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CAM Use by Women in Midlife
By Russell H. Greenfield, MD, Dr. Greenfield is Clinical Assistant Professor, School of Medicine, University of North Carolina, Chapel Hill, NC, and Visiting Assistant Professor, University of Arizona, College of Medicine, Tucson, AZ; he reports no consultant, stockholder, speaker's bureau, research, or other financial relationships with companies having ties to this field of study.
Source: Brett KM, et al. Complementary and alternative medicine use among midlife women for reasons including menopause in the United States: 2002. Menopause 2007;14:300-307.
Abstract: Data from the Alternative Health/Complementary and Alternative Medicine supplement of the 2002 National Health Interview Survey, or NHIS, was analyzed to obtain nationally representative estimates of recent complementary and alternative medicine (CAM) use among midlife women (ages 45-57 years, n = 3,621). In the survey, specific questions were asked about individual CAM therapies including use within the past 12 months, whether a given modality was used to treat a specific health condition, and the self-reported importance placed on the use of CAM for the respondent's health. Information was also obtained on whether respondents told their doctor(s) about CAM use, and the reason behind CAM use. Demographic information and self-assessed health status was also queried.
Results showed that almost half (45%) of respondents had used some form of CAM within the prior 12 months, with approximately one-fourth using herbs, one-fourth using mind/body therapies, and 14% using body work (massage and chiropractic). Whereas 55% did not use any CAM in the prior 12 months, 12% had used two different forms of CAM, and 9% had used three or more. Use of CAM did not vary by age, but white race, higher education, and residence in the West were associated with increased use. Less than half (45%) of CAM users mentioned their use to a conventional medical provider. The majority of respondents utilized CAM to address pain (either specific or general recurring in nature), with only 3% mentioning CAM use specifically for menopause (being the 11th most common condition for which CAM was used). However, the odds ratio for use of CAM in the past year was 1.9 for women with menopausal symptoms.
Geographic region was significantly associated with CAM use, with higher rates in the West and lowest rates in the South. The demographic variable most highly association with CAM use, however, was level of education achieved—for every CAM grouping studied, women with less than a high school education were half as likely to report using CAM as women who had received a college degree or higher. The most commonly reported CAM types used by respondents were herbs/natural products and relaxation techniques (26% and 22%, respectively). Almost half (45%) of recent users of CAM considered it to have been very important to their health. The authors conclude that CAM use among midlife women in the United States is high, although not specifically for menopausal concerns.
The NHIS has been conducted continuously since 1957, and is a nationally representative household survey that uses a national sample of the civilian, non-institutionalized U.S. population, sampling approximately 30,000 adults each year (with over-sampling of both black and Hispanic populations). These 2002 data coincide with announcement of the Women's Health Initiative (WHI) findings that traditional hormone therapy may increase health risks. Since that time, rates of hormone therapy for the treatment of menopausal symptoms have declined considerably, while an increasing number of women have explored CAM therapies for relief. The results of this study are somewhat surprising in that regional studies of CAM use for menopausal symptoms have suggested a higher prevalence than the 3% noted here, but a deeper look tells a different tale. The rate of CAM use among midlife women with menopausal symptoms was almost twice that of midlife women without such symptoms, but for reasons other than menopause.
Unlike many other survey reports, this study excluded data on the use of special diets, prayer, and spiritual healing. As the authors note, inclusion of traditional therapies commonly employed by women of South American or Caribbean descent could have had a significant impact on findings, and one would hope that future investigations would include questions on curanderos and faith healing, to name but two.
This study emphasizes the importance of asking our patients about the use of CAM therapies, a point that has been borne out in a number of trials, but it is another finding that should draw our attention. The fact that CAM was primarily employed among midlife women to aid in relieving pain should be a wake-up call to all health care practitioners.