| Supplements & Herbs for Menopause |
Menopause is a natural process for women as they age.
Menopause can also occur as a result of certain medical
treatments that affect a woman's ovaries (see Question 1).
Many women and their health care providers have become
interested in complementary and alternative medicine (CAM) for
menopausal symptoms. This fact sheet is based on findings
from a 2005 National Institutes of Health (NIH)
State-of-the-Science (SoS) conference on the management of
menopause-related symptoms. It answers some frequently
asked questions and lists resources for more information.
Key Points
* Many women have few or no symptoms related to menopause,
or feel that their symptoms are not enough of a problem that
they need to seek treatment. Some symptoms traditionally seen
as menopausal may be related to aging in general.
* Menopause should not be viewed as a disease, according to
the SoS conference panel.
* For many years, menopausal hormone therapy (MHT; in the
past, it was called hormone replacement therapy or HRT) was
the primary treatment for troubling menopausal symptoms.
Recent studies have found increased risks, however, for certain
serious health problems from prolonged use of MHT.
* Women with severe or long-lasting symptoms of menopause
that have not been adequately relieved in other ways should
consult their health care providers about their personal risks and
benefits for using MHT. Certain lifestyle changes can also be
helpful.
1. What is menopause?
Menopause (also called the "change of life") is a normal part of a
woman's aging. It is the time when her ability to have children
comes to an end. In American women, the transition into
menopause usually begins around age 47, with the final
menstrual period usually around age 51. However, some women
experience it earlier. Menopause occurs over a period of time
because the levels of a hormone called estrogen, which is
produced by the ovaries, begin to decline slowly. A woman is
said to have completed natural menopause when she has not
had a period for 12 months in a row. Menopause will occur
immediately if a woman has her uterus and/or both ovaries
removed surgically (an operation to remove the uterus is called a
hysterectomy). This is because at least one ovary and the
uterus are needed for a woman to have menstrual periods.
Menopause also begins right away if a woman's ovaries are
damaged by cancer treatment with radiation therapy or certain
anticancer drugs.
Top
2. What are the most common symptoms that women have
during the menopausal transition?
Some symptoms that women experience are related to
menopause and decreased activity of the ovaries. Others are
related to aging in general. The scientific evidence that certain
symptoms are linked to menopause is strongest for the
following symptoms:
* Hot flashes, night sweats, or perspiring excessively (these are
examples of what are called vasomotor symptoms, because they
involve expansion of the blood vessels)
* Sleep difficulties
* Vaginal dryness, which can lead to painful intercourse and
sexual problems
It is not certain whether the following symptoms are due to
menopause, other factors that can come with aging (such as
stress, economic concerns, or changes in personal
relationships), or a combination of them:
* Changes in mood, such as depression, anxiety, and/or
irritability
* Problems in thinking or in remembering things
* Urinary incontinence (that is, loss of ability to control urination)
* Painful joints or muscles, or other physical complaints, such as
tiredness and stiff joints
The expert panel assembled for the NIH SoS conference noted
that menopause is a normal part of women's aging, and advised
that menopause not be viewed as a disease (that it be
"demedicalized").
Top
3. What treatment does conventional medicine offer for
menopausal symptoms?
For many decades, estrogen (available by prescription with or
without another hormone called progestin) has been the main
treatment in conventional medicine for menopausal symptoms.1
For a long time this treatment was called hormone replacement
therapy (HRT), but the preferred term now is menopausal
hormone therapy (MHT). MHT has been the most effective
therapy to date for women who have severe or long-lasting
problems related to menopause. It is especially effective against
hot flashes and night sweats.
MHT has some other beneficial effects as well. For example, it
helps to protect against osteoporosis, an age-related disease in
which the bones become brittle and can break more easily. The
risk for osteoporosis goes up in both men and women as they
age, but it is greater for women after menopause. Drug
treatments other than MHT, however, are available for reducing
the risk of osteoporosis in both men and women, and certain
lifestyle changes also may help.
1 Conventional medicine is medicine as practiced by holders of
M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees
and by their allied health professionals such as nurses, physical
therapists, and dietitians. CAM is a group of diverse medical and
health care systems, practices, and products that are not
currently considered to be part of conventional medicine.
Complementary medicine is used along with conventional
medicine. Alternative medicine is used instead of conventional
medicine. Some conventional medicine practitioners also practice
CAM.
Top
4. Why are many people concerned about the effectiveness and
safety of MHT?
MHT was widely prescribed until a few years ago. In 2002,
findings from a large study called the Women's Health Initiative
raised concerns about its safety and side effects. Researchers
found increased risks for serious health problems (including
heart disease, breast cancer, stroke, and blood clots) in women
who had taken a combination of estrogen and progestin for
several years. Women who were taking estrogen alone had an
increased risk for stroke and blood clots.
MHT is being used more cautiously now. The U.S. Food and
Drug Administration (FDA) recommends that it be used at the
lowest dose for the shortest period of time possible. However,
the specific risks and benefits of these low doses, and how long
to use them, are not known. The NIH SoS conference panel
noted that estrogen may not be an appropriate treatment for
some menopausal complaints. This situation is one reason that
many women and their health care providers have become
interested in whether CAM treatments could be helpful for
menopausal symptoms.
Top
5. What should women consider if they are thinking about using
CAM for menopausal symptoms?
There is very little scientific evidence to support the
effectiveness of CAM therapies for menopausal symptoms.
However, it is possible that some CAM therapies, while not as
effective as MHT, may provide some relief to women during the
menopausal transition. Here are some points to keep in mind
about these therapies:
* It is important for women who are considering or using CAM
therapies for any health reason to discuss them with their health
care provider. This is to help ensure safety and a comprehensive
treatment plan.
* Botanical and other dietary supplements can interact with
prescription and over-the-counter drugs, affecting how the
body reacts. Supplements can pose other safety issues as well.
Some have been found to be contaminated, contain unlabeled
ingredients, or have different amounts of ingredients than are
listed on the label. "Natural" does not automatically mean "safe."
* Pharmacists can be a helpful source of information about
supplements. However, their advice should not be viewed as a
substitute for the advice of a health care provider.
* The claims for many CAM therapies can be attractive, ranging
from enhancing well-being to producing health results that
might seem unbelievable. Check whether such claims are based
only on personal stories (testimonials) or on the results of
controlled research studies. It is important to know whether
scientific research has proven that a therapy works (for more,
see "For More Information").
* The cost of a CAM therapy may be a concern, as many CAM
therapies are not covered by insurance.
About Dietary Supplements
Dietary supplements were defined in a law passed by Congress
in 1994. A dietary supplement must meet all of the following
conditions:
* It is a product (other than tobacco) intended to supplement
the diet, which contains one or more of the following: vitamins;
minerals; herbs or other botanicals; amino acids; or any
combination of the above ingredients.
* It is intended to be taken in tablet, capsule, powder, softgel,
gelcap, or liquid form.
* It is not represented for use as a conventional food or as a
sole item of a meal or the diet.
* It is labeled as being a dietary supplement.
Other important information about dietary supplements:
* They are regulated as foods, not drugs, so there could be
quality issues in the manufacturing process.
* Supplements can interact with prescribed or over-the-counter
medicines, and other supplements.
* "Natural" does not necessarily mean "safe" or "effective."
* Consult your health care provider before starting a
supplement, especially if you are pregnant or nursing, or
considering giving a supplement to a child.
CAM therapies are not the only alternatives to MHT to consider.
Certain lifestyle changes can contribute to healthy aging,
including during the menopausal transition. For example,
quitting smoking, eating a healthy diet, and exercising regularly
have been shown to reduce the risks of heart disease and
osteoporosis. Women may want to try one or more of these
changes as well.
Top
6. What are phytoestrogens?
Some botanical products, such as soy and red clover, are called
phytoestrogens. Plants rich in phytoestrogens may help relieve
some symptoms of menopause. However, it is uncertain
whether this relief comes from actual estrogens or from other
compounds in the plant. Much remains to be learned about
these plant products, including exactly how they work in the
human body. Doctors caution that certain women need to be
particularly careful before using phytoestrogens, especially:
* Women who have had or are at increased risk for diseases or
conditions that are affected by hormones, such as breast,
uterine, or ovarian cancer; endometriosis; or uterine fibroids
* Women who are taking drugs that increase estrogen levels in
the body, such as birth control pills; MHT; or a type of cancer
drug called selective estrogen receptor modulators (SERMs),
such as tamoxifen
Top
7. What is the scientific evidence on the CAM therapies
considered by the NIH SoS conference panel?
The panel discussed the evidence on 10 of these therapies:
* Six botanicals--black cohosh, red clover, dong quai root,
ginseng, kava, and soy
* DHEA (dehydroepiandrosterone), a dietary supplement
* Exercise
* Paced respiration
* Health education
Readers can find science-based information on these or any
CAM therapy that interests them through the National Center
for Complementary and Alternative Medicine (NCCAM)
Clearinghouse or the PubMed database, which are listed in "For
More Information."
Top
8. What is known about the effectiveness and safety of these
therapies for menopausal symptoms?
As mentioned in Question 5, very little well-designed research
has been done on CAM therapies for menopausal symptoms. A
small number of studies have been published, but they have had
limitations (such as the way the research was done or treatment
periods that may not have been long enough). As a result, the
findings from these studies are not strong enough for scientists
to draw any conclusions. Also, many studies of botanicals have
not used a standardized (that is, chemically consistent) product.
NCCAM is sponsoring a number of studies on botanicals using
products that are both well characterized and well standardized
(that is, their ingredients have been carefully studied and the
dosages are controlled), and on other CAM therapies that have
shown possible promise for reducing menopausal symptoms.
The aim is to learn more about their safety and effectiveness
and how they work in the body.
It is important to know that botanicals and other supplements
can have side effects and can interact with herbs, other
supplements, or drugs. A small number of these issues are
listed below. In addition to consulting your health care provider,
see "For More Information" for ways to find out about side
effects and safety issues.
Botanicals
* Black cohosh (Actaea racemosa, Cimicifuga racemosa). This
herb has received more scientific attention for its possible
effects on menopausal symptoms than have other botanicals.
Studies of its effectiveness in reducing hot flashes have had
mixed results. Recent research suggests that black cohosh does
not act like estrogen, as once was thought. Black cohosh has
had a good safety record over a number of years. Some
concerns have been raised about whether it may cause liver
problems, but an association has not been proven.
* Red clover (Trifolium pratense). The panel reported that five
controlled studies found no consistent or conclusive evidence
that red clover leaf extract reduces hot flashes. Clinical studies
in women report few side effects, and no serious health
problems have been discussed in the literature. However, there
are some cautions. Animal studies have raised concerns that red
clover might have harmful effects on hormone-sensitive tissue
(for example, in the breast and uterus).
* Dong quai (Angelica sinensis). Only one randomized clinical
study of dong quai has been done. The researchers did not find
it to be useful in reducing hot flashes. Dong quai is known to
interact with, and increase the activity in the body of, the
anticoagulant drug warfarin. This can lead to bleeding
complications in women who take this medicine.
* Ginseng (Panax ginseng or Panax quinquefolius). The panel
concluded that ginseng may help with some menopausal
symptoms, such as mood symptoms and sleep disturbances,
and with one's overall sense of well-being. However, it has not
been found helpful for hot flashes.
* Kava (Piper methysticum). Kava may decrease anxiety, but
there is no evidence that it decreases hot flashes. It is important
to note that kava has been associated with liver disease. The
FDA has issued a warning to patients and providers about kava
because of its potential to damage the liver.
* Soy. The scientific literature includes both positive and
negative results for soy extracts on hot flashes. When taken as
a food or dietary supplement for short periods of time, soy
appears to have few if any serious side effects. However,
long-term use of soy extracts has been associated with
thickening of the lining of the uterus.
DHEA
DHEA (dehydroepiandrosterone) is a naturally occurring
substance that is changed in the body to the hormones
estrogen and testosterone. It is also manufactured and sold as
a dietary supplement. The only randomized clinical trial of DHEA
that has been done so far found no benefit for hot flashes. The
NIH SoS conference panel added that a few small,
nonrandomized studies have suggested that DHEA might
possibly have some benefit for hot flashes and decreased sexual
arousal, but this has not been confirmed. The side effects, risks,
and benefits of using DHEA for longer than a few months have
not been well studied.
Concerns have been raised about whether DHEA is safe and
effective. For this reason, NCCAM is providing additional
information. DHEA has been used in conventional medicine for a
range of health problems other than symptoms of menopause,
but there is no good scientific evidence to support these uses.
Because levels of natural DHEA in the body decline with age,
some people believe that taking DHEA as a supplement can help
treat or prevent conditions related to aging. However, there is
no good scientific evidence to support this popular notion.
NCCAM does not recommend that consumers use
over-the-counter DHEA supplements for any health concerns,
including for menopausal symptoms. Little is known about the
long-term safety of DHEA, and scientists are not certain
whether it might increase the risk for breast or prostate cancer.
Therefore, consumers who have questions about whether DHEA
could be of benefit for their personal situation should discuss
those questions with their health care provider.
Other CAM Therapies
The NIH SoS conference panel chose to address the three other
therapies below, which they considered CAM "behavioral
interventions." They noted that these treatments may be an
important area for further research because they cause few, if
any, health problems. However, their effectiveness has not yet
been proven through large, well-designed studies.
* Exercise has improved the quality of life in women with
menopausal symptoms. However, it has not had any effect on
vasomotor symptoms or vaginal dryness.
* Paced respiration (also called paced breathing) is a technique
of slow, deep breathing. One small study found that it appeared
to be helpful for hot flashes.
* Health education involves educating women about what to
expect from menopause and what they themselves can do. It
has been found to improve women's knowledge, but not to have
effects on menopausal symptoms.
Menopause can also occur as a result of certain medical
treatments that affect a woman's ovaries (see Question 1).
Many women and their health care providers have become
interested in complementary and alternative medicine (CAM) for
menopausal symptoms. This fact sheet is based on findings
from a 2005 National Institutes of Health (NIH)
State-of-the-Science (SoS) conference on the management of
menopause-related symptoms. It answers some frequently
asked questions and lists resources for more information.
Key Points
* Many women have few or no symptoms related to menopause,
or feel that their symptoms are not enough of a problem that
they need to seek treatment. Some symptoms traditionally seen
as menopausal may be related to aging in general.
* Menopause should not be viewed as a disease, according to
the SoS conference panel.
* For many years, menopausal hormone therapy (MHT; in the
past, it was called hormone replacement therapy or HRT) was
the primary treatment for troubling menopausal symptoms.
Recent studies have found increased risks, however, for certain
serious health problems from prolonged use of MHT.
* Women with severe or long-lasting symptoms of menopause
that have not been adequately relieved in other ways should
consult their health care providers about their personal risks and
benefits for using MHT. Certain lifestyle changes can also be
helpful.
1. What is menopause?
Menopause (also called the "change of life") is a normal part of a
woman's aging. It is the time when her ability to have children
comes to an end. In American women, the transition into
menopause usually begins around age 47, with the final
menstrual period usually around age 51. However, some women
experience it earlier. Menopause occurs over a period of time
because the levels of a hormone called estrogen, which is
produced by the ovaries, begin to decline slowly. A woman is
said to have completed natural menopause when she has not
had a period for 12 months in a row. Menopause will occur
immediately if a woman has her uterus and/or both ovaries
removed surgically (an operation to remove the uterus is called a
hysterectomy). This is because at least one ovary and the
uterus are needed for a woman to have menstrual periods.
Menopause also begins right away if a woman's ovaries are
damaged by cancer treatment with radiation therapy or certain
anticancer drugs.
Top
2. What are the most common symptoms that women have
during the menopausal transition?
Some symptoms that women experience are related to
menopause and decreased activity of the ovaries. Others are
related to aging in general. The scientific evidence that certain
symptoms are linked to menopause is strongest for the
following symptoms:
* Hot flashes, night sweats, or perspiring excessively (these are
examples of what are called vasomotor symptoms, because they
involve expansion of the blood vessels)
* Sleep difficulties
* Vaginal dryness, which can lead to painful intercourse and
sexual problems
It is not certain whether the following symptoms are due to
menopause, other factors that can come with aging (such as
stress, economic concerns, or changes in personal
relationships), or a combination of them:
* Changes in mood, such as depression, anxiety, and/or
irritability
* Problems in thinking or in remembering things
* Urinary incontinence (that is, loss of ability to control urination)
* Painful joints or muscles, or other physical complaints, such as
tiredness and stiff joints
The expert panel assembled for the NIH SoS conference noted
that menopause is a normal part of women's aging, and advised
that menopause not be viewed as a disease (that it be
"demedicalized").
Top
3. What treatment does conventional medicine offer for
menopausal symptoms?
For many decades, estrogen (available by prescription with or
without another hormone called progestin) has been the main
treatment in conventional medicine for menopausal symptoms.1
For a long time this treatment was called hormone replacement
therapy (HRT), but the preferred term now is menopausal
hormone therapy (MHT). MHT has been the most effective
therapy to date for women who have severe or long-lasting
problems related to menopause. It is especially effective against
hot flashes and night sweats.
MHT has some other beneficial effects as well. For example, it
helps to protect against osteoporosis, an age-related disease in
which the bones become brittle and can break more easily. The
risk for osteoporosis goes up in both men and women as they
age, but it is greater for women after menopause. Drug
treatments other than MHT, however, are available for reducing
the risk of osteoporosis in both men and women, and certain
lifestyle changes also may help.
1 Conventional medicine is medicine as practiced by holders of
M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees
and by their allied health professionals such as nurses, physical
therapists, and dietitians. CAM is a group of diverse medical and
health care systems, practices, and products that are not
currently considered to be part of conventional medicine.
Complementary medicine is used along with conventional
medicine. Alternative medicine is used instead of conventional
medicine. Some conventional medicine practitioners also practice
CAM.
Top
4. Why are many people concerned about the effectiveness and
safety of MHT?
MHT was widely prescribed until a few years ago. In 2002,
findings from a large study called the Women's Health Initiative
raised concerns about its safety and side effects. Researchers
found increased risks for serious health problems (including
heart disease, breast cancer, stroke, and blood clots) in women
who had taken a combination of estrogen and progestin for
several years. Women who were taking estrogen alone had an
increased risk for stroke and blood clots.
MHT is being used more cautiously now. The U.S. Food and
Drug Administration (FDA) recommends that it be used at the
lowest dose for the shortest period of time possible. However,
the specific risks and benefits of these low doses, and how long
to use them, are not known. The NIH SoS conference panel
noted that estrogen may not be an appropriate treatment for
some menopausal complaints. This situation is one reason that
many women and their health care providers have become
interested in whether CAM treatments could be helpful for
menopausal symptoms.
Top
5. What should women consider if they are thinking about using
CAM for menopausal symptoms?
There is very little scientific evidence to support the
effectiveness of CAM therapies for menopausal symptoms.
However, it is possible that some CAM therapies, while not as
effective as MHT, may provide some relief to women during the
menopausal transition. Here are some points to keep in mind
about these therapies:
* It is important for women who are considering or using CAM
therapies for any health reason to discuss them with their health
care provider. This is to help ensure safety and a comprehensive
treatment plan.
* Botanical and other dietary supplements can interact with
prescription and over-the-counter drugs, affecting how the
body reacts. Supplements can pose other safety issues as well.
Some have been found to be contaminated, contain unlabeled
ingredients, or have different amounts of ingredients than are
listed on the label. "Natural" does not automatically mean "safe."
* Pharmacists can be a helpful source of information about
supplements. However, their advice should not be viewed as a
substitute for the advice of a health care provider.
* The claims for many CAM therapies can be attractive, ranging
from enhancing well-being to producing health results that
might seem unbelievable. Check whether such claims are based
only on personal stories (testimonials) or on the results of
controlled research studies. It is important to know whether
scientific research has proven that a therapy works (for more,
see "For More Information").
* The cost of a CAM therapy may be a concern, as many CAM
therapies are not covered by insurance.
About Dietary Supplements
Dietary supplements were defined in a law passed by Congress
in 1994. A dietary supplement must meet all of the following
conditions:
* It is a product (other than tobacco) intended to supplement
the diet, which contains one or more of the following: vitamins;
minerals; herbs or other botanicals; amino acids; or any
combination of the above ingredients.
* It is intended to be taken in tablet, capsule, powder, softgel,
gelcap, or liquid form.
* It is not represented for use as a conventional food or as a
sole item of a meal or the diet.
* It is labeled as being a dietary supplement.
Other important information about dietary supplements:
* They are regulated as foods, not drugs, so there could be
quality issues in the manufacturing process.
* Supplements can interact with prescribed or over-the-counter
medicines, and other supplements.
* "Natural" does not necessarily mean "safe" or "effective."
* Consult your health care provider before starting a
supplement, especially if you are pregnant or nursing, or
considering giving a supplement to a child.
CAM therapies are not the only alternatives to MHT to consider.
Certain lifestyle changes can contribute to healthy aging,
including during the menopausal transition. For example,
quitting smoking, eating a healthy diet, and exercising regularly
have been shown to reduce the risks of heart disease and
osteoporosis. Women may want to try one or more of these
changes as well.
Top
6. What are phytoestrogens?
Some botanical products, such as soy and red clover, are called
phytoestrogens. Plants rich in phytoestrogens may help relieve
some symptoms of menopause. However, it is uncertain
whether this relief comes from actual estrogens or from other
compounds in the plant. Much remains to be learned about
these plant products, including exactly how they work in the
human body. Doctors caution that certain women need to be
particularly careful before using phytoestrogens, especially:
* Women who have had or are at increased risk for diseases or
conditions that are affected by hormones, such as breast,
uterine, or ovarian cancer; endometriosis; or uterine fibroids
* Women who are taking drugs that increase estrogen levels in
the body, such as birth control pills; MHT; or a type of cancer
drug called selective estrogen receptor modulators (SERMs),
such as tamoxifen
Top
7. What is the scientific evidence on the CAM therapies
considered by the NIH SoS conference panel?
The panel discussed the evidence on 10 of these therapies:
* Six botanicals--black cohosh, red clover, dong quai root,
ginseng, kava, and soy
* DHEA (dehydroepiandrosterone), a dietary supplement
* Exercise
* Paced respiration
* Health education
Readers can find science-based information on these or any
CAM therapy that interests them through the National Center
for Complementary and Alternative Medicine (NCCAM)
Clearinghouse or the PubMed database, which are listed in "For
More Information."
Top
8. What is known about the effectiveness and safety of these
therapies for menopausal symptoms?
As mentioned in Question 5, very little well-designed research
has been done on CAM therapies for menopausal symptoms. A
small number of studies have been published, but they have had
limitations (such as the way the research was done or treatment
periods that may not have been long enough). As a result, the
findings from these studies are not strong enough for scientists
to draw any conclusions. Also, many studies of botanicals have
not used a standardized (that is, chemically consistent) product.
NCCAM is sponsoring a number of studies on botanicals using
products that are both well characterized and well standardized
(that is, their ingredients have been carefully studied and the
dosages are controlled), and on other CAM therapies that have
shown possible promise for reducing menopausal symptoms.
The aim is to learn more about their safety and effectiveness
and how they work in the body.
It is important to know that botanicals and other supplements
can have side effects and can interact with herbs, other
supplements, or drugs. A small number of these issues are
listed below. In addition to consulting your health care provider,
see "For More Information" for ways to find out about side
effects and safety issues.
Botanicals
* Black cohosh (Actaea racemosa, Cimicifuga racemosa). This
herb has received more scientific attention for its possible
effects on menopausal symptoms than have other botanicals.
Studies of its effectiveness in reducing hot flashes have had
mixed results. Recent research suggests that black cohosh does
not act like estrogen, as once was thought. Black cohosh has
had a good safety record over a number of years. Some
concerns have been raised about whether it may cause liver
problems, but an association has not been proven.
* Red clover (Trifolium pratense). The panel reported that five
controlled studies found no consistent or conclusive evidence
that red clover leaf extract reduces hot flashes. Clinical studies
in women report few side effects, and no serious health
problems have been discussed in the literature. However, there
are some cautions. Animal studies have raised concerns that red
clover might have harmful effects on hormone-sensitive tissue
(for example, in the breast and uterus).
* Dong quai (Angelica sinensis). Only one randomized clinical
study of dong quai has been done. The researchers did not find
it to be useful in reducing hot flashes. Dong quai is known to
interact with, and increase the activity in the body of, the
anticoagulant drug warfarin. This can lead to bleeding
complications in women who take this medicine.
* Ginseng (Panax ginseng or Panax quinquefolius). The panel
concluded that ginseng may help with some menopausal
symptoms, such as mood symptoms and sleep disturbances,
and with one's overall sense of well-being. However, it has not
been found helpful for hot flashes.
* Kava (Piper methysticum). Kava may decrease anxiety, but
there is no evidence that it decreases hot flashes. It is important
to note that kava has been associated with liver disease. The
FDA has issued a warning to patients and providers about kava
because of its potential to damage the liver.
* Soy. The scientific literature includes both positive and
negative results for soy extracts on hot flashes. When taken as
a food or dietary supplement for short periods of time, soy
appears to have few if any serious side effects. However,
long-term use of soy extracts has been associated with
thickening of the lining of the uterus.
DHEA
DHEA (dehydroepiandrosterone) is a naturally occurring
substance that is changed in the body to the hormones
estrogen and testosterone. It is also manufactured and sold as
a dietary supplement. The only randomized clinical trial of DHEA
that has been done so far found no benefit for hot flashes. The
NIH SoS conference panel added that a few small,
nonrandomized studies have suggested that DHEA might
possibly have some benefit for hot flashes and decreased sexual
arousal, but this has not been confirmed. The side effects, risks,
and benefits of using DHEA for longer than a few months have
not been well studied.
Concerns have been raised about whether DHEA is safe and
effective. For this reason, NCCAM is providing additional
information. DHEA has been used in conventional medicine for a
range of health problems other than symptoms of menopause,
but there is no good scientific evidence to support these uses.
Because levels of natural DHEA in the body decline with age,
some people believe that taking DHEA as a supplement can help
treat or prevent conditions related to aging. However, there is
no good scientific evidence to support this popular notion.
NCCAM does not recommend that consumers use
over-the-counter DHEA supplements for any health concerns,
including for menopausal symptoms. Little is known about the
long-term safety of DHEA, and scientists are not certain
whether it might increase the risk for breast or prostate cancer.
Therefore, consumers who have questions about whether DHEA
could be of benefit for their personal situation should discuss
those questions with their health care provider.
Other CAM Therapies
The NIH SoS conference panel chose to address the three other
therapies below, which they considered CAM "behavioral
interventions." They noted that these treatments may be an
important area for further research because they cause few, if
any, health problems. However, their effectiveness has not yet
been proven through large, well-designed studies.
* Exercise has improved the quality of life in women with
menopausal symptoms. However, it has not had any effect on
vasomotor symptoms or vaginal dryness.
* Paced respiration (also called paced breathing) is a technique
of slow, deep breathing. One small study found that it appeared
to be helpful for hot flashes.
* Health education involves educating women about what to
expect from menopause and what they themselves can do. It
has been found to improve women's knowledge, but not to have
effects on menopausal symptoms.
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