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Alternative medicine

By Mayo Clinic staff

In addition to conventional therapies, many women transitioning toward menopause want to know more about complementary and alternative approaches to treating symptoms. Researchers are looking into these therapies to determine their safety and effectiveness, but evidence is still often lacking.

Some of the options studied include:

  • Black cohosh. This herb extract is used by some women to treat hot flashes and other menopausal symptoms. A recent in-depth review of studies found there was not enough evidence to support its use. Black cohosh can be harmful to the liver, and it may not be safe for women with or at risk of breast cancer.
  • Phytoestrogens. These estrogens occur naturally in certain foods. There are two main types of phytoestrogens — isoflavones and lignans. Isoflavones are found in soybeans, chickpeas and other legumes. Lignans occur in flaxseed, whole grains, and some fruits and vegetables. There are also plant-derived compounds that have estrogen-like properties. Isoflavone supplements generally come from soy or red clover. Lignans come mainly from flaxseed. Studies on phytoestrogens — whether from food or supplements — conflict on whether they help reduce menopausal symptoms. Studies also conflict on whether it's possible that phytoestrogens could increase the risk of breast cancer or interfere with the effectiveness of tamoxifen.
  • Bioidentical hormones. The term "bioidentical" implies the hormones in the product are chemically identical to those your body produces. However, compounded bioidentical hormones are not regulated by the Food and Drug Administration (FDA), so quality and risks could vary. But there are many FDA-approved bioidentical formulations available in a variety of strengths at the pharmacy — talk with your provider to see if any of these may be a good option for you.
  • Dehydroepiandrosterone (DHEA). This is a natural steroid produced by your adrenal gland that can be purchased as a dietary supplement. Recent research has found no evidence to support its use, and there are some concerns about possible harmful effects.

Low-risk complementary therapies, such as acupuncture, yoga and paced breathing may help reduce stress and improve psychological well-being. However, research on the ability of acupuncture and exercise to decrease hot flashes is inconclusive. There is evidence that relaxation helps reduce stress, which may in turn help improve symptoms of hot flashes.

Talk with your doctor before taking any herbal or dietary supplements for perimenopausal or menopausal symptoms. The FDA does not regulate herbal products, and some can be dangerous or interact with other medications you take, putting your health at risk.

References
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  2. Casper RF. Clinical manifestations and diagnosis of menopause. http://www.uptodate.com/home. Accessed March 10, 2013.
  3. Melmed S, et al. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/191205553-3/0/1555/0.html#. Accessed March 10, 2013.
  4. AskMayoExpert. What are the US Food and Drug Administration (FDA)-approved clinical indications for menopausal hormone therapy (HT) prescribing? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
  5. Menopause and menopause treatments. Office on Women's Health. http://www.womenshealth.gov. Accessed March 8, 2013.
  6. Harlow SD, et al. Executive Summary of the Stages of Reproductive Aging Workshop + 10: Addressing the Unfinished Agenda of Staging Reproductive Aging. Journal of Clinical Endocrinology and Metabolism. 2012;97:1159.
  7. Casper RF, et al. Menopausal hot flashes. http://www.uptodate.com/home. Accessed March 10, 2013.
  8. Sood R, et al. Paced breathing compared with usual breathing for hot flashes. Menopause. 2013;20:179.
  9. Welt CK. Ovarian development and failure (menopause) in normal women. http://www.uptodate.com/home. Accessed March 11, 2013.
  10. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 128. Diagnosis of Abnormal Uterine Bleeding: in Reproductive-Aged Women. Clinical Management Guidelines. Obstetrics and Gynecology. 2012;120;197.
  11. Goodman AK. Initial approach to the premenopausal woman with abnormal uterine bleeding. http://www.uptodate.com/home. Accessed March 4, 2013.
  12. Bedell S, et al. The pros and cons of plant estrogens for menopause. Journal of Steroid Biochemistry and Molecular Biology. In press. Accessed April 7, 2013.
  13. MenoNote: Vaginal dryness. The North American Menopause Society. http://www.menopause.org/docs/for-women/mndryness.pdf. Accessed April 4, 2013.
  14. Zacur HA. Managing an episode of severe or prolonged uterine bleeding. http://www.uptodate.com/home. Accessed March 4, 2013.
  15. 15. Lo JC, et al. Bone and the perimenopause. Obstetrics & Gynecology Clinics of North America. 2011;38:503.
  16. 16. Leach MJ, et al. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007244.pub2/abstract. Accessed March 11, 2013.
  17. Lentz GM, et al. Comprehensive Gynecology. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/linkTo?type=bookPage&isbn=978-0-323-06986-1&eid=4-u1.0-B978-0-323-06986-1..C2009-0-48752-X--TOP. Accessed March 10, 2013.
  18. Fisher TE, et al. Lifestyle alterations for the amelioration of hot flashes. Maturitas. 2012;71:217.
  19. Kang HS, et al. The use of acupuncture for managing gynaecologic conditions: An overview of systematic reviews. Maturitas. 2011;68:346.
  20. Rosen HN, et al. Overview of the management of osteoporosis in postmenopausal women. http://www.uptodate.com/home. Accessed March 11, 2013.
  21. 21. Metzger ML, et al. Female reproductive health after childhood, adolescent and young adult cancers: Guidelines for the assessment and management of female reproductive complications. Journal of Clinical Oncology. 2013;31:1239.
  22. Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Dec. 6, 2012.
  23. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and the American Society for Reproductive Medicine Practice Committee. Committee Opinion No. 532: Compounded bioidentical menopausal hormone therapy. Obstetrics & Gynecology. 2012;120:411.
DS00554 April 20, 2013

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