Boyond Hormones

Women Are Looking to Change Their ‘Change of Life’ Treatment Options

By Melinda T. Willis
ABCNEWS
June 20

If you're afflicted with mood swings and hot flashes, it may be time to get back to your roots — your licorice roots, that is.
Women are on the hunt for a proven, natural alternative to treat the uncomfortable and disruptive symptoms that accompany menopause, brought about by decreases in levels of the female hormones estrogen and progesterone. Each day in the United States, about 4,000 women enter menopause.

And it's not just hot flashes, vaginal dryness and mood swings. Osteoporosis is a complication that is also associated with this drop in hormones.

While hormone replacement therapy, or HRT, is currently the "gold standard" of treatment, its potential side effects make some women ineligible and others unwilling to receive it. That's led to an increased interest in alternative, non-synthetic treatments such as herbs.

"I think we're seeing a greater awareness for women and their practitioners to look at options, to look at alternatives," Dr. JoAnn Pinkerton, associate professor of obstetrics and gynecology at the University of Virginia in Charlottesville and director of the Women's Place Midlife Health Center, told ABCNEWS' John McKenzie.

There are many herbal treatments for menopause that are available in health food stores, including black cohosh, red clover, dong quai and licorice root. And experts say that women are taking them in large numbers.

"Anywhere from 40 to 60 percent of women in midlife are using them alone or in combination [with other therapies]," says Stacie Geller, director for the Center of Excellence in Women's Health in the department of obstetrics and gynecology at the University of Illinois at Chicago.

Yet while such natural remedies are commonly used and readily available, little is known about these treatments — how they work, how they should be taken and for which symptoms and perhaps most importantly, if they will interact dangerously with other medications.

HRT to Herbs

At the same time, the risks of commonly prescribed HRT can be serious. Long-term use is associated with an increased risk of breast cancer. Blood clots and related vascular problems may also occur.

"It is still good for [preventing] bone loss, but many women are afraid of the risk of breast cancer," says Fredi Kronenberg, director of the Rosenthal Center for Complementary and Alternative Medicine at Columbia University in New York.

And hopes that HRT may confer heart-protective benefits have also been dashed by recent research. "Everyone [once] hailed it as a wonderful [all-purpose] treatment, but the science has not backed that up," says Geller.

The hope is that herbal alternatives will improve symptoms without carrying these risks. However, that remains to be determined through close scientific scrutiny.

"The problem with alternative supplements is that they have not gone through the same rigors of scientific testing as HRT has," says Arlette Perry, a researcher with the School of Education at the University of Miami.

Several researchers are trying to change that. Medical centers from Chicago to New York to Miami are conducting the kinds of rigorous scientific trials that will pit these herbs against placebos and HRT to find out exactly how safe and effective these treatments really are.

And many are hopeful that some herbs, black cohosh in particular, will prove promising. A plant grown in the Eastern United States, it's sold here as a dietary supplement. But in many parts of Europe, it's a popular prescription drug for menopausal hot flashes.

The U.S. government is now funding a 12-month study of black cohosh, following up on years of German research. "The weight of that data suggests it is beneficial," says Kronenberg. "We wouldn't be spending time and money and hours doing a clinical trial if we thought this wouldn't work."

Treating the Symptomss

Women are also turning to non-herbal alternative approaches such as biofeedback and acupuncture to manage their menopausal symptoms. Also important are diet and exercise, which can help preserve bone and improve mood for some women. Vitamin E and soy may provide relief for hot flashes, according to some research.

Despite all the alternatives, for about a quarter of women going through menopause, the hot flashes are so severe and so frequent — occurring more than a dozen times a day — the only effective treatment is hormone replacement.

Regardless of the approach, experts say women need to understand what their motivation is in seeking treatment and how lifestyle changes can play a key role in alleviating symptoms.

"It is important to look at what is bothering you — what your symptoms are and what you want," says Geller. "There is a huge interaction effect between menopausal symptoms and what is happening in your life."

While future research may give women more options for coping with the inevitable symptoms of this late-life change, experts also point to the need for change in the way that women are coming to view menopause as a whole.

"Women are seeing menopause as a more natural event — they don't want to turn it into a disease state," says Geller. "They see it as a natural life transition and don't want to medicate themselves their whole lives."