“I am hot, irritable and feeling low; what alternatives do i have besides hormone replacement therapy?”
Women at the end of their reproductive age often complain of climacteric symptoms which can be quite debilitating at times. Physiological changes due to deficient oestrogen have received global attention in the search for an acceptable and safe measure to improve quality of life for women with these complaints. Hormone replacement therapy (HRT) used to be the main treatment for menopausal symptoms. Lately there are concerns about its possible adverse effects of increasing risks of breast malignancy, heart diseases, etc. Complementary Alternative Medicine (CAM) plays a significant role in relieving these climacteric symptoms especially in women with contraindications to hormonal therapy and in those who are worried of its adverse effects. It is important for women to be aware of these CAM to provide them with options to improve their quality of life. This paper explores other pharmacological and non-pharmacological measures as alternatives to hormone replacement therapy (HRT), to assess how useful and reliable they are according to available scientific evidence.
Kronenberg F. Hot flashes: epidemiology and physiology. Ann N Y Acad Sci. 1990;592:52-86.
Sturdee DW, Wilson KA, Pipili E, et al. Physiological aspects of menopausal hot flush. Br Med J. 1978;2(6130):79-80.
Shanafelt TD, Barton DL, Adjei AA, et al. Pathophysiology and treatment of hot flashes. Mayo Clin Proc. 2002; 77(11):1207-18.
Stearns V, Ullmer L, Lopez JF, et al. Hot flushes. Lancet. 2002;360(9348):1851-61.
Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002; 288(3):321-33.
Cardini F, Lesi G, Lombardo F, et al. The use of Complementary and Alternative Medicine by women experiencing menopausal symptoms in Bologna. BMC Women’s Health. 2010;10:7.
MacLennan A, Lester S, Moore V. Oral oestrogen replacement therapy versus placebo for hot flushes. Cochrane Database Syst Rev. 2002;(1):CD002978.
Writing Group for the Consensus Panel. Advice to medical practitioners regarding the use of postmenopausal hormone therapy. Royal Australian and New Zealand College of Obstetricians and Gynaecologist; 2004. http://www.ranzcog.edu.au/media/pdfs/HTAdviceStatement12th%20Aug.pdf (accessed 15 Feb 2010).
Bachmann GA. The clinical platform for the 17beta-estradiol vaginal releasing ring. Am J Obstet Gynecol. 1998;178(5): S257-60.
Cardozo L, Bachmann G, McClish D, et al. Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol. 1998;92(4 Pt 2):722-7.
Banks E, Reeves G, Beral V, et al. Impact of use of hormone replacement therapy on false positive recall in the NHS breast screening programme: results from the Million Women Study. BMJ. 2004;328(7451):1291-2. [
Andrews H, Christie B, Colledge N. Consensus statement. J R Coll Physicians Edinb. 2004;34(suppl 13):2-3.
Cummings SR, Black DM, Rubin SM. Lifetime risks of hip, Colles’, or vertebral fracture and coronary heart disease among white postmenopausal women. Arch Intern Med. 1989;149(11):2445-8.
Naftolin F, Schneider HP, Sturdee DW, et al. Guidelines for the hormone treatment of women in the menopausal transition and beyond. Climacteric. 2004;7(1):8-11.
LeBlanc ES, Janowsky J, Chan BK, et al. Hormone replacement theraphy and cognition: systematic review and meta-analysis. JAMA. 2001;285(11):1489-99.
Shumaker SA, Legault C, Kuller L, et al. Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women’s Health Initiative Memory Study. JAMA. 2004;291(24):2947-58.
Zaborowska E, Brynhildsen J, Damberg S, et al. Effects of acupuncture, applied relaxation, estrogens and placebo on hot flushes in postmenopausal women: an analysis of two prospective, parallel, randomized studies. Climacteric. 2007;10(1):38-45.
Irvin JH, Domar AD, Clark C, et al. The effects of relaxation response training on menopausal symptoms. J Psychosom Obstet Gynaecol. 1996;17(4):202-7.
Borrelli F, Ernst E. Alternative and complementary therapies for the menopause. Maturitas. 2010;66(4):333-43.
David A, Don R, Tajchner G, et al. Veralipride: alternative antidopaminergic treatment for menopausal symptoms. Am J Obstet Gynecol. 1988;158(5):1107-15.
Goldberg RM, Loprinzi CL, O’Fallon JR., et al. Transdermal clonidine for ameliorating tamoxifen-induced hot flashes. J Clin Oncol. 1994;12(1):155-8.
Evans ML, Pritts E, Vittinghoff E, et al. Management of postmenopausal hot flushes with venlafaxine hydrochloride: a randomized, controlled trial. Obstet Gynecol. 2005;105(1):161-6.
Stearns V, Beebe KL, Iyengar M, et al. Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial. JAMA. 2003;289(21):2827-34.
Secreto G, Chiechi LM, Amadori A, et al. Soy isoflavones and melatonin for the relief of climacteric symptoms: a multicenter, double-blind, randomized study. Maturitas. 2004;47(1):11-20.
Jacobson JS, Troxel AB, Evans J, et al. Ran-domized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol. 2001;19(10):2739-45.
Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med. 2002;137(10):805-13.
Kruse SO, Lohning A, Pauli GF, et al. Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Planta Med.1999;65(8):763-4.
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin no. 28. Clinical Management Guidelines for Obstetrician-Gynecologists. Use of botanicals for management of menopausal symptoms. Obstet Gynecol. 2001;97(6):suppl 1-11.
Carroll DG. Nonhormonal therapies for hot flashes in menopause. Am Family Physician. 2006;73(3):457-64.
Adlercreutz H, Hamalainen E, Gorbach S, et al. Dietary phytooestrogens and the menopause in Japan. Lancet.1992;339(8803):1233.
Wiklund IK, Mattsson LA, Lindgren R, et al. Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a doubleblind, placebo-controlled trial. Swedish Alternative Medicine Group. Int J Clin Pharmacol Res. 1999;19(3):89-99.
Lunny CA, Fraser SN. The use of complementary and alternative medicines among a sample of Canadian menopausal-aged women. J Midwifery Womens Health. 2010;55(4):335-43.