Use of complementary and alternative medicine during the menopause transition: longitudinal results from the Study of Women's Health Across the Nation

Effects of St John's wort (Hypericum perforatum L.) extracts on epileptogenesis

The purpose of this study was to investigate the effects of treatment with water, n-butanol and ether extracts of Hypercom perforatum L. on epileptogenesis in rabbits. Animals from the control group received solvent-ethanol, and the kindling model of epilepsy was used. Epileptic focus was induced in Chinchilla rabbits by stimulation of the hippocampus. The following parameters were determined: the minimum current strength necessary to induce after-discharge (AD) - discharges appearing after cessation of stimulation; AD duration; the number of stimulations necessary to induce spontaneous kindling; and the latency time for the development of full kindling. The results obtained indicate that epileptogenesis is influenced by Hypericum perforatum L. extract treatment. Animals treated with an ether extract of Hypericum perforatum L. required significantly weaker minimum current strengths for the development of epileptogenic focus, and displayed longer AD times, while the number of electro-stimulations necessary for full kindling was less. In contrast, animals treated with water and n-butanol extracts required increased electro-stimulations for the development of epileptic discharge, and displayed shortened AD durations versus controls.

Acupuncture for hot flushes in perimenopausal and postmenopausal women: a randomised, sham-controlled trial

OBJECTIVES

To determine the effect of acupuncture in treating hot flushes in perimenopausal or postmenopausal women.

METHODS

The study was a randomised single-blind sham-controlled clinical trial. Perimenopausal or postmenopausal women with moderate or severe hot flushes were randomised to receive real or sham acupuncture. Both groups underwent a 4-week run-in period before the treatment. The real acupuncture group received 11 acupuncture treatments for 7 weeks, and the control group underwent sham acupuncture on non-acupuncture points during the same period. Both groups were followed for 8 weeks after the end of treatment period. Changes from baseline in the hot flush scores at week 7, measured by multiplying the hot flush frequency and severity, were the primary outcome. Hot flush frequency, severity and menopause-related symptoms measured with the Menopause Rating Scale Questionnaire were regarded as secondary outcomes.

RESULTS

54 participants were randomised into the real acupuncture group (n=27) and the sham acupuncture group (n=27). The mean change in hot flush scores was -6.4±5.2 in the real acupuncture group and -5.6±9.2 in the sham group at week 7 from values at the start of the acupuncture treatment (10.0±8.1 vs 11.7±12.6), respectively (p=0.0810). No serious adverse events were observed during the whole study period.

CONCLUSIONS

Compared to sham acupuncture, acupuncture failed to show significantly different effects on the hot flush scores but showed partial benefits on the hot flush severity. Further consideration is needed to develop appropriate strategies for distinguishing non-specific effects from observed overall effectiveness of acupuncture for hot flushes. Whether acupuncture has point-specific effects for hot flushes should be also considered in designing future researches.

A comparative study of complementary and alternative medicine use among heterosexually and lesbian identified women: data from the ESTHER Project (Pittsburgh, PA, 2003-2006)

OBJECTIVES

The prevalence of complementary and alternative medicine (CAM) use among women in the United States is high. Little is known about how CAM use may differ based on sexual orientation. Study aims were to measure the prevalence of CAM use in a community sample of women, explore differences in CAM use patterns by sexual orientation, and identify correlates of CAM use.

DESIGN/SUBJECTS

Analyses were based on women (Total N = 879; n = 479 lesbians) enrolled in the Epidemiologic STudy of HEalth Risk in Women (ESTHER) Project, a cross-sectional heart-disease risk-factor study.

SETTINGS/LOCATION

Data were collected through convenience sampling of adult females in Pittsburgh, PA (2003-2006).

OUTCOME MEASURES

Main outcome measures included lifetime and past 12-month CAM use, and types of CAM modalities used in the past 12 months.

RESULTS

The prevalence of having ever used CAM was 49.8%, with 42% having reported CAM use within the past 12 months. Lesbians had greater odds of having ever used CAM (adjusted odds ratio [AOR] = 1.68 [95% confidence interval (CI): 1.23, 2.28]) and of having used CAM in the past 12 months (AOR = 1.44 [CI: 1.06, 1.97]) than heterosexuals. In multivariate analyses, correlates of lifetime and past 12-month CAM use included being lesbian, white, higher educated, and a large-city resident; experiencing perceived discrimination in a health care setting; and having a greater spirituality rating and a history of a diagnosed mental health disorder. Past 12-month CAM use was also associated with having a provider of usual health care. Among women who used CAM within the past 12 months, heterosexuals had significantly higher yoga participation rates than lesbians.

