Skip to main content
PMC home page
Canadian Family Physician logoLink to Canadian Family Physician
. 1998 Jun;44:1299–1308.

Alternative treatments for menopausal symptoms. Systematic review of scientific and lay literature.

M M Seidl 1, D E Stewart 1
PMCID: PMC2278276  PMID: 9640524

Abstract

OBJECTIVE: To review the scientific literature on common alternative remedies for treatment of symptoms attributed to menopause and to contrast this with available lay literature. QUALITY OF EVIDENCE: Scientific articles were identified by searching MEDLINE, CINAHL, and HEALTH databases from 1966 to mid-1997 for English-language articles. More than 200 references were reviewed; 85 were selected for citation based on specific reference to alternative medicine for symptoms commonly attributed to menopause (e.g., hot flashes), to the effects of changing estrogen levels (e.g., irregular menses, vaginal dryness), and to reported side effects of the treatments. MAIN FINDINGS: The scientific literature was categorized under the headings nutritional supplements, herbal remedies, homeopathic remedies, and physical approaches. Some scientific evidence of the safety and efficacy of alternative treatments during menopause was uncovered, with the strongest evidence emerging in favour of phytoestrogens, which occur in high concentrations as isoflavones in soy products. CONCLUSIONS: In available controlled studies, the strongest data support phytoestrogens for their role in diminishing menopausal symptoms related to estrogen deficiency and for possible protective effects on bones and the cardiovascular system. Randomized controlled trials, standardization of dosage, and accurate safety and efficacy labeling are required to ensure proper use of alternative remedies.

