Considerable interest has been expressed by women regarding the use of complementary/ alternative therapies; approximately 60% women aged 45-55 years reported using them in a South Australian study. This may relate in part to availability without prescription and also the misconception that these compounds are “natural” and therefore safe. However, these remedies exhibit medicinal properties and there is increasing recognition of adverse effects including interaction with conventional pharmaceuticals. An explanation for the observed effect of many of these therapies is the placebo response of up to 58% seen in RCTs for vasomotor symptoms.

10.6.1 Phytoestrogens

Phytoestrogens are plant-derived oestrogen-like compounds which exhibit both agonist and antagonist properties. Genistein and daidzein, found in soybean, possess the greatest estrogenic activity. Despite observational studies indicating potential benefits of phytoestrogens in regard to cardiovascular risk factors, bone density and menopausal symptoms, meta-analyses of interventional studies show no benefit compared with placebo. Epidemiological evidence suggests an inverse association between phytoestrogen intake and the risk of breast or endometrial cancer; however, RCTs have demonstrated conflicting results with respect to breast cancer and the safety of phyto-oestrogens in this patient population is unknown.

10.6.2 Herbal therapies

Specific herbs purported to be efficacious for menopausal symptoms include ginseng, passion flower, St. John’ wort, valerian, balm, black cohosh, chaste tree and ginkgo; but, meta-analyses indicate no benefit compared with placebo. The long term safety of these therapies is unknown.

10.6.3 Alternative Therapies

There is a lack of high quality, consistent evidence in support of alternative therapies including acupuncture, yoga, homeopathy, cognitive behavioural therapy, paced respiration, relaxation therapy, reflexology and body manipulation in the management of menopausal symptoms.

10.6.4 “Bio-identical” hormone therapy

“Bio-identical” hormone therapy is the use of preparations (usually creams or troches) containing various amounts/ combinations of oestrogen, progesterone, testosterone, dehydroepiandrosterone, and other hormones prepared by compounding pharmacists.  They are often prescribed on the basis of salivary hormone testing results which can be inaccurate and are unsubstantiated. A common misconception is that they are safer than conventional HRT; however, there is no credible scientific evidence regarding efficacy and safety and as they may contain significant amounts of oestrogen, they are likely to carry similar risks (with anecdotal reports of endometrial carcinoma and pulmonary embolism associated with their use). One study demonstrated that topical progestogen-containing creams (either progesterone or plant-derived “yam” cream) do not provide effective endometrial protection. They are not TGA approved and the major menopause and endocrine societies do not support their use.

10.7 References

Content updated Deecember 2010