CONCLUSIONS

Sexual orientation is important in understanding lifetime and past 12-month CAM use. Because of the high prevalence of CAM use found in this study, medical practitioners should inquire about the CAM practices of female patients, particularly lesbians.

Natural remedy use in a prospective cohort of breast cancer patients in southern Sweden

BACKGROUND

complementary and alternative medicine (CAM) use is common among breast cancer patients. Several CAM therapies may have negative side effects or interact with conventional therapies. We studied biologically based CAM use with and without vitamins/minerals in relation to patient and tumor characteristics as well as treatment in an ongoing prospective cohort of 855 primary breast cancer patients.

METHODS

patients from two hospitals in southern Sweden were included. Pre-operative and follow-up questionnaires containing questions on food intake, lifestyle, and concomitant medications, including natural remedies, were completed up to five years postoperatively. Clinical information was obtained from clinical records and tumor characteristics from pathology reports.

RESULTS

CAM and/or vitamins/minerals were used by 34.2% pre-operatively and by 57.9% during at least one visit. Over 100 different preparations were reported. At least eight of the commonly used preparations may interact with conventional breast cancer therapies. CAM users more often had a BMI <25 kg/m(2) (OR 1.76; 95%CI 1.33-2.33), were more often nulliparous (OR 1.59; 1.08-2.34), alcohol (OR 2.13; 1.44-3.14), antidepressants (OR 1.48; 1.02-2.15), and hormone therapy users (OR 1.57; 1.18-2.07), less often smokers (OR 0.71; 0.50-0.99), and consumed less coffee (OR 0.88; 0.82-0.95) than non CAM users. Tumor characteristics were not associated with CAM use. CAM use was more common among tamoxifen (OR 1.32; 1.00-1.75) and less common among chemotherapy (OR 0.63; 0.42-0.92) treated patients. Vitamins/minerals use was more common in aromatase inhibitor treated patients (OR 1.84; 1.33-2.53). There was no significant association between short-term disease-free survival and CAM use.

CONCLUSION

CAM use was common and associated with certain patient characteristics. CAM use may cause clinically significant drug interactions and it is therefore of clinical interest to identify potential CAM users.

The role of soy foods in the treatment of menopausal symptoms

The findings of the Women's Health Initiative resulted in a sharp decline in the use of estrogen therapy. Increasingly, menopausal women have been interested in soy foods as an alternative to estrogen therapy for the treatment of menopausal symptoms. This article provides an overview of the limited number of studies that assess the effectiveness of soy foods to alleviate vasomotor and urogenital symptoms. The evidence of the efficacy of soy foods in improving menopausal symptoms is limited due to the small number of trials reporting conflicting results.

Acupuncture for menopausal hot flashes: a qualitative study about patient experiences

OBJECTIVE

The aim of this study was to describe any changes in health experienced by postmenopausal women after having acupuncture treatment for hot flashes.

MATERIALS AND METHODS

Our sample was drawn from women participating in a randomized controlled trial (ACUFLASH) investigating the effect of acupuncture on menopausal hot flashes. One hundred and twenty-seven (127) women from the intervention group who had received a course of 10 acupuncture treatments were asked to make a written statement about any kind of change they had perceived that they considered could be related to the acupuncture treatment. Qualitative data were analyzed using systematic text condensation.

RESULTS

Many women reported a substantial impact from the treatment with respect to a reduction in frequency and intensity of hot flashes both by night and by day. Changes related to improved sleep pattern were also reported, and a variety of different bodily and mental changes were described (i.e., feeling in a good mood, not so run down, and calmer). Several women were uncertain whether any changes had occurred. A few reported feeling worse.

CONCLUSIONS

Our results describe a variety of health changes that may not be revealed by limited outcome measures in acupuncture studies. Further analysis of the relationship between such bodily experiences could lead to the development of hypotheses or models for how the acupuncture effect is mediated in complex bodily systems, and also contribute to development of outcome measures relevant for acupuncture studies.

