Use of CAM for Menopause
Abstract & Commentary
By Donal P. O'Mathuna, PhD Dr. O'Mathuna is a lecturer in Health Care Ethics, School of Nursing, Dublin City University, Ireland; he repots no financial relationships relevant to this field of study.
Source: Bair YA, et al. Use of complementary and alternative medicine during the menopause transition: longitudinal results from the Study of Women's Health Across the Nation. Menopause. 2008;15:32-43.
This study examined whether use of complementary and alternative (CAM) therapies during the menopause transition varied by ethnicity.
Design: The Study of Women's Health Across the Nation is a prospective cohort study following a group of 3,302 women from five racial/ethnic groups at seven clinical sites nationwide. Using longitudinal data encompassing six years of follow-up, we examined trends in use of five categories of CAM (nutritional, physical, psychological, herbal, and folk) by menopause status and ethnicity. To account for potential secular trends in CAM use or availability, we also evaluated the trends in CAM use over calendar time.
Results: Approximately 80% of all participants had used some form of CAM at some time during the six-year study period. White and Japanese women had the highest rates of use (60%), followed by Chinese (46%), African-American (40%), and Hispanic (20%) women. Overall use of CAM therapy remained relatively stable over the study period. In general, CAM use did not seem to be strongly associated with change in menopause transition status. Use of CAM among white women did not change with transition status. Among Chinese and African-American participants, we observed an increase in CAM use as women transitioned to perimenopause and a decrease in CAM use with transition to postmenopause. Among Hispanic and Japanese women, we observed a decrease in use of CAM in early perimenopause, followed by an increase as women entered late perimenopause and a decrease as they progressed to postmenopause. Patterns of use for the five individual types of CAM varied. White women had relatively stable use of all CAM therapies through the transition. Japanese women decreased use of nutritional and psychological remedies and increased use of physical remedies as they transitioned into late perimenopause. Among African-American women, use of psychological remedies increased as they progressed through menopause.
Conclusions: Although CAM use did vary in some ethnic groups in relation to advancing menopause status, there was no evidence of influence of calendar time on CAM use. Patterns of CAM use during menopause are likely to be driven by personal experience, menopausal health, and access to therapies. Women's personal preferences should be taken into consideration by healthcare providers for medical decision making during menopause and throughout the aging process.
Commentary
Women are the primary consumers of complementary and alternative medicine (CAM), and of healthcare in general. Historically, menopausal symptoms have been one of the most common indications for which herbal remedies were pursued.1 Interest in CAM for menopausal symptoms was heightened after studies in 2002 reported higher incidences of certain adverse events after long-term use of hormone replacement therapy (HRT).2
However, even prior to those reports, many women considered CAM preferable to HRT. A survey of almost 1,000 US women aged 45 to 65 found that 76.1% had used at least one alternative therapy and 22.1% had used CAM to treat menopausal symptoms.3 Almost two-thirds of these women believed a natural approach to managing menopause was better than HRT. Herbal and homeopathic remedies made up the particular form of alternative therapy most popular with these women (13.1% of all women), followed by relaxation techniques (9.1%), and then soy products (7.4%).
The study by Bair et al sought to provide information on changes in CAM use during the menopause transition and also to look at any variation in use dependant on ethnicity. The data for this report derive from the Study of Women's Health Across the Nation (SWAN) study. At each of seven clinical sites around the United States, cohorts of white women and one other ethnic minority group were recruited. Four African-American cohorts were recruited. However, the Hispanic, Japanese, and Chinese Groups were each recruited in one city only and, thus, do not represent a nationwide sample.
When recruited, the 3,302 women were aged between 42 and 52 years and were either pre- or early perimenopausal at baseline. Women were excluded if, at baseline, they had experienced a hysterectomy or bilateral oophorectomy, were pregnant, or were using oral contraceptives or menopausal hormone therapy. As Bair et al noted, these criteria and other factors (such as the participants of all ethnic groups being more educated and affluent than the general population) limit the generalizability of the findings of this study.
Participants undertook several self-administered and interviewer-administered surveys at baseline and annually for six years (1996 to 2003). Use of CAM was evaluated using a five-item survey. Participants were asked each year whether or not they had used any of the following five groups of CAM in the previous 12 months:
- Herbs and herbal remedies, including homeopathy and teas;
- Special diets or vitamins and dietary supplements;
- Psychological therapies, such as meditation or relaxation techniques;
- Physical methods, such as acupuncture, massage or acupressure; and/or
- Folk medicine or traditional Chinese medicine.
Data on the fifth category was not reported here because so few participants reported using this category. The use of such broad categories makes it difficult to interpret the implications of this study. Hence, it is not surprising that 80% of participants reported using CAM at some point during the study. However, this does not adequately distinguish between people using an approach that might not be perceived as CAM (such as vitamins or massage) and those committed to practices widely acknowledged as being part of CAM (such as herbs or acupuncture).
Similarly, the level of use of CAM is not captured in this report. It is not completely clear how participants were to respond to the CAM survey, but it appears that they answered either yes or no to using the therapies. As the researchers acknowledge, more specific questions would have elicited "a more detailed and accurate assessment of women's actual practices," which would have given a more meaningful description of what is happening in practice. Further analyses are currently under way.
Nonetheless, this report does highlight that a significant number of women are using CAM during the transition through menopause. Of interest is the finding that such use was not strongly associated with transition status. However, ethnic variations were noted, which should be kept in mind when discussing CAM use with patients.
References
1. Pinn G. Herbs used in obstetrics and gynaecology. Aust Fam Physician. 2001;30:351-354, 356.
2. Nelson HD, et al. Postmenopausal hormone replacement therapy: scientific review. JAMA. 2002;288:872-881.
3. Newton KM, et al. Use of alternative therapies for menopause symptoms: results of a population-based survey. Obstet Gynecol. 2002;100:18-25.
O’Mathuna D. Use of CAM for Menopause. 2008;10:69-70.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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