Other Treatments for Menopause

Some women decide not to take hormone therapy (HT) or estrogen replacement therapy (ERT) to relieve the symptoms of menopause, and turn to herbal products or to certain estrogen-like chemicals in plants (called phytoestrogens) for help. There are many over-the-counter and herbal products that claim to help women with menopausal symptoms, but there is limited, and sometimes conflicting, research on the safety and success of them. Discuss herbal products with your HCP before taking them. You also should tell your provider if you are taking any other medicines, since some of the herbal products can have harmful interactions with other drugs.

The American College of Obstetricians and Gynecologists (ACOG) issued these guidelines on the most popular herbal products for menopause:

• Soy and isoflavones (plant estrogens found in beans, particularly soybeans). High isoflavone intake (about 50 grams of soy protein per day) may be helpful in the short-term (2 years or less) to relieve hot flashes and night sweats. However, results from one recent study released in July 2003 found that isoflavone supplements (pills) made from red clover did not help women with hot flashes or other menopause symptoms. Another study of breast cancer survivors found that taking soy products did not help their hot flashes. But, taken over a long time, soy and isoflavones may have good effects on cholesterol and bones. Results from other recent studies show that, while eating foods with soy can be safe, taking very large amounts of soy and isoflavone supplements may be harmful to women who have had a type of breast cancer called estrogen-dependent breast cancer, and may be harmful to other women as well. These results leave open the question of whether soy products may protect women against breast cancer or add to its cause.

• St. John's wort. May be helpful in the short-term (2 years or less) to treat mild to moderate depression in women (when given in doses of less than 1.2 milligrams a day). A recent study showed it does not help severe depression. It also can increase skin sensitivity to the sun and may interfere with prescription antidepressants.

• Black cohosh. May be helpful in the short-term (6 months or less) to treat hot flashes and night sweats. It seems to be safe, but studies have been small and brief, with none longer than six months.

• Chasteberry (also known as monk's pepper, Indian spice, sage tree hemp, and tree wild pepper). There are very few studies on the use of this in menopausal women. A study of women with premenstrual syndrome (PMS) who used it found it helped them with symptoms such as anger, headache, and breast fullness, but not bloating and other symptoms.

• Evening primrose. Although some women take evening primrose for breast pain, bladder symptoms, and menopausal symptoms, there is little or no proof that it works. One study on hot flashes found that taking evening primrose was no better than taking placebo (a sugar pill).

• Dong quai. A study that looked at dong quai's effect on hot flashes found that it was no better than placebo (sugar pill) -although the 4.5-gram dose used in the study was lower than that typically given in Chinese medicine. This herb can be toxic (poison) because it contains compounds that can thin the blood, causing excessive bleeding. It also can make the skin more sensitive to sun and increase your risk of skin cancer.

• Valerian root. This has traditionally been used as a sleeping aid. But the U.S. Pharmacopoeia, which sets manufacturing standards for medicines, does not support its use. There also have been reports of heart problems and delirium (severe confusion) linked to suddenly stopping its use.

• Ginseng. Most of the labels on ginseng products (including Siberian, Korean, and American, white and red) say they relieve stress and boost immunity (the body's response to fight illness). A study of menopausal women by the leading maker of ginseng found the product did not relieve hot flashes, but did improve women's sense of well-being. But, there have been many reports of problems with ginseng products. For instance, some ginseng products had little or no ginseng in them. Others contained large amounts of caffeine. Some products even contained pesticides or lead.

• Wild and Mexican yam. There are no published reports that show wild and Mexican yam cream helps menopausal symptoms.