Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials.
BACKGROUND
Women commonly use soy products, herbs, and other complementary and alternative medicine (CAM) therapies for menopausal symptoms. Randomized, controlled trials have evaluated the efficacy and short-term safety of these therapies.


OBJECTIVE
To review randomized, controlled trials of CAM therapies for menopausal symptoms in order to better inform practice and guide future research.


METHODS
Searches of MEDLINE for articles published from January 1966 through March 2002, of the Alternative and Complementary Database (AMED) of the British Library for articles published from January 1985 through December 2000, and of the authors' own extensive files. Search terms were hot flash/flush, menopause, and climacteric, combined with phytoestrogens, alternative medicine, herbal medicine, traditional medicine, Traditional Chinese Medicine (TCM ), Ayurveda, naturopathy, chiropractic, osteopathy, massage, yoga, relaxation therapy, homeopathy, aromatherapy, and therapeutic touch.


METHODS
29 randomized, controlled clinical trials of CAM therapies for hot flashes and other menopausal symptoms were identified; of these, 12 dealt with soy or soy extracts, 10 with herbs, and 7 with other CAM therapies.


METHODS
Each author extracted information from half of the studies on the number of patients, study design, outcome measures, and results; the other author then checked these results.


RESULTS
Soy seems to have modest benefit for hot flashes, but studies are not conclusive. Isoflavone preparations seem to be less effective than soy foods. Black cohosh may be effective for menopausal symptoms, especially hot flashes, but the lack of adequate long-term safety data (mainly on estrogenic stimulation of the breast or endometrium) precludes recommending long-term use. Single clinical trials have found that dong quai, evening primrose oil, a Chinese herb mixture, vitamin E, and acupuncture do not affect hot flashes; two trials have shown that red clover has no benefit for treating hot flashes.


CONCLUSIONS
Black cohosh and foods that contain phytoestrogens show promise for the treatment of menopausal symptoms. Clinical trials do not support the use of other herbs or CAM therapies. Long-term safety data on individual isoflavones or isoflavone concentrates are not available.
Kronenberg
Fredi
F
Rosenthal Center for Complementary and Alternative Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, Box 75, New York, NY 10032, USA.
Fugh-Berman
Adriane
A
D015670:Acupuncture Therapy; D001521:Behavior Therapy; D000529:Complementary Therapies; D004032:Diet; D004968:Estrogens, Non-Steroidal / Q000627:therapeutic use; D019584:Hot Flashes / Q000628:therapy*; D006801:Humans; D007529:Isoflavones / Q000627:therapeutic use; D008593:Menopause / Q000502:physiology*; D009824:Ointments; D048789:Phytoestrogens; D028321:Plant Preparations / Q000627:therapeutic use; D011374:Progesterone / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D030262:Soybean Proteins / Q000627:therapeutic use; D014810:Vitamin E / Q000627:therapeutic use
D004968:Estrogens, Non-Steroidal; D007529:Isoflavones; D009824:Ointments; D048789:Phytoestrogens; D028321:Plant Preparations; D030262:Soybean Proteins; D014810:Vitamin E; D011374:Progesterone