For many years, hormone replacement therapy (HRT) was conventional medicine's primary treatment for menopausal symptoms. But in 2002, a large clinical trial called the Women's Health Initiative raised significant concern about the safety of hormone therapy for menopause. Although doctors had for many years recommended that women take hormones to alleviate symptoms such as hot flashes, the findings suggested that a specific type of HRT may actually raise the risk for heart disease and breast cancer.

Since then, many women have turned to alternative or complementary treatments for the hot flashes, night sweats, sleep problems, vaginal dryness, urinary incontinence, and mood swings that may come with menopause. Although there is little or no medical data to back up the claims that supplements like dehydroepiandrosterone (DHEA) or botanicals like soy actually work, there is still a huge market for them.

The U.S. National Institutes of Health (NIH) have noted that alternative and complementary therapies for menopausal symptoms are popular despite the scarcity of sound research on their effectiveness. The few published studies in this area were undependable, NIH scientists say, either because the products tested weren't chemically similar or because the studies were not carried out over a sufficient time period. Therefore, the findings do not support any particular conclusions. The Institutes' National Center for Complementary and Alternative Medicine is currently sponsoring more reliable studies on promising complementary and alternative medicine (CAM) for menopausal symptoms. These studies address safety as well as effectiveness.

Some of the supplements and plant extracts women have taken to ease menopausal symptoms include:

Black cohosh. This botanical sold as a dietary supplement in the United States has been the subject of studies attempting to evaluate its effectiveness at reducing hot flashes, with mixed results. But taken at the recommended dosages, it has had a good safety record over time.

Dong quai. The only randomized study of this botanical found that it was not useful in reducing hot flashes. It interacts with and increases the effect of the anticoagulant drug warfarin.

Ginseng. At the 2005 NIH conference on the management of menopausal symptoms, a panel found that ginseng was not effective for hot flashes but may increase a sense of well-being and help with sleep problems and mood swings.

Kava. Although it may decrease anxiety, the NIH panel found no evidence that kava helps with hot flashes. Kava has also been associated with liver disease.

Red clover. Studies have failed to find conclusive evidence that red clover reduces hot flashes, but few side effects and no serious health problems were reported. It does, however, contain phytoestrogens, estrogen-like compounds that might cause harm to hormone-sensitive tissues in areas such as the breast and uterus.

Soy. This too contains phytoestrogens. Studies have found conflicting results between soy and hot flashes. Doctors caution that soy, which contains isoflavones, may be harmful to women who have had or are at risk for breast cancer. Some experts think isoflavones may stimulate estrogen receptor-positive breast cancer and interfere with the breast cancer drug tamoxifen.

DHEA. Dehydroepiandrosterone is a dietary supplement. It is also a naturally occurring substance in the body that is converted to the hormones estrogen and progesterone. While some studies have suggested it can help treat hot flashes and waning sexual arousal, others have shown no benefit. Concerns have been raised about its safety and effectiveness, and long-term benefits of DHEA have not been well studied. Scientists are unsure whether it might increase the risk for breast cancer.

There has been recent interest in using plant-derived progesterone creams as an alternative to conventional hormone therapy. However, scientists have not yet determined what their exact benefits might be.

The authors of a 1999 study to assess the effectiveness of progesterone cream concluded that it did seem to help relieve hot flashes, but did not aid in preventing bone loss. Ninety women completed the year-long study, during which they regularly massaged cream into their arms, breasts, and thighs.

However, a 2002 review of this and other CAM studies suggested that the progesterone dosage used in the 1999 experiment and insufficient study length may have been partly responsible for the absence of a measurable preventive effect on bone loss.

Subsequent research has raised questions about the safety of creams containing natural progesterone because they may expose women to higher levels of the hormone than was commonly thought.

Acupuncture involves stimulating points on the body with thin metal needles. It has been practiced in Asia for thousands of years to relieve pain and treat a variety of conditions.

Researchers have conducted a few pilot trials suggesting that acupuncture may modestly alleviate hot flashes. But a 2007 study of medical vs. sham acupuncture by researchers at the Mayo Clinic College of Medicine found that one was no more effective than the other.

Several small studies have suggested that yoga may provide some relief to women going through menopause. One intriguing study used skin conductors to measure whether yoga affected the frequency and intensity of hot flashes the women experienced, and at the same time the women kept diaries of their symptoms. The women reported far fewer hot flashes than recorded by the skin conductors. Researchers suggested that the women may have not noticed all of their hot flashes, or perhaps they were less bothered by them.

If there wasn't a clear, documented reduction in the frequency of hot flashes, the same small study suggested that women who were practicing yoga noticed that they were better able to get a good night's sleep than before they began the yoga program.

Some women who use CAM to ease menopausal symptoms may find relief, despite the lack of scientific evidence for the effectiveness of many of these therapies. However, there may be some risks involved with certain dietary supplements. The amount of herb in the product, as well as its quality and purity may vary from brand to brand and even among batches of the same brand of herbs.

Remember that even "natural" substances can interact with other drugs or cause harm, so it's important to tell your health care providers about any complementary and alternative drugs and practices you are using.

-- Susan Murphy is an award-winning journalist and former staff writer for The Phoenix Gazette and The Press-Enterprise in Riverside, California. She has worked as a medical/clinical content editor for companies providing patient education and has won two National Health Information awards.

References

First published December 3, 2008
Copyright © 2008 Consumer Health Interactive

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