Managing Postmenopausal Symptoms With Nonpharmacological Therapies

Certain herbal and complementary medicines may be a valuable treatment option for women with postmenopausal symptoms, according to a new review outlining the advantages and limitations of the available treatments of postmenopausal symptoms.¹
   
Symptoms commonly associated with menopause include vasomotor symptoms (hot flushes), vaginal dryness, sexual dysfunction, frequent urinary tract infections, urinary incontinence, joint pain, and sleep and mood disturbances. Vasomotor symptoms, the most common menopausal symptom, affect approximately two thirds of women who have experienced menopause and can last up to 15 years in about 20% of women, said the review author. The most effective treatment of vasomotor symptoms is hormone replacement therapy (HRT), which can improve symptoms in 80% to 90% of women.¹ However, the risks of breast cancer, blood clots, stroke, and cardiovascular disorders that have been associated with HRT use has made this treatment unpopular with many patients and physicians.

According to the review, 50% to 75% of postmenopausal women use herbal or complementary therapies to manage vasomotor symptoms, of which the most studied are soy, red clover, and black cohosh.1 Previous research has shown that soy can reduce vasomotor symptoms by 20% to 55%, and both red clover and black cohosh have been reported to lessen postmenopausal symptoms as well.¹

Because there are no significant adverse effects associated with the use of these herbal treatments, soy, red clover, and black cohosh could be recommended for use in patients with postmenopausal symptoms, advises the review author. However, they should only be recommended to women who have no history of breast cancer, are not at high risk for breast cancer, or are not taking tamoxifen.

The data on whether soy, black cohosh, and red clover are effective in the treatment of menopausal symptoms have been conflicting, however. A meta-analysis has shown that the evidence supporting widespread recommendations for using black cohosh is insufficient.² Another study found that red clover and black cohosh were no better than placebo in treating menopausal symptoms.³ A disadvantage of using herbal and complementary therapies is that these agents are not regulated by the FDA, making it possible that the amount of active ingredient could vary between samples and that the fillers could be potentially dangerous.

Despite these risks, the review author states that because so many women-up to 75%-use herbal and complementary medicines to manage their postmenopausal symptoms, it is important that physicians be informed about nonpharmacological therapies that are available for postmenopausal symptoms in women who do not want to use HRT.

Pertinent Point:
- Being knowledgeable about herbal therapies, such as soy, red clover, or black cohosh, for the management of postmenopausal symptoms is advisable, because 50% to 75% of postmenopausal women use them to manage vasomotor symptoms.
 

References:

1. Tong IL. Nonpharmacological treatment of postmenopausal symptoms. The Obstetrician and Gynaecologist. 2013;15:19-25.
2. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012;9:CD007244.
3. Geller SE, Shulman LP, van Breemen RB, et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause. 2009;16:1156-1166.