Full text

PDF
1300

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adlercreutz H., Hämäläinen E., Gorbach S., Goldin B. Dietary phyto-oestrogens and the menopause in Japan. Lancet. 1992 May 16;339(8803):1233–1233. doi: 10.1016/0140-6736(92)91174-7. [DOI] [PubMed] [Google Scholar]
  2. Anderson J. W., Johnstone B. M., Cook-Newell M. E. Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med. 1995 Aug 3;333(5):276–282. doi: 10.1056/NEJM199508033330502. [DOI] [PubMed] [Google Scholar]
  3. BLATT M. H. G., WIESBADER H., KUPPERMAN H. S. Vitamin E and climacteric syndrome; failure of effective control as measured by menopausal index. AMA Arch Intern Med. 1953 Jun;91(6):792–799. doi: 10.1001/archinte.1953.00240180101012. [DOI] [PubMed] [Google Scholar]
  4. Barrett-Connor E., Bush T. L. Estrogen and coronary heart disease in women. JAMA. 1991 Apr 10;265(14):1861–1867. [PubMed] [Google Scholar]
  5. Bernardi M., D'Intino P. E., Trevisani F., Cantelli-Forti G., Raggi M. A., Turchetto E., Gasbarrini G. Effects of prolonged ingestion of graded doses of licorice by healthy volunteers. Life Sci. 1994;55(11):863–872. doi: 10.1016/0024-3205(94)90042-6. [DOI] [PubMed] [Google Scholar]
  6. Buckman R., Lewith G. What does homoeopathy do--and how? BMJ. 1994 Jul 9;309(6947):103–106. doi: 10.1136/bmj.309.6947.103. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cahill D. J., Fox R., Wardle P. G., Harlow C. R. Multiple follicular development associated with herbal medicine. Hum Reprod. 1994 Aug;9(8):1469–1470. doi: 10.1093/oxfordjournals.humrep.a138731. [DOI] [PubMed] [Google Scholar]
  8. Caso Marasco A., Vargas Ruiz R., Salas Villagomez A., Begoña Infante C. Double-blind study of a multivitamin complex supplemented with ginseng extract. Drugs Exp Clin Res. 1996;22(6):323–329. [PubMed] [Google Scholar]
  9. Chenoy R., Hussain S., Tayob Y., O'Brien P. M., Moss M. Y., Morse P. F. Effect of oral gamolenic acid from evening primrose oil on menopausal flushing. BMJ. 1994 Feb 19;308(6927):501–503. doi: 10.1136/bmj.308.6927.501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Clapp J. F., 3rd, Little K. D. The interaction between regular exercise and selected aspects of women's health. Am J Obstet Gynecol. 1995 Jul;173(1):2–9. doi: 10.1016/0002-9378(95)90160-4. [DOI] [PubMed] [Google Scholar]
  11. Deshpande S. S. Food legumes in human nutrition: a personal perspective. Crit Rev Food Sci Nutr. 1992;32(4):333–363. doi: 10.1080/10408399209527603. [DOI] [PubMed] [Google Scholar]
  12. Dwyer J. T., Goldin B. R., Saul N., Gualtieri L., Barakat S., Adlercreutz H. Tofu and soy drinks contain phytoestrogens. J Am Diet Assoc. 1994 Jul;94(7):739–743. doi: 10.1016/0002-8223(94)91939-9. [DOI] [PubMed] [Google Scholar]
  13. Düker E. M., Kopanski L., Jarry H., Wuttke W. Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. Planta Med. 1991 Oct;57(5):420–424. doi: 10.1055/s-2006-960139. [DOI] [PubMed] [Google Scholar]
  14. Einer-Jensen N., Zhao J., Andersen K. P., Kristoffersen K. Cimicifuga and Melbrosia lack oestrogenic effects in mice and rats. Maturitas. 1996 Oct;25(2):149–153. doi: 10.1016/0378-5122(96)01052-3. [DOI] [PubMed] [Google Scholar]
  15. Eisenberg D. M., Kessler R. C., Foster C., Norlock F. E., Calkins D. R., Delbanco T. L. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 1993 Jan 28;328(4):246–252. doi: 10.1056/NEJM199301283280406. [DOI] [PubMed] [Google Scholar]
  16. Ernst E. Is homoeopathy a placebo? Br J Clin Pharmacol. 1990 Aug;30(2):173–174. doi: 10.1111/j.1365-2125.1990.tb03761.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Ernst E., Resch K. L. Concept of true and perceived placebo effects. BMJ. 1995 Aug 26;311(7004):551–553. doi: 10.1136/bmj.311.7004.551. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Gambacciani M., Spinetti A., Piaggesi L., Cappagli B., Taponeco F., Manetti P., Weiss C., Teti G. C., La Commare P., Facchini V. Ipriflavone prevents the bone mass reduction in premenopausal women treated with gonadotropin hormone-releasing hormone agonists. Bone Miner. 1994 Jul;26(1):19–26. doi: 10.1016/s0169-6009(08)80159-6. [DOI] [PubMed] [Google Scholar]
  19. Griffiths F. Women's health concerns. Is the promotion of hormone replacement therapy for prevention important to women? Fam Pract. 1995 Mar;12(1):54–59. doi: 10.1093/fampra/12.1.54. [DOI] [PubMed] [Google Scholar]
  20. Hammar M., Berg G., Lindgren R. Does physical exercise influence the frequency of postmenopausal hot flushes? Acta Obstet Gynecol Scand. 1990;69(5):409–412. doi: 10.3109/00016349009013303. [DOI] [PubMed] [Google Scholar]
  21. Hertog M. G., Kromhout D., Aravanis C., Blackburn H., Buzina R., Fidanza F., Giampaoli S., Jansen A., Menotti A., Nedeljkovic S. Flavonoid intake and long-term risk of coronary heart disease and cancer in the seven countries study. Arch Intern Med. 1995 Feb 27;155(4):381–386. [PubMed] [Google Scholar]
  22. Hirata J. D., Swiersz L. M., Zell B., Small R., Ettinger B. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril. 1997 Dec;68(6):981–986. doi: 10.1016/s0015-0282(97)00397-x. [DOI] [PubMed] [Google Scholar]
  23. Hopkins M. P., Androff L., Benninghoff A. S. Ginseng face cream and unexplained vaginal bleeding. Am J Obstet Gynecol. 1988 Nov;159(5):1121–1122. doi: 10.1016/0002-9378(88)90426-7. [DOI] [PubMed] [Google Scholar]
  24. Hulka B. S., Meirik O. Research on the menopause. Maturitas. 1996 Mar;23(2):109–112. doi: 10.1016/0378-5122(95)00967-1. [DOI] [PubMed] [Google Scholar]
  25. Huxtable R. J., Awang D. V. Pyrrolizidine poisoning. Am J Med. 1990 Oct;89(4):547–548. doi: 10.1016/0002-9343(90)90403-z. [DOI] [PubMed] [Google Scholar]
  26. Huxtable R. J. The myth of beneficent nature: the risks of herbal preparations. Ann Intern Med. 1992 Jul 15;117(2):165–166. doi: 10.7326/0003-4819-117-2-165. [DOI] [PubMed] [Google Scholar]
  27. Katan M. B. Flavonoids and heart disease. Am J Clin Nutr. 1997 May;65(5):1542–1543. doi: 10.1093/ajcn/65.5.1542. [DOI] [PubMed] [Google Scholar]
  28. Khoo S. K., Munro C., Battistutta D. Evening primrose oil and treatment of premenstrual syndrome. Med J Aust. 1990 Aug 20;153(4):189–192. doi: 10.5694/j.1326-5377.1990.tb136857.x. [DOI] [PubMed] [Google Scholar]
  29. Kleijnen J. Evening primrose oil. BMJ. 1994 Oct 1;309(6958):824–825. doi: 10.1136/bmj.309.6958.824. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Knight D. C., Eden J. A. A review of the clinical effects of phytoestrogens. Obstet Gynecol. 1996 May;87(5 Pt 2):897–904. [PubMed] [Google Scholar]
  31. Knight D. C., Eden J. A. Phytoestrogens--a short review. Maturitas. 1995 Nov;22(3):167–175. doi: 10.1016/0378-5122(95)00937-g. [DOI] [PubMed] [Google Scholar]
  32. Lissner L., Bengtsson C., Björkelund C., Wedel H. Physical activity levels and changes in relation to longevity. A prospective study of Swedish women. Am J Epidemiol. 1996 Jan 1;143(1):54–62. doi: 10.1093/oxfordjournals.aje.a008657. [DOI] [PubMed] [Google Scholar]
  33. Lo A. C., Chan K., Yeung J. H., Woo K. S. Danggui (Angelica sinensis) affects the pharmacodynamics but not the pharmacokinetics of warfarin in rabbits. Eur J Drug Metab Pharmacokinet. 1995 Jan-Mar;20(1):55–60. doi: 10.1007/BF03192289. [DOI] [PubMed] [Google Scholar]
  34. Lock M. Contested meanings of the menopause. Lancet. 1991 May 25;337(8752):1270–1272. doi: 10.1016/0140-6736(91)92931-q. [DOI] [PubMed] [Google Scholar]
  35. Marwick C. Growing use of medicinal botanicals forces assessment by drug regulators. JAMA. 1995 Feb 22;273(8):607–609. [PubMed] [Google Scholar]
  36. McLAREN H. C. Vitamin E in the menopause. Br Med J. 1949 Dec 17;2(4641):1378-82, illust. doi: 10.1136/bmj.2.4641.1378. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Miksicek R. J. Commonly occurring plant flavonoids have estrogenic activity. Mol Pharmacol. 1993 Jul;44(1):37–43. [PubMed] [Google Scholar]
  38. Milewicz A., Gejdel E., Sworen H., Sienkiewicz K., Jedrzejak J., Teucher T., Schmitz H. Vitex agnus castus-Extrakt zur Behandlung von Regeltempoanomalien infolge latenter Hyperprolaktinämie. Ergebnisse einer randomisierten Plazebo-kontrollierten Doppelblindstudie. Arzneimittelforschung. 1993 Jul;43(7):752–756. [PubMed] [Google Scholar]
  39. Millar W. J. Use of alternative health care practitioners by Canadians. Can J Public Health. 1997 May-Jun;88(3):154–158. doi: 10.1007/BF03403879. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Murkies A. L., Lombard C., Strauss B. J., Wilcox G., Burger H. G., Morton M. S. Dietary flour supplementation decreases post-menopausal hot flushes: effect of soy and wheat. Maturitas. 1995 Apr;21(3):189–195. doi: 10.1016/0378-5122(95)00899-v. [DOI] [PubMed] [Google Scholar]