The use of complementary and alternative medicines among a sample of Canadian menopausal-aged women

INTRODUCTION

Despite questionable efficacy and safety, many women use a variety of complementary and alternative medicine (CAM) therapies to relieve menopause symptoms.

METHODS

We examined the determinants and use of CAM therapies among a sample of menopausal-aged women in Canada by using a cross-sectional Web-based survey.

RESULTS

Four hundred twenty-three women who were contacted through list serves, e-mail lists, and Internet advertisements provided complete data on demographics, use of CAM, therapies, and menopausal status and symptoms. Ninety-one percent of women reported trying CAM therapies for their symptoms. Women reported using an average of five kinds of CAM therapies. The most common treatments were vitamins (61.5%), relaxation techniques (57.0%), yoga/meditation (37.6%), soy products (37.4%), and prayer (35.7%). The most beneficial CAM therapies reported were prayer/spiritual healing, relaxation techniques, counseling/therapy, and therapeutic touch/Reiki. Demographic factors and menopausal symptoms contributed to 14% of the variance (P < .001) in the number of CAM therapies tried.

DISCUSSION

Results support previous research showing that menopausal women have high user rates of CAM therapy and show that specific demographic factors and somatic symptomatology relate to use of CAM therapies. Health care providers can benefit from understanding the determinants and use of CAM by women during the menopause transition if they are to help and provide quality care for this population.

Complementary Medicine Use by Middle-aged and Older Women

This study analysed NEO Five Factor Inventory (NEO-FFI) personality trait data in middle-aged and older Australian women and their CAM usage. Participants were women from the Longitudinal study of Ageing in Women (LAW study) aged 47 to 87 years ( N = 419). Only the NEO-FFI trait of Openness was significantly correlated with cumulative CAM product use. Regression models revealed that number of specialists’ consultations, number of CAM products used and reported level of physical and leisure activities were predictive of CAM therapy use; while age was predictive of CAM product use.

Coagulation activation and fluid retention associated with the use of black cohosh: a case study

Black cohosh is one of the most popular herbal therapies for premenstrual discomfort, hot flushes and other climacteric and menopausal symptoms. Most often, it is tolerated well. However, there are some recent reports on serious adverse events, probably associated with this complementary and alternative herbal medicine. We report a case of coagulation activation, fluid retention and transient autoimmune hepatitis most likely triggered by the use of black cohosh. Diagnostic procedures aimed to explain lower leg edema are not uncommon in the age group of women suffering from climacteric and menopausal symptoms. Therefore, black cohosh-induced fluid retention and coagulation activation should be considered in differential diagnosis, especially if thrombosis has been excluded.

The soy isoflavones for reducing bone loss (SIRBL) study: a 3-y randomized controlled trial in postmenopausal women

BACKGROUND

Our previous study indicated that soy protein with isoflavones lessened lumbar spine bone loss in midlife women.

OBJECTIVE

We examined the efficacy of isoflavones (extracted from soy protein) on bone mineral density (BMD) in nonosteoporotic postmenopausal women. We hypothesized that isoflavone tablets would spare BMD, with biological (age, body weight, serum 25-hydroxyvitamin D) and lifestyle (physical activity, dietary intake) factors modulating BMD loss.

DESIGN

Our double-blind, randomized controlled trial (36 mo) included healthy postmenopausal women (aged 45.8-65.0 y) with intent-to-treat (n = 224) and compliant (n = 208) analyses. Treatment groups consisted of a placebo control group and 2 soy isoflavone groups (80 compared with 120 mg/d); women received 500 mg calcium and 600 IU vitamin D(3). Outcomes included lumbar spine, total proximal femur, femoral neck, and whole-body BMD.

RESULTS

Analysis of variance for intent-to-treat and compliant (> or =80%) models, respectively, showed no treatment effect for spine (P = 0.46, P = 0.21), femur (P = 0.86, P = 0.46), neck (P = 0.17, P = 0.14), or whole-body (P = 0.86, P = 0.78) BMD. From baseline to 36 mo, BMD declined regardless of treatment. In intent-to-treat and compliant models, respectively, BMD decreases were as follows: spine (-2.08%, -1.99%), femur (-1.43%, -1.38%), neck (-2.56%, -2.51%), and whole body (-1.66%, -1.62%). Regression analysis (compliant model) indicated that age, whole-body fat mass, and bone resorption were common predictors of BMD change. After adjustment for these factors, 120 mg (compared with placebo) was protective (P = 0.024) for neck BMD. We observed no treatment effect on adverse events, endometrial thickness, or bone markers.

CONCLUSION

Our results do not show a bone-sparing effect of extracted soy isoflavones, except for a modest effect at the femoral neck. This trial was registered at clinicaltrials.gov as NCT00043745.

Quality of life impairment among postmenopausal women varies according to race

BACKGROUND

Few studies have addressed the impact of menopausal symptom severity over quality of life (QoL) in Latin American women with different ethnics.

OBJECTIVE

To assess menopausal symptom severity and the QoL among postmenopausal Colombian women with three different ethnicities.

METHOD

Data of healthy naturally occurring postmenopausal Hispanic, indigenous and black women aged 40-59 years who participated in a cross-sectional study filling out the Menopause Rating Scale (MRS) and a general questionnaire was analysed.

RESULTS

A total of 579 women were included, 153 Hispanic, 295 indigenous and 131 Afro-descendent. Hispanic women had an average age of 55.3 +/- 3.3 years. Indigenous and black women were less educated than the Hispanic ones (2.2 +/- 1.8 and 4.6 +/- 4.4 vs. 6.4 +/- 3.5 years, p < 0.0001). Hispanic women displayed lower total MRS scores (better QoL) when compared to indigenous and black women. Urogenital scoring was worse among indigenous women compared to Hispanic and black women. Black women presented higher MRS psychological and somatic scorings than Hispanic and indigenous women. After adjusting for confounding factors, indigenous and black women continued to display a higher risk for impaired QoL, total MRS score > 16 (OR: 3.11, 95% CI: 1.30-7.44 and OR: 5.29, 95% CI: 2.52-11.10, respectively), which was significantly higher among indigenous women due to urogenital symptoms (OR: 102.75, 95% CI: 38.33-275.47) and black women due to psychological (OR: 6.58, 95% CI: 3.27-13.27) and somatic symptoms (OR: 3.88, 95% CI: 1.83-8.22).

CONCLUSION

In this postmenopausal Colombian series, menopausal symptoms in indigenous (urogenital) and black (somatic/psychological) women were more severe (impaired QoL) when compared to Hispanic ones.

Second generation complementary and alternative medicine physiologic data collection and monitoring research platform

Progress on our second generation portable system specifically designed to collect 24 hour ambulatory physiologic data from human subjects is reported. The upgraded system has more sensor flexibility and better performance and is smaller, lighter, and simpler to use than our previous version. The new system continues to support a wide variety of sensors found useful for complementary and alternative medicine (CAM) research and has been designed using a modular approach for future expansion of capabilities. The system has improved data storage and supports popular physiologic data formats. Support for wireless control and real-time data monitoring has been added which demonstrates capabilities to be used for physiologic feedback control. The system was designed specifically to support the needs of investigators studying CAM mind-body interventions but could be used for a variety of research needs.

Patient decision aid on natural health products for menopausal symptoms: randomized controlled trial

Objective

To evaluate the impact of a patient decision aid (PDA) regarding the use of natural health products (NHPs) at menopause on decisional conflict, knowledge of NHPs, congruence between values and choice, persistence with an option, intention to disclose the use of NHPs to a physician or a pharmacist and intention to use decision support interventions in the future.

Study design

A randomized controlled trial in which 90 women, aged 45–64 years, facing a decision about using NHPs for menopausal symptoms, received a PDA (experimental group) or a general information brochure about menopause (control group).

Main outcome

Decisional conflict.

Measures

Women were evaluated at baseline and after a two-week period using the decisional conflict scale (DCS). Analysis of covariance was used to determine the differences between both groups on the DCS.

Results

Both groups experienced a statistically significant reduction on the DCS (−0.55 ± 0.59, P < 0.0001 versus −0.52 ± 0.73, P < 0.0001). However, there was no statistically significant difference between the groups ( P = 0.32). Both groups experienced a statistically significant improvement in knowledge of NHPs (0.86 ± 1.77, P = 0.002 versus 0.51 ± 1.47, P = 0.031). However, there was no statistically significant difference between the groups ( P = 0.162).

Conclusion

A PDA regarding the use of NHPs for menopausal symptoms impacted favourably on women's decisional conflict, but was not superior to a general information brochure on menopause.