title: Use and perceived efficacy of complementary and alternative medicines after discontinuation of hormone therapy: a nested United Kingdom Collaborative Trial of Ovarian Cancer Screening cohort study.
abstract: OBJECTIVE
  Given that the Women's Health Initiative reported in 2002 increased risks of breast cancer and cardiovascular events with hormone therapy (HT) use and many women discontinued use, we assessed the use and perceived efficacy of complementary and alternative medicines (CAMs) for menopausal symptom relief after discontinuation of HT.
  
  
  METHODS
  Postmenopausal women aged 50 to 65 years within the United Kingdom Collaborative Trial of Ovarian Cancer Screening who were willing to take part in a secondary study were mailed a survey to evaluate menopausal symptom management. Use and perceived efficacy of CAMs for relief of vasomotor symptoms (VMS) upon discontinuation of HT were examined.
  
  
  RESULTS
  The survey was sent to 15,000 women between July 2 and July 9, 2008. Seventy-one percent (10,662 of 15,000) responded, and 10,607 women with complete data were included. Ever use of HT was reported by 60.2% (6,383 of 10,607). At survey completion, 79.3% (5,060 of 6,383) had discontinued HT, with 89.7% (4,540 of 5,060) of the latter reporting using one or more CAMs for VMS relief. About 70.4% (3,561 of 5,060) used herbal remedies, with evening primrose oil (48.6%; 2,205 of 4,540) and black cohosh (30.3%;1,377 of 4,540) being most commonly used. Exercise was used by 68.2% (3,098 of 4,540), whereas other behavioral/lifestyle approaches were less frequently reported (13.9%; 629 of 4,540). Contrarily, more women (57%-72%) rated behavioral/lifestyle approaches as effective compared with herbal remedies (28%-46%; rating ≥4 on a "helpfulness" scale from 1-10). Among medical treatments, selective serotonin reuptake inhibitors were used by 10% and rated effective by 72.1%.
  
  
  CONCLUSIONS
  Although more women use over-the-counter medicines, behavioral/lifestyle approaches seem to provide better relief of VMS. There is a pressing need for better evidence-based lay information to support decision-making on CAM use for relief of VMS.
authors.affiliation: From the 1Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; 2Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; and 3Department of Psychology, Institute of Psychiatