Alternative Treatment

As we are repeatedly discussing on this website, standard medical therapy does not always succeed in successfully remedying menopausal symptoms. Consequently, a large percentage of symptomatic women in the U.S. have chosen to use so-called alternative and/or supplemental treatments, which, since considered food supplements by federal authorities, can be bought over-the-counter, without prescriptions from a physician.

These agents do, however, often have medicinal potency. To assume that they can be ingested without side effects and or complications, just because they are offered over- the-counter, is, therefore, categorically incorrect! Indeed, these substances, like any other bio-active chemicals, whether considered pharmaceuticals or supplements, do have side effects, carry risks and can have adverse interactions with other medications and/or supplements. They should, therefore, be taken with caution and, especially if taken with other medications, or in the presence of medical conditions, only after consultation with a knowledgeable health care professional.

The adjacent table summarizes some of the alternative/complementary non-prescription supplements frequently utilized by the public:

Alternative/Complementary Non-Prescription Supplements
PHYTOESTROGENS/ISOFLAVONS: Primarily found in soy and red clover. A recent well controlled study of soy usage in menopause was unable to confirm any beneficial effects on menopause symptoms! Other studies of lesser scientific quality did report beneficial effects on hot flashes and other symptoms of menopause. Phytoestrogens have either an agonistic (enhancing) or antagonistic (blocking) action on the cell receptors for the female hormone estrogen. Isoflavons can bind to estrogen receptors. Both substances, therefore, may work in the body similar to estrogens. WOMEN, WHO FEAR ESTROGENS SHOULD BE AWARE OF THIS FACT! In addition to allergic reactions, these substances can also cause gastrointestinal disturbances. They can work additive or in competition (for receptor sites) with estrogens and can cause reduced absorption of thyroid medications in hypothyroid women with a need for such drugs.
BLACK COHOSH: The American College of Obstetricians and Gynecologists, in a consensus opinion, concluded that this supplement may be helpful in the treatment of vasomotor symptoms, though only for the short term (i.e., six months or less). This opinion is, however, not shared by the Office of Dietary Supplements at the National Institutes of Health (NIH), which feels that currently available data do not support such a recommendation. The National Center for Complementary and Alternative Medicine at NIH is in the process of funding/ conducting a study to resolve this question. While this substance was previously believed to have estrogenic effects, this is no longer the prevailing opinion. Its potential mechanism of action is unknown. Reported side effects include gastrointestinal disturbances, low blood pressure, headache, weight gain and dizziness. This supplement may work additive with anticoagulants, leading to bleeding and may increase antihypertensive effects of blood pressure lowering drugs, leading to low blood pressure.
DONG QUAI: Even though widely used for the treatment of menopausal symptoms, there is no scientific evidence supporting its effectiveness in suppressing hot flashes or other menopausal symptoms. The supplement is, though, believed to bind to estrogen receptors and to induce, therefore, the same intracellular response into estrogen-responsive cells as estrogen does. An estrogen-like clinical effect may, therefore, be possible, after all. WOMEN, WHO FEAR ESTROGEN SHOULD BE AWARE OF THIS FACT! The substance interacts with the anticoagulant warfarin and can, therefore, lead to bleeding episodes in women on warfarin treatment. Most concerning, however, it contains the substance furocoumadin, which can cause sensitivity to sun light (i.e., photosensitization), and the substance psoralen, which is mutagenic (causing genetic mutations in offspring) and carcinogenic (causing cancers) in animals. This herb has been in use in traditional Chinese medicine for the relief of menopausal symptoms for thousands of years.
FLAXSEED: The data on this supplement is limited. However, at least one study suggested that 40 grams per day of this supplement was similarly effective to 0.625mg of conjugated equine estrogen in improving mild menopausal symptoms. This dosage of equine estrogen represents a frequently prescribed allopathic medication in the treatment of menopause. This supplement contains omega-3 fatty acids and plant-based estrogens, so-called phytoestrogens which are believed to be effective against some symptoms of menopause andhave been claimed, bys some, to be protective against breast cancer and to prevent coronary heart disease. Especially claims of preventive potential should, however, be viewed with caution.
DEHYDROEPIANDROSTERONE (DHEA): In the U.S., DHEA is classified as a dietary supplement, and can, therefore, be purchased over-the-counter. It is a naturally occurring, mild androgen hormone, which is present in females as well as males. In women, natural DHEA levels decline by approximately 50% by the time menopause is reached. The use of DHEA in menopause has recently attracted increasing attention and is actively being investigated at MRI. MRI’s sister organization, CHR, discovered that DHEA administration to women with aging ovaries improves their chances to conceive. DHEA would appear to represent an ideal medication for the menopausal woman since this naturally occurring hormone in the body, very quickly, is converted into the two sex-hormones estradiol and testosterone. Which both significantly decrease in the middle-aged female. Estradiol is the quintessential hormone supportive of bone health, while the hormone testosterone has been associate with an improved sex drive in females. There are only limited studies available on the use of DHEA in menopause. Amongst the few that have been published, some did, while others did not, demonstrate improvements in menopausal symptoms. We have previously noted the lack of standardization in DHEA products which are available over the counter. MRI, therefore, strongly recommends the use of pharmaceutical grade, micronized DHEA, which has to be obtained by prescription. A study of DHEA products, available in the market, revealed that 3/16 products contained no DHEA at all and the DHEA content of available product ranged between 0-150% of amounts claimed on the lable ( Parasrampuria et al., JAMA 1998;280:1565). THESE DATA POINT OUT THE UNEVENESS OF CONTENT IN OVER-THE-COUNTER-SUPPLEMENTS. DHEA is well tolerated, though long-term effects of long-term use are, as with basically all supplements, unknown. MRI, therefore, prescribes DHEA only under an experimental consent.
LICORICE: Glycesterone, a substance in this supplement, has weak estrogenic properties. Indeed, it is estimated to have only 1/533 the estrogenic activity of the female hormone estradiol. Many traditional Chinese preparations, often prescribed in menopause, contain this supplement. It, however, can cause hypertension which will not recede for months after caesation of treatment. In addition, even very small amounts can cause a rather severe medical condition, called pseudo-aldosteronism which can present clinically with excessive fatigue, hypertension, sodium retention, potassium wasting and, ultimately, congestive heart failure.
RED CLOVER: This herb contains isoflavons, plant based estrogenic compounds. It Is widely used to relieve menopausal symptoms and has been claimed to reduce the risk of bone loss and coronary heart disease. Such long- term claims should, however, be viewed with caution.
VITAMINS: While many claims for vitamin supplementation have been made only VITAMIN E has been demonstrated in some small studies to show a potential benefit in menopausal women. These studies suggested that a dosage of 400-800 IU of the vitamin per day may beneficially effect hot flashes, nervousness and the fatigue of menopause. This vitamin can, however, reduce the effectiveness of statins, the cholesterol-lowering drugs, which many menopausal women nowadays are taking. VITAMIN D is, of course, in association with CALCIUM, crucial for bone health, with the latter being absorbed into the body only f the vitamin is present. As the vitamin diminishes with age, calcium deficiency may arise. This, of course, can contribute to OSTEOPOROSIS and FRACTURES. Moderate exposure to sun will create adequate Vitamin D amounts. VITAMIN K has been suggested to prevent bone loss at a daily dosage of 45mg. It, however, also increases blood clotting.
CHASTEBERRY (VITEX): This substance has a strong ability to bind to the estrogen receptor in cells. It, therefore, may induce estrogenic effects. It is well known, however, that this supplement contains substances with ant-androgenic (anti-male hormone) effects. Since androgens are believed to be important for the sex drive of the postmenopausal woman, at least theoretically, these drugs may induce adverse effects in that regard. No factual data of significance are, however, available for this supplement’s use in menopause.
GINSENG: Little information is also available on this widely used root. Some data suggest that this supplement improves general well being, mood and sleep patterns. It, however, does not appear to affect hot flashes. Whether this herb has estrogen- like activity, has remained controversial.
KAVA: While this supplement may be effective in reducing anxiety, it does not appear to have any effects on other menopausal symptoms. Moreover, it appears to have significant liver toxicity, warranting a rare warning (for a supplement) by the Food and Drug Administration (FDA).
EVENING PRIMROSE OIL: Although widely marketed for the relief of menopausal symptoms, a still limited number of clinical trials have failed to support such an effect.
WILD YAM: This herb is frequently used as a cream, where it is alleged to especially improve vaginal dryness. It has, however, never been seriously investigated as a remedy to relieve any symptoms of menopause.
OMEGA-3 FATTY ACIDS: These can be found in fish oil and flaxid andappear to decreae the risk of coronary heart disease in women and men.
MELATONIN: Has been, by some, suggested to improve sleeping patterns during menopause. Other studies have disputed this fact.
THE FOLLOWING ADDITIONAL HERBS ARE, AT TIMES, PRESCRIBED BY HERBALISTS: STINGING NETTLE UVA URSI VALERIAN ROOT ANGELICA ROOT SAW PALMETTO None of these herbs has, however, been investigated in their efficacy in treating menopausal symptoms.
THE FOLLOWING REMEDIES MAY, AT TIMES, BE PRESCRIBED BY HOMEOPATHS: BELLADONNA for hot flashes; SILVER NITRATE for insomnia, irritability, anxiety; SULFUR for hot flashes; SEPIA (CUTTLEFISH) for vaginal dryness, irritability, mood swings; LACHESIS for hot flashes, irritability; CALCIUM PHOSPHATE for bone health; LYCOPODIUM (CLUB MOSS) for pain with intercourse (dyspareunia); None of these remedies have, however, been formally investigated in their efficacy in treating menopausal symptoms.
This table utilized information from Wysocki and Thorneycroft, The Forum 2005; 3;18-25

In summary, a large variety of supplements are in wide use for the menopausal woman. A careful review of reported data, however, reveals that surprisingly little is known about the efficacy of these substances. Moreover, some may, indeed, have significant side effects and/or risks, which the public is not always aware of. The lesson from all of this is, of course, that over-the-counter supplements should, like all medications, be taken with great care. Just because they are offered over-the-counter does not mean that they are safe. Moreover, they often don’t contain what they promise and can frequently be contaminated. We, therefore, stronglys suggest that competent medical advice be obtained before treatment with such supplements is initiated.