  41. Ozaki Y., Ma J. P. Inhibitory effects of tetramethylpyrazine and ferulic acid on spontaneous movement of rat uterus in situ. Chem Pharm Bull (Tokyo) 1990 Jun;38(6):1620–1623. doi: 10.1248/cpb.38.1620. [DOI] [PubMed] [Google Scholar]
  42. Pearce J. M. The placebo enigma. QJM. 1995 Mar;88(3):215–220. [PubMed] [Google Scholar]
  43. Punnonen R., Lukola A. Oestrogen-like effect of ginseng. Br Med J. 1980 Oct 25;281(6248):1110–1110. doi: 10.1136/bmj.281.6248.1110. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Pye J. K., Mansel R. E., Hughes L. E. Clinical experience of drug treatments for mastalgia. Lancet. 1985 Aug 17;2(8451):373–377. doi: 10.1016/s0140-6736(85)92506-1. [DOI] [PubMed] [Google Scholar]
  45. Reid I. R., Ames R. W., Evans M. C., Gamble G. D., Sharpe S. J. Effect of calcium supplementation on bone loss in postmenopausal women. N Engl J Med. 1993 Feb 18;328(7):460–464. doi: 10.1056/NEJM199302183280702. [DOI] [PubMed] [Google Scholar]
  46. Reilly D. T., Taylor M. A., McSharry C., Aitchison T. Is homoeopathy a placebo response? Controlled trial of homoeopathic potency, with pollen in hayfever as model. Lancet. 1986 Oct 18;2(8512):881–886. doi: 10.1016/s0140-6736(86)90410-1. [DOI] [PubMed] [Google Scholar]
  47. Ryan P. J., Harrison R., Blake G. M., Fogelman I. Compliance with hormone replacement therapy (HRT) after screening for post menopausal osteoporosis. Br J Obstet Gynaecol. 1992 Apr;99(4):325–328. doi: 10.1111/j.1471-0528.1992.tb13732.x. [DOI] [PubMed] [Google Scholar]
  48. SHAPIRO A. K. A HISTORIC AND HEURISTIC DEFINITION OF THE PLACEBO. Psychiatry. 1964 Feb;27:52–58. doi: 10.1080/00332747.1964.11023375. [DOI] [PubMed] [Google Scholar]
  49. Schubert W., Cullberg G., Edgar B., Hedner T. Inhibition of 17 beta-estradiol metabolism by grapefruit juice in ovariectomized women. Maturitas. 1994 Dec;20(2-3):155–163. doi: 10.1016/0378-5122(94)90012-4. [DOI] [PubMed] [Google Scholar]
  50. Sliutz G., Speiser P., Schultz A. M., Spona J., Zeillinger R. Agnus castus extracts inhibit prolactin secretion of rat pituitary cells. Horm Metab Res. 1993 May;25(5):253–255. doi: 10.1055/s-2007-1002090. [DOI] [PubMed] [Google Scholar]
  51. Tamaya T., Sato S., Okada H. Inhibition by plant herb extracts of steroid bindings in uterus, liver and serum of the rabbit. Acta Obstet Gynecol Scand. 1986;65(8):839–842. doi: 10.3109/00016348609157034. [DOI] [PubMed] [Google Scholar]
  52. Valente M., Bufalino L., Castiglione G. N., D'Angelo R., Mancuso A., Galoppi P., Zichella L. Effects of 1-year treatment with ipriflavone on bone in postmenopausal women with low bone mass. Calcif Tissue Int. 1994 May;54(5):377–380. doi: 10.1007/BF00305522. [DOI] [PubMed] [Google Scholar]
  53. Viana M., Barbas C., Bonet B., Bonet M. V., Castro M., Fraile M. V., Herrera E. In vitro effects of a flavonoid-rich extract on LDL oxidation. Atherosclerosis. 1996 Jun;123(1-2):83–91. doi: 10.1016/0021-9150(95)05763-3. [DOI] [PubMed] [Google Scholar]
  54. Wardell D. W., Engebretson J. C. Women's anticipations of hormonal replacement therapy. Maturitas. 1995 Nov;22(3):177–183. doi: 10.1016/0378-5122(95)00939-i. [DOI] [PubMed] [Google Scholar]
  55. Wilbur J., Holm K., Dan A. The relationship of energy expenditure to physical and psychologic symptoms in women at midlife. Nurs Outlook. 1992 Nov-Dec;40(6):269–276. [PubMed] [Google Scholar]
  56. Wilcox G., Wahlqvist M. L., Burger H. G., Medley G. Oestrogenic effects of plant foods in postmenopausal women. BMJ. 1990 Oct 20;301(6757):905–906. doi: 10.1136/bmj.301.6757.905-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Wren B. G., Brown L. Compliance with hormonal replacement therapy. Maturitas. 1991 Mar;13(1):17–21. doi: 10.1016/0378-5122(91)90281-t. [DOI] [PubMed] [Google Scholar]
  58. Wyon Y., Lindgren R., Hammar M., Lundeberg T. Akupunktur mot klimakteriebesvär? Färre vegetativa symtom efter menopaus. Lakartidningen. 1994 Jun 8;91(23):2318–2322. [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES