The use of complementary and alternative medications by menopausal women in South East Queensland

Chinese and Indian women's experience with alternative medications for menopause related symptoms: A qualitative analysis

OBJECTIVE

To explore women's rationalization for using alternative medications, their experience and view on safety of long-term use.

METHODS

Two focus group discussions, involving 5 participants each for Chinese and Indian groups, were conducted separately. Participant's personal information was collected anonymously. The discussion covered 5 areas: determinants for taking medications; reason for choosing alternative medications rather than hormone replacement therapy (HRT); how these medications help them; their view on cost-effectiveness and concerns over long-term use. The discussions were audio-taped, transcribed and analyzed.

RESULTS

Chinese participants took supplements for controlling symptoms while Indian participants used herbs as a preventive measure during menopause according to their tradition. Women of both groups mentioned that they did not take HRT because of fear of side effects. Chinese group mentioned that medications remarkably improved their symptoms whereas Indian participants appreciated their herbals more for improvement in general wellbeing than for specific symptoms. All members agreed that using alternative medication was cost-effective. Both Chinese and Indian participants were quite confident in saying that long-term use will not be associated with any side effects. However, Indian group emphasized that proper preparation of herbal compound using different types of leaves, is essential in order to avoid untoward effects.

CONCLUSIONS

Chinese and Indian women used alternative medicine in prevention and treatment of menopause-related problems even as they were avoiding HRT because of the fear of side effects. They believed that their supplements were effective, safe and cost-beneficial even with long-term use.

The use of traditional medicine in maternity care among African women in Africa and the diaspora: a systematic review

BACKGROUND

There is a paucity of literature describing traditional health practices and beliefs of African women. The purpose of this study was to undertake a systematic review of the use of traditional medicine (TM) to address maternal and reproductive health complaints and wellbeing by African women in Africa and the diaspora.

METHOD

A literature search of published articles, grey literature and unpublished studies was conducted using eight medical and social science databases (CINAHL, EMBASE, Infomit, Ovid Medline, ProQuest, PsychINFO, PubMed and SCOPUS) from the inception of each database until 31 December 2016. Critical appraisal was conducted using a quality assessment tool (QAT).

RESULT

A total of 20 studies conducted in 12 African countries representing 11,858 women were included. No literature was found on African women in the diaspora related to maternal use of TM or complementary and alternative medicine (CAM). The prevalence of TM use among the African women was as high as 80%. The most common TM used was herbal medicine for reasons related to treatment of pregnancy related symptoms. Frequent TM users were pregnant women with no formal education, low income, and living far from public health facilities. Lack of access to the mainstream maternity care was the major determining factor for use of TM.

CONCLUSION

TM is widely used by African women for maternal and reproductive health issues due to lack of access to the mainstream maternity care. Further research is required to examine the various types of traditional and cultural health practices (other than herbal medicine), the beliefs towards TM, and the health seeking behaviors of African women in Africa and the diaspora.

Meanings of Menopause

Attitudes and sociocultural perceptions provide the context within which women experience menopause. Cultural influences greatly affect how women perceive and manage their menopausal symptoms. Cultures may be categorized based on way of life, including traditional, immigrant, and modern. Varying perceptions and symptom experiences are described, including modifiable and nonmodifiable factors that affect the level of distress women feel with menopause. Helping women actively participate in management of menopausal symptoms including self-care strategies will contribute to feelings of control of menopausal symptoms and overall health. By using the highest levels of evidence regarding management of menopause, becoming familiar with the cultural and psychosocial influences of menopause and then empowering women to make decisions regarding management, health care providers can improve their care of perimenopausal and menopausal women.

Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use

BACKGROUND

There is increasing evidence that complementary medicine (CM) services are being used by a substantial proportion of the Australian population and this topic has attracted keen interest from primary health care providers and policy makers. This article outlines the first summative critical review of the predictors of CM use in Australia as well as the characteristics and perceptions of Australian CM users over the last 14 years.

METHODS

A literature search was conducted to ascertain original research from 2000 to 2014 in the AMED; CINAHL; and PubMed databases. Selected articles were subject to a critical appraisal analysis to identify the quality of the article. The search was confined to peer reviewed original articles published in English which identified the nature of CM services use in Australia.

RESULTS

The findings indicate a correlation between CM users and gender, with reports of a higher rate of use from females compared to males. Female CM users are more likely to be middle-aged with a higher education and higher annual income in comparison to female non-CM users. An association between resident location and use of CM disciplines was also identified with reports of rural residents utilising manual therapies more frequently compared to urban residents. CM users are more likely to seek CM services for a range of chronic conditions including diseases identified as National Health Priority Areas by the Australian Government.

CONCLUSIONS

This article provides the first comprehensive review examining the nature of CM use in Australia. The review findings offer important insights into the characteristics and features of CM use in Australia and provide insights for national and regional primary health care initiatives and of interest to medical doctors, allied health professionals, CM practitioners, researchers and policy makers.

A survey of the availability in Canadian pharmacy chains of over-the-counter natural health products for menopause symptoms

BACKGROUND

Menopause is a natural phase in a woman's aging process, characterized by the cessation of menstruation. Women who are going through the menopause transition can experience physiological symptoms that significantly impact their quality of life. Concern about adverse effects of traditional hormone therapy often leads women to purchase over-the-counter (OTC) natural health products (NHPs). The goal of this study was toinvestigate the range of OTC NHPs for menopause available to Canadian women, and the packaging information they can access to make self-management decisions.

METHODS

Edmonton stores belonging to each of nine Canadian pharmacy chains were visited to identify NHPs marketed for the relief of menopausal symptoms. Details were extracted from the packaging: a) product name and manufacturer, b) Health Canada license number, c) medically active ingredients, d) claims of efficacy, e) contra-indications and warnings, and f) daily cost. Data were entered and analyzed using Microsoft Excel.

RESULTS

We identified 20 OTC NHP menopausal products, 19 of which had Health Canada license numbers. Twenty-eight medically active ingredients were identified, with the most common being black cohosh (in 14 products) and soy isoflavones (n = 7), chaste tree (n = 5), and dong quai (n = 3). Most products claimed they would relieve vasomotor symptoms, including hot flashes (n = 14) and night sweats (n = 10). Each product had a labeled contraindication for at least one specific condition. Costs per recommended daily dose ranged from $0.07 to a maximum of $2.50 (CAD$).

CONCLUSION

Natural health products for menopausal symptoms are easily available to Canadian women. The lack of clear evidence of product efficacy makes the need for easily accessible, balanced information on this topic important for women to make well informed choices.

Critical review of complementary and alternative medicine use in menopause: focus on prevalence, motivation, decision-making, and communication

OBJECTIVE

This study aims to undertake the first critical review of complementary and alternative medicine (CAM) use among menopausal women (a term here used to include premenopausal, perimenopausal and postmenopausal women) by focusing on the prevalence of CAM use and CAM users' characteristics, motivation, decision-making, and communication with healthcare providers.

METHODS

A comprehensive search of 2002-2012 international literature in the Medline, CINAHL, AMED, and SCOPUS databases was conducted. The search was confined to peer-reviewed articles published in English with abstracts and reporting new empirical research findings regarding CAM use and menopause.

RESULTS

A considerable level of CAM use was observed among women in menopause. Many menopausal women use CAM concurrently with their conventional medicine. However, communication regarding CAM between menopausal women and healthcare providers seems less than optimal, with a demand for further information on the safety and efficacy of medicines. Existing literature is of variable methodological rigor, often presenting small sample sizes and low-quality data collection. Further rigorous research on this topic-including quantitative and qualitative methods using large national samples, where relevant-is required.

CONCLUSIONS

The findings of this critical review provide insights for those practicing and managing health care in this area of women's health. Healthcare providers should prepare to inform menopausal women about all treatment options, including CAM, and should be aware of the possible adverse effects of CAM and potential interactions between CAM and conventional medicine among women in menopause who are under their care.

Menopausal symptoms of postmenopausal women in a rural community of Delhi, India: A cross-sectional study

Background:

There is very little data on the consequence of menopause on women in South East Asia region, especially from rural India. Importance is always given to reproductive health from menarche to menopause. Menopausal health demands priority in Indian scenario due to rising population of postmenopausal women.

Objectives:

The aim was to determine the mean age at attaining menopause and the prevalence of various self-reported menopausal symptoms complained by postmenopausal women (40-54 years). Furthermore, to determine the prevalence of anxiety and depression among postmenopausal women.

Materials and Methods:

A cross-sectional study was conducted in a rural area of New Delhi among 252 postmenopausal women from October 2011 to March 2013. A pretested, self-designed, semi structured, interview based, oral questionnaire was used. The Statistical Package for Social Sciences software Version 21.0 (SPSS) was used for analyses.

Results:

The mean age at attaining menopause was 46.24 (Standard Deviation = 3.38) years. Only 4 (1.6%) postmenopausal women had premature menopause. A total of 225 (89.3%) postmenopausal women experienced at least one or more menopausal symptom(s). The most common complaints of postmenopausal women were sleep disturbances (62.7%), muscle or joint pain (59.1%), hot flushes (46.4%) and night sweats (45.6%). A total of 32.1% (n=81) postmenopausal women suffered from depression and 21.0% (n=53) postmenopausal women suffered from anxiety.

Conclusion:

It is necessary to critically introspect health needs of postmenopausal women and specific components can be incorporated in the national health programs.

Determination of the use of complementary and alternative medicine by women in the climacteric period in the Turkish city of Samsun

This quantitative descriptive study was carried out in order to determine the use of complementary and alternative medicine (CAM) for management of menopausal symptoms in women in Samsun, Turkey. Data on general demographic characteristics, menopause-related symptoms, and the use of CAM and herbal therapy were collected from 281 women undergoing the process of the climacteric period, admitted to the gynaecology polyclinic of a hospital in Samsun province. To evaluate the data, descriptive statistics, Student t-tests, and logistic regression analysis were used. In this study the most common CAM methods were identified as herbal therapy (29.9%), dieting (29.5%), exercise (29.2%), and massage (27.8%). Approximately one-third of the women identified as benefitting from CAM methods. More than half identified as not having informed a health care professional about their use of these methods of achieving symptom relief.

A longitudinal study of the impact of chronic psychological stress on health-related quality of life and clinical biomarkers: protocol for the Australian Healthy Aging of Women Study

Background

Despite advancements in our understanding of the importance of stress reduction in achieving good health, we still only have limited insight into the impact of stress on cellular function. Recent studies have suggested that exposure to prolonged psychological stress may alter an individual’s physiological responses, and contribute to morbidity and mortality. This paper presents an overview of the study protocol we are using to examine the impact of life stressors on lifestyle factors, health-related quality of life and novel and established biomarkers of stress in midlife and older Australian women.

The primary aim of this study is to explore the links between chronic psychological stress on both subjective and objective health markers in midlife and older Australian women. The study examines the extent to which exposure frightening, upsetting or stressful events such as natural disasters, illness or death of a relative, miscarriage and relationship conflict is correlated with a variety of objective and subjective health markers.

Methods/Design

This study is embedded within the longitudinal Healthy Aging of Women’s study which has collected data from midlife and older Australian women at 5 yearly intervals since 2001, and uses the Allostastic model of women’s health by Groër and colleagues in 2010. The current study expands the focus of the HOW study and will assess the impact of life stressors on quality of life and clinical biomarkers in midlife and older Australian women to explain the impact of chronic psychological stress in women.

Discussion

The proposed study hypothesizes that women are at increased risk of exposure to multiple or repeated stressors, some being unique to women, and the frequency and chronicity of stressors increases women’s risk of adverse health outcomes. This study aims to further our understanding of the relationships between stressful life experiences, perceived quality of life, stress biomarkers, chronic illness, and health status in women.

Demographic, behavioral, and health correlates of complementary and alternative medicine and prayer use among midlife women: 2002

OBJECTIVE

This study investigated the demographic, behavioral, and health correlates of the most frequently used types of complementary and alternative medicine (CAM) therapy and the use of prayer for health among midlife women. We also examined the extent to which women used CAM for treatment of health conditions, including menopausal symptoms, and for general health and well-being.

METHODS

Data from the 2002 National Health Interview Survey (NHIS), a cross-sectional, household survey representative of the U.S. civilian adult population, were used. Midlife women aged 40-59 years (n = 5849) were analyzed. Bivariate prevalence estimates were obtained, and binomial logistic regression models were estimated; all analyses were weighted.

RESULTS

Overall, 46% of midlife women used any type of CAM in the past 12 months, and 54% reported using prayer for health reasons. The top five specific CAM therapies used were herbs and natural products; relaxation techniques; chiropractic care; yoga, tai chi, or qi gong; and massage. Multivariate results demonstrated different patterns of association between demographic, health, and behavioral characteristics and specific CAM therapies. A higher percentage of women used chiropractic care for an existing health condition than those using relaxation techniques, and few women used CAM specifically for menopausal symptoms.

CONCLUSIONS

CAM and prayer are frequently used by midlife women, and herbs and natural supplements are the mostly frequently used. The findings underscore the importance, particularly in the clinical setting, of asking women about their use of individual CAM therapies. Such clinical assessment is also important because of the potential for interactions of CAM therapies with prescribed therapies.

"They're made in factories and not by witches on the allotment": a qualitative study of midlife women in the united kingdom, exploring their approaches to complementary and alternative medicines

This article explores midlife women's experiences and approaches related to complementary and alternative therapies (CAMS). Ninety-six midlife women were asked about their use of CAMs as part of their overall approach to midlife health. Qualitative thematic analysis was combined with a case-based approach. Women set their experience of CAMs in the context of conventional medicine taking and discussed their safety and different uses. For treatments requiring direct contact with a practitioner, accessibility and quality of the relationship were crucial. Four overall approaches could be discerned (political-critical, pragmatic, careful and wellbeing-oriented) that dynamically interacted with women's experiences.

The use of Complementary and Alternative Medicine by women experiencing menopausal symptoms in Bologna

Background

The present study describes Complementary and Alternative Medicine (CAM) use amongst Italian women transitioning through menopause. Popularity and perceived effectiveness of CAM treatments, use of pharmaceutical medications, characteristics of CAM users, the extent of communication between medical practitioners and women about their use of CAM, and variables associated with CAM use were also investigated.

Methods

Women, aged 45-65 years attending Family Planning and Women's Health clinics or Menopause Centres in Bologna were invited to complete a voluntary, anonymous, self administered questionnaire, which was used in a previous study in Sydney. The questionnaire was translated and adapted for use amongst Italian women. Data on general demographic and health characteristics, menopause related symptoms and the use of CAM and pharmaceutical treatments during the previous 12 months were collected.

Results

In total, 1,203 women completed the survey, of which 1,106 were included in the final sample. Of women who had symptoms linked with menopause and/or used remedies to alleviate symptoms, 33.5% reported to have used CAM. Among these, 23.5% had consulted one or more practitioners and 24% had used at least one CAM product.

Approximately nine out of ten respondents reported medical practitioners did not seek information about their use of CAM; while one third of CAM users did not disclose the use of CAM to their physician. Nevertheless, medical practitioners were the most popular source of information. From the multivariate analysis, variables associated with CAM use were: professional employment, time since the last natural menses, use of CAM for conditions other than menopause, and presence of some severe symptoms.

Conclusions

The relatively high prevalence of CAM use by women transitioning through menopause should encourage research initiatives into determining which CAM treatments are the safest and effective. The increasing and likely concomitant use of CAM with HRT and other pharmaceuticals underlines the need for the implementation of a surveillance system to report and monitor possible drug-herb adverse events. The discrepancy between women preferring to seek information about CAM from their medical doctor and the difficulties noted in communication between doctor and patient should encourage educational initiatives on CAM by health-care agencies and institutions.

A randomized placebo-controlled trial on the effectiveness of an herbal formula to alleviate menopausal vasomotor symptoms

OBJECTIVE

To evaluate the effectiveness of a formula containing Chinese herbs and Cimicifuga racemosa in alleviating vasomotor symptoms and improving quality of life.

METHODS

Between September 2004 and October 2005, 93 healthy women aged 45 to 65 years who reported six or more vasomotor symptoms per 24 hours were recruited into a 20-week randomized, double-blind, placebo-controlled trial. Women were consulted in clinics conducted within the Sydney metropolitan area. After a 4-week baseline period, women were randomly allocated to receive herbal (equivalent to 3,150 mg dry herb) or identical placebo tablets for 16 weeks. Women recorded the number and severity (1 = mild to 4 = very severe) of vasomotor symptoms in a daily hot flash diary and completed the Greene Climacteric and Hot Flash Related Daily Interference scales at each monthly consultation.

RESULTS

Intention-to-treat and per-protocol analyses found no statistically significant differences in mean hot flash scores (product of frequency and intensity), Greene Climacteric Scale scores, and Hot Flash Related Daily Interference Scale scores between the placebo and herbal treatment groups after 16 weeks of intervention.

CONCLUSIONS

This herbal formula containing Chinese herbs and Cimicifuga cannot be recommended to alleviate menopausal vasomotor symptoms or improve quality of life.

Women's health during mid-life survey

OBJECTIVE

To survey the extent of complementary and alternative medicine (CAM) use among women for the alleviation of menopausal symptoms.

DESIGN

A total of 1,296 eligible women aged 45 to 65 years were recruited from three Sydney menopause clinics, general practice clinics, and government agencies between July 2003 and July 2004. Volunteers were invited to complete a 19-item questionnaire covering basic demographics, general health status, use of CAM therapies and products, use of pharmaceuticals, and sources of CAM advice.

RESULTS

Of respondents, 53.8% had visited a CAM practitioner and/or used a CAM product during the past year, with 34% using a product only and 5% consulting a practitioner only. The most commonly visited practitioners were naturopaths (7.2%) and acupuncturists (4.8%), whereas the most popular products were soy (25.4%) and evening primrose oil (18.4%). Massage, chiropractic, and nutrition were rated the most effective therapies, and phytoestrogen tablets, evening primrose oil, and black cohosh were deemed the most effective products. Of the 59.9% of respondents currently using prescription or over-the-counter pharmaceuticals, 62.5% reported using CAM products during the past 12 months. Of CAM users 71% had informed their doctor about CAM use, whereas 26.4% of respondents reported their doctor had inquired about CAM use.

CONCLUSIONS

CAM use by women to alleviate menopausal symptoms is common, with several therapies perceived to be effective. Although a significant proportion of women may use CAM in conjunction with pharmaceuticals, relevant communication between medical practitioners and patients remains inadequate and may expose the patient to potential drug-herb interactions.

Factors associated with the use of complementary medicine and non-pharmacological interventions in symptomatic menopausal women

BACKGROUND

Hormone replacement therapy is now thought to have serious adverse effects; consequently, many menopausal women are seeking to use complementary and alternative medicine (CAM), including non-pharmacological interventions (NPI), to alleviate symptoms. The prevalence and perceived effectiveness of CAM and NPI for ameliorating menopausal symptoms are not widely known and factors likely to predict CAM and NPI utilization for menopausal symptom management have not been comprehensively documented.

OBJECTIVES

The objectives of this study were to (1) determine the prevalence of using CAM and NPI for menopausal symptoms; (2) describe the perceived effectiveness of CAM and NPI for symptom management; and (3) investigate lifestyle and demographic factors associated with CAM/NPI use among menopausal women with vasomotor symptoms.

METHODS

Women aged 46-55 years were recruited via six socioeconomically diverse general practices. Participants completed a postal questionnaire that contained items relating to demographics, lifestyle factors, weight, height, exercise behavior, menopausal status, vasomotor symptoms and utilization and perceived effectiveness of a range of CAM/NPI for symptom management.

RESULTS

Of 1,206 women who responded, 563 (47%) were symptomatic. The most commonly used CAM/NPI for symptom management were diet/nutrition (44.3%), exercise/yoga (41.5%), relaxation/stress management (27.4%) and homeopathic/naturopathic remedies (25.4%). Of women who used these interventions, large proportions reported them to be helpful. The characteristics that were independently associated with use of CAM/NPI were White ethnicity, being physically active, and not smoking.

CONCLUSIONS

Many menopausal symptomatic women are using a wide range of CAM/NPI and report these to be effective, particularly those who are white, physically active and do not smoke.

US women desire greater professional guidance on hormone and alternative therapies for menopause symptom management

OBJECTIVE

Women increasingly use alternative therapies for menopause symptom relief. We examined 1) current use and perceptions of hormone and alternative therapies for symptom relief among US women, and 2) healthcare provider involvement in women's decision making.

DESIGN

An online survey was completed by a national sample of 781 US women aged 40 to 60 years (72% survey completion rate) drawn from the Knowledge Networks panel in June 2004. Nationally representative estimates of women's use and perceptions of hormone and alternative therapies were made by accounting for sampling weights and survey design.

RESULTS

Hormone therapy was reported among 263 or 37% of this largely symptomatic sample, of whom 59% had stopped primarily due to concern about its potential risks. Herbal products and soy supplements separately were used among 31% and 13% of symptomatic women, of whom 41% and 67% were current users. Forty-four percent of herb users considered these products helpful with symptom relief. Sampled women generally felt ill informed about proper doses and usage of herbal products. Also, 58% of the sampled women expressed at least some concerns about these products, whereas proven safety was the most important factor when women consider such products. Despite considering healthcare providers the most reliable source of information, sampled women expressed low confidence in their ability to give sufficient information about treatment options for menopause symptoms.

CONCLUSIONS

Alternative therapies have become increasing popular and are quickly approaching hormone therapy in frequency as therapies for symptom relief among menopause-age women in the United States. However, large gaps exist between patient expectations and provider preparedness to guide patient decision making.

Complementary and hormonal therapy for vasomotor symptom relief: a conservative clinical approach

Vasomotor symptoms are the most common menopausal symptom experienced by women and the leading reason menopausal women seek health care advice. The recent shift towards a more conservative use of hormone therapy (HT) during menopause has prompted the need for treatment regimens to be individualized according to symptom severity. Our objective was to develop a new algorithm that enables practitioners to customize treatment regimens according to symptom severity. In order to develop a comprehensive treatment algorithm, we conducted a literature review and considered the findings from recently published treatment guidelines from around the world. We also evaluated the results of systematic reviews investigating the efficacy and safety of complementary and alternative medicines. We found a growing trend away from prescription HT in women with mild to moderate symptoms and an increasing trend toward lifestyle modification and the use of complementary and alternative medicines. On the basis of these findings, we have developed an algorithm that accounts for symptom severity. The algorithm presented here provides treatment options based on symptom severity and a comprehensive approach for integrating lifestyle modifications and complementary therapies with prescription treatment regimens.