Clinical Abstracts: CAM Use for Menopause

Source: Newton KM, et al. Use of alternative therapies for menopause symptoms: Results of a population-based survey. Obstet Gynecol 2002;100:18-25.

Design/Setting/Subjects: Telephone survey of 886 women (ages 45-65; 794 white) in a health maintenance organization (Group Health Cooperative) in Washington state. Women were asked about their use of eight complementary and alternative medicine (CAM) categories: herbal, homeopathic, or naturopathic therapies; visits to a homeopathic or naturopathic physician; visits to an herbalist; dietary soy products; acupuncture; massage therapy or other bodywork; chiropractic; or relaxation and stress management. Women were asked about past or present use of the therapy category; if they had ever used it for menopausal symptoms, and if so, how helpful the therapy was.

Funding: Centers for Disease Control and Prevention (Contract # U48/CCU-009654, and the Office of Women’s Health, CDC)

Results: For past and present use for any reason, relaxation or stress management was the most popular therapy reported, being utilized by 362 (43.1%) of respondents; herbal, homeopathic, or naturopathic therapies were used by 328 (37%); chiropractic by 280 (31.6%); bodywork by 261 (29.5%); dietary soy products by 203 (22.9%); acupuncture by 92 (10.4%); visits to a homeopathic or naturopathic physician 83 (9.4%); and visits to an herbalist 41 (1.2%).

For menopausal symptoms, 22.1% used at least one therapy to treat menopausal symptoms (see comments); 13.1% used herbal, homeopathic, or naturopathic therapies; 9.1% used relaxation/stress management; and 7.4% used dietary soy products. Of those who used CAM therapies, more than 80% in each category reported that the therapies were somewhat or very helpful for symptom relief. Women who were not on hormone replacement therapy (HRT) were twice as likely to use alternative therapies than women on HRT. Some current HRT users reported adjuvant alternative therapy use specifically to manage menopausal symptoms: 8.1% used stress management; 8.1% used herbal, homeopathic, or naturopathic therapies; and 4.4% used dietary soy. Women with a history of breast cancer were six times more likely to use soy for menopausal symptoms than women without a history of breast cancer.

Comments: CAM use may be common for treating menopausal symptoms, but it’s difficult pinning down specifics in this survey. Women were allowed to consider anything they wanted "meno-pausal symptoms" and weren’t queried about specific therapies. The authors state that "the alternative therapy questions allowed women the broadest definition of menopause symptoms and the greatest freedom to define their choice of a therapy to treat symptoms." Why do they think that’s a good thing? Even the demographic information collected is appallingly vague: Surely having the only two race/ethnicity categories as "white" and "other" went out in the 1970s.

Additionally, some of the numbers don’t add up. For example, it is stated at several points that there were 886 subjects in the survey, but in the table, the number of respondents adds up to 916. It is stated that breast cancer use was associated with a sixfold increase, but this should have been qualified by the fact that the study only included 35 women with breast cancer.

There are interesting data here, but the charts are missing information and difficult to read; the tables and text don’t mesh well; and the write-up obfuscates as often as it clarifies.