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National Institutes of Health • National Center for Complementary and Alternative Medicine

NCCAM Clinical Digest. For health professionals.

Menopausal Symptoms and Complementary Health Practices :
What the Science Says

September 2013
Two mature women smiling

Since the 2005 NIH panel’s findings, scientists are continuing to build an evidence base on complementary therapies for menopausal symptoms. Results of research suggest that some mind and body approaches may be promising for reducing menopausal symptoms, while there is little evidence that natural products have any additional beneficial effects.

Mind and Body Therapies for Menopausal Symptoms

A growing body of evidence suggests that mind and body practices such as yoga, tai chi, qi gong, hypnosis, and acupuncture may benefit women during menopause. Research is under way to explore these preliminary findings.

  • A 2010 review of 21 papers assessed mind and body therapies for menopausal symptoms. The researchers found that yoga, tai chi, and meditation-based programs may be helpful in reducing common menopausal symptoms including the frequency and intensity of hot flashes, sleep and mood disturbances, stress, and muscle and joint pain.
  • Another 2010 review assessed studies that examined the use of acupuncture for hot flashes related to natural or induced menopause. The studies that the researchers included in their review were limited to acupuncture studies performed using needles stimulated by hand or electrically. The researchers found that acupuncture may reduce the frequency and severity of hot flashes; they also concluded that the effect may occur regardless of where the acupuncture needle is placed on the body. However, some studies did not provide sufficient evidence to support the use of acupuncture for hot flashes due to their small size and poor quality. Further research is needed in order to provide more conclusive results.
  • A study funded by NCCAM found that hypnosis significantly improved various measures of hot flashes in a group of postmenopausal women. Although the mechanism of how clinical hypnosis works is unknown, the women in this same study who practiced hypnosis had significantly greater levels of satisfaction than the control group. An earlier study found that hypnosis appears to reduce perceived hot flashes in breast cancer survivors and may have additional benefits such as improved mood and sleep.

Natural Products and Menopausal Symptoms

Many natural products have been studied for their effects on menopausal symptoms, but scientists have found little evidence that they are helpful. While some herbs and botanicals are often found in over-the-counter formulas and combinations, many of these combination products have not been studied. Further, because natural products used for menopausal symptoms can have side effects and can interact with other botanicals or supplements or with medications, research in this area is addressing safety as well as efficacy. Some findings from this research are highlighted below.

Black Cohosh (Actaea racemosa, Cimicifuga racemosa)

Strength of Evidence

  • Black cohosh has received more scientific attention for its possible effects on menopausal symptoms than have other botanicals.

Research Results

  • A 2012 Cochrane systematic review on black cohosh for menopausal symptoms concludes that its efficacy has yet to be demonstrated.
  • Other research suggests that black cohosh does not act like estrogen, as once was thought.

Safety

  • United States Pharmacopeia experts suggest that women should discontinue use of black cohosh and consult a health care practitioner if they have a liver disorder or develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice.
  • There have been several case reports of hepatitis (inflammation of the liver), as well as liver failure, in women who were taking black cohosh. It is not known if black cohosh was responsible for these problems. Although these cases are very rare and the evidence is not definitive, scientists are concerned about the possible effects of black cohosh on the liver.

Soy

Strength of Evidence

There have been many studies on the effects of soy isoflavone supplements for menopausal symptoms.

Research Results

  • The scientific literature includes mixed results on soy extracts for hot flashes. Some studies find benefits, but others do not.

Safety

  • Although information on adverse effects is limited, soy extracts appear to be generally safe when taken for short periods of time. However, long-term use of soy extracts (which also contain phytoestrogens) has been associated with thickening of the lining of the uterus.

DHEA

DHEA is a naturally occurring substance that is changed in the body to the hormones estrogen and testosterone. DHEA is manufactured and sold as a dietary supplement.

Strength of Evidence

  • There have been several small studies of DHEA for menopausal symptoms.

Research Results

  • A few small studies have suggested that DHEA might possibly have some benefit for hot flashes and decreased sexual arousal, although small randomized controlled trials have shown no benefit.

Safety

  • Concerns have been raised about the safety of DHEA because it is converted in the body to hormones, which are known to carry risks. Its long-term effects, risks, and benefits have not been well studied, and it remains unclear whether it might increase the risk for breast or prostate cancer.
  • There is the possibility that even short-term use of DHEA supplements might have detrimental effects on the body.

Other Natural Products

  • Other natural products have been studied for their effects on menopausal symptoms. The 2005 NIH panel found no consistent or conclusive evidence that red clover, Asian ginseng, or kava decreases hot flashes. Very few studies of dong quai have been done, but findings from one trial demonstrated no benefit.
  • A review of the research literature of red clover also found no apparent evidence of adverse events from short-term use (up to 16 weeks). However, the same review noted the lack of data on the safety of long-term use. There are some concerns that red clover, which contains phytoestrogens, might have harmful effects on hormone-sensitive tissue.
  • Short-term use of Asian ginseng at recommended doses appears to be safe for most people; however, some sources suggest that prolonged use might cause side effects. Asian ginseng may lower levels of blood sugar; this effect may be seen more in people with diabetes. Therefore, people with diabetes should use extra caution with Asian ginseng, especially if they are using medicines to lower blood sugar or taking other herbs, such as bitter melon and fenugreek, that are also thought to lower blood sugar.
  • It is important to note that kava has been associated with liver disease. The U.S. Food and Drug Administration (FDA) has issued a warning to patients and providers about kava because of its potential to damage the liver.
  • Dong quai is known to interact with, and increase the activity in the body of, the blood-thinning medicine warfarin. This can lead to bleeding complications in women who take dong quai.

Bioidentical Hormone Replacement Therapy

“Bioidentical hormone replacement therapy,” or BHRT, is a marketing term that is not recognized by the FDA. It is a term used to describe medications that are prepared in specialized pharmacies. BHRT may contain any variation of hormones including estrone, estradiol, estriol, progesterone, and testosterone.

Compounded bioidentical hormones are often marketed as natural and safe alternatives to conventional hormone therapy prescription medications. However, compounded formulas are often inconsistent and can vary depending on the batch or the pharmacist. While FDA-approved hormone preparations have been tested for efficacy, purity, safety, and potency, there is a lack of scientific evidence surrounding BHRT and the safety and efficacy of these compounds. As a result, compounded bioidentical hormones are not approved by the FDA.

 

NCCAM Clinical Digest is a service of the National Center for Complementary and Alternative Medicine, NIH, DHHS. NCCAM Clinical Digest, a monthly e-newsletter, offers evidence-based information on CAM, including scientific literature searches, summaries of NCCAM-funded research, fact sheets for patients, and more.

The National Center for Complementary and Alternative Medicine is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCAM's Clearinghouse toll-free at 1-888-644-6226, or visit the NCCAM Web site at nccam.nih.gov. NCCAM is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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