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Am Fam Physician. 2006;74(9):1623-1624

The most common symptoms related to menopause include hot flashes, night sweats, vaginal dryness, and sleep disorders. These symptoms cause approximately 40 percent of perimenopausal or menopausal women to seek medical advice. With the recent concerns about estrogen therapy, more women are exploring alternative therapies. A significant number of adults use alternative medicine, and a high percentage do not inform their physicians about their use of dietary supplements. The National Center for Complementary and Alternative Medicine categorizes these therapies as: (1) biologically based, (2) mind-body, (3) energy, (4) manipulative and body-based, and (5) whole medical systems. Nedrow and colleagues evaluated the effectiveness of complementary and alternative therapies in the management of menopausal symptoms.

The study was a systematic review of the literature. The authors searched MEDLINE, PsychINFO, Cochrane Library, MANTIS, and AMED for articles that had used randomized placebo-controlled trials or meta-analyses evaluating complementary and alternative therapies in the treatment of menopausal symptoms. The studies were evaluated for quality by two of the authors, and only those with the highest quality and most rigorous designs were included. Common reasons for excluding a study included fewer than 20 study participants, study duration of less than 12 weeks, and not reporting group differences or ages of the participants.

Black cohosh
Cimicifuga racemosa
Dehydroepiandrosterone
Evening primrose oil (gamolenic acid)
Genistein
Guar gum
Kava
Linseed-rich diet
Melatonin
Phospholipid liposomes
Phytoestrogen (tablet and topical)
Phytoestrogen-rich diet (e.g., soy, miso, flax seed, diagzein, genistein, lignans)
Red clover
S-adenosyl-L-methionine
Soy isoflavones (flour, beverages, and powders)
Soy-rich diet
Vaginal moisturizer
Vitamin E
Wild yam cream

The authors identified 1,432 trials that were reviewed. Of those, 70 met the inclusion criteria for the study. Forty-eight of the trials were biologically based therapies, nine were mind-body therapies, one was a manipulative or body-based therapy, two were energy therapies, and 10 were for whole medical systems. The studies concerning biologic agents (see accompanying table) showed varying results. Four of the 15 trials on phytoestrogens showed a benefit, and one of the four trials on black cohosh showed a benefit. The studies concerning mind-body, energy, manipulative and body-based, and whole medical systems therapies showed little benefit in treating menopausal symptoms.

The authors conclude that even though some individual studies suggest some benefit to complementary and alternative therapies for menopausal symptoms, there are inadequate data to support the effectiveness of these therapies. They add that many of these therapies need to be evaluated with rigorous controlled trials to assess their effectiveness and safety.

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