Too many Australian women are using treatments for menopause symptoms that don’t work, the authors of a new study say.
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Are you a woman in mid life struggling with menopause symptoms like hot flushes and night sweats?
If you’re using complementary and alternative medicines like phytoestrogens, evening primrose oil, black cohosh or ginseng to help, you’re wasting your money, the authors of a new study say.
It’s estimated nearly 500,000 women a month are using these medicines to control so-called vasomotor symptoms like night sweats, vaginal dryness and hot flushes says Dr Roisin Worsley, from Monash University’s School of Public Health and Preventive Medicine, who co-authored the study in the Medical Journal of Australia.
(Vasomotor symptoms relate to constriction or dilation of blood vessels and are generally regarded as “the most bothersome” of menopause problems.)
“But none of these [remedies] have been proven in scientific studies to actually be of any benefit,” Worsley says.
The study is the first to provide good quality data on how many Australians suffer these problems and what they are doing about it.
While some complementary therapies for menopause problems have not been as well researched as others, black cohosh and phytoestrogens at least have been the subject of multiple high quality studies known as randomised controlled trials and meta-analyses, Worsley says. “There really was no evidence of any benefit.”
Most alternative menopause therapies may also cause shorter term side effects including nausea, headache and upset stomach. Some known side effects of ginseng include hypertension, diarrhoea and sleeplessness.
Phytoestrogens can cause some vaginal bleeding as well,” she says.
So what does work?
The most effective remedy “by far” for menopause symptoms is hormone replacement therapy (HRT). “It will reduce hot flushes by 80 per cent in most people,” for instance, Worsley says. “It’s really amazing how quickly it works as well.”
But women and doctors alike were scared off HRT after research findings released in 2002 suggested it increased the risk of breast cancer. The fear was understandable because “it was very scary evidence at the time”.
But the original analysis of study data was misleading because it focused on older women (average age 69) and those taking hormones for longer periods. This is because the original study set out to investigate a different question: whether oestrogen therapy could help prevent heart disease and dementia in older women. While the analysis showed HRT was linked with a raised risk of breast cancer, blood clots and strokes, “these were older women, who had already developed some forms of disease anyway”.
Now the data has been reanalysed to work out the effect of the hormones on women who “actually want to use hormone therapy for their hot flushes”. These are younger women (usually in their early 50s) who use hormones for a shorter period of time and the conclusions are different.
“The reanalysis of the old data suggests the benefits of hormone therapy [for menopause symptoms] outweigh the risks for short-term use in healthy women.”
Current guidelines say women should take the lowest dose of HRT for the shortest amount of time possible, but can use it for up to five years. However, all women should discuss their individual risk and personal preference with their doctor.
Getting the right advice
But treatments other than hormone therapy do exist and if women want to try them, Worsley thinks that’s “completely reasonable”. They include low-dose antidepressants and anticonvulsants.
The key is to get good advice about options, something that can be tricky as it is very hard for GPs to stay up to date.
“It’s a really complicated topic and it’s been changing rapidly over the last decade.”
At present, “women with very severe debilitating symptoms have to navigate this really complex pathway. They try all different types of practitioners, they try every kind of diet and detox and various exercise things. And they’re trying all kinds of supplements. I think a lot of women are not getting high quality information on which to make a decision”.
She suggests seeking out a “really good GP who’s got an interest in women’s health” or ask for a referral to a specialist who deals with menopausal symptoms. These are often gynaecologists or hormone specialists. There are also some lifestyle measures that can help.
While menopause is a natural process, it “can be really disabling” for some women. “You can see why women are trying everything they possibly can to try and deal with it.”
Phytoestrogens the hope vs reality
Phytoestrogens are compounds from plants that mimic the action of the human hormone oestrogen. Taken either as food supplements or in concentrated tablet form, they are the most commonly used complementary and alternative medicine for menopausal symptoms.
“We always thought they would help with hot flushes but unfortunately that hasn’t worked out,” Worsley says.
What’s more phytoestrogens may pose a health risk because studies have shown when they are applied to isolated breast cancer cells in a laboratory dish, the cells multiply.
Because of this, “we actually recommend if women have had breast cancer they shouldn’t take these substances”.
Whether phytoestrogens might increase the risk of breast cancer in healthy women isn’t known.
“That’s another point women don’t realise: we don’t have the long-term safety data on a lot of these remedies. They are a bit of an unknown quantity.”