More women than ever may now look for other ways to ease menopausal symptoms after the news that long-term hormone therapy increases slightly the risk of heart attacks, strokes and breast cancer.
One of the most likely options, experts say, will be natural therapies.
Already, more than 30 percent of women say they use herbs and other supplements, according to the North American Menopause Society. And doctors say an estimated half of all menopausal women refuse hormone therapy when their doctors suggest it.
"Anything that raises the risk of breast cancer is going to be of concern to women," said Dr. Mary Hardy, medical director of the Cedars-Sinai Integrative Medicine Program.
Experts last week cautioned the estimated 6 million women taking estrogen and progesterone to discuss their regimen with their personal physicians before making changes. But Hardy predicts that some women will be quick to drop hormones and turn to natural alternatives.
"The women who stop taking hormones and develop (menopause) symptoms are going to say, 'So what do I do now?' " she said.
Downside to nature
A majority of women experience at least some discomfort during menopause the time during which the body's natural production of estrogen ceases and an estimated 5 percent to 15 percent have severe symptoms that can include hot flashes, night sweats, insomnia, fatigue, irritability, urinary tract infections, incontinence, mood swings, thinning hair and skin, vaginal dryness and low libido.
Natural remedies may alleviate some of those discomforts without the attendant risks linked to hormones, experts say. But before rushing to the health food store, women should be aware that natural remedies also have a downside. Among them:
There is scant scientific evidence on the risks and benefits of most natural remedies.
Studies on herbal supplements typically have examined only short-term use.
Natural cures including exercise, stress-reduction techniques and dietary supplements tend to work best for mild to moderate symptoms.
Any benefits gained will usually be apparent only after several months of use.
Because dietary supplements are largely unregulated by the federal government, there is no guarantee that the products contain the ingredients listed or are free of adulterations.
Some herbs may interact with medications to cause serious side effects. Some herbs, such as dong quai, may also be toxic.
"As dire as the (hormone study) data may sound, at least we have data, whereas there are no substantive data regarding any alternatives," said Dr. Maida Taylor, associate clinical professor at the University of California-San Francisco and a senior clinical research physician for Eli Lilly & Co.
Short of evidence
Last year, the American College of Obstetricians and Gynecologists warned doctors that, when it comes to easing menopausal symptoms, there is little evidence supporting the use of the majority of products, including such popular remedies as dong quai, evening primrose, wild yam and Mexican yam, valerian root and chasteberry.
The report cautioned that natural does not mean safe or effective. For example, both dong quai and valerian have been linked to serious side effects, said Taylor, who wrote the report.
According to the report, the most
helpful natural supplements for menopause appear to be black cohosh, isoflavones (estrogen-like plant compounds called phytoestrogens) and St. John's wort.
Black cohosh, which is the active ingredient in the menopause remedy RemiFemin, has been shown to ease hot flashes and night sweats. Isoflavones found in soy and some grains may alleviate hot flashes and could provide some protection against osteoporosis and heart disease. St. John's wort has shown some impact in easing mild depression.
In addition, red clover may reduce hot flashes and night sweats. Calcium is considered useful for protection against osteoporosis, and the amino acid SAM-e may help with depression.
A sense of empowerment
Because experts say hormone therapy remains safe for short-term use (three years or fewer), women may want to stick with hormones for that time period, said Taylor. She predicts some women will drop hormones but will not find relief in natural products.
"If a woman is having a dreadful time with hot flashes, we know there is a medication (estrogen) that is relatively safe, though in the long term it would not be advisable," she said.
The quality of dietary supplements is also a concern for women relying on them for menopausal relief. For example, one study by ConsumerLab, an independent supplement testing company, found that five of 18 isoflavone products had less isoflavone content than stated on the label.
Women should consult with their doctors to find the best natural products, Hirschenbein said.
"A lot of the women I see have come to me having done herbs on their own and failed that," he said. "The problem with herbal preparations, in general, is there is a lot of difference between the companies that put out good products and the companies that don't."
But even the best natural therapies require patience, Hardy notes. Exercise, for example, may help reduce hot flashes, but only as part of a dedicated regimen. Herbs, too, may work subtly.
"The big problem is that women may think that herbal medicines will act like drugs," Hardy said. "With estrogen, you take it and in two weeks you'll feel better. With black cohosh, peak response times are two or three months. It's a whole different mind-set."
Herbs are also unlikely to satisfy women with severe menopausal symptoms, she said. And while exercise, healthy eating and stress reduction could be helpful, the benefits won't be obvious.
"A lot of these benefits are on the margin, but they give women a sense of empowerment," Hardy said.