatment consisted of a treatment designated as a general tonic specifically designed to benefit the flow of Ch'i (energy). Results from the experimental acupuncture treatment group showed a decrease in mean monthly hot flush severity for site-specific acupuncture. The comparison acupuncture treatment group had no significant change in severity from baseline over the treatment phase. Sleep disturbances in the experimental acupuncture treatment group declined over the study. Mood changes in both the experimental acupuncture treatment group and the comparison acupuncture treatment group showed a significant difference between the baseline and the third month of the study. Acupuncture using menopausal-specific sites holds promise for nonhormonal relief of hot flushes and sleep disturbances.

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_______________________________________

The information on this website is compiled and written by;
Raeghan Siemens, R.Ac., DTCM
Raeghan Siemens has always had an interest in medicine;
but she found her true passion in Traditional Chinese Medicine & Acupuncture.
Her special interests are treating Menopause and Pregnancy related issues.

Raeghan practices at Acubalance Wellness Centre Ltd. in Vancouver BC Canada.

_______________________________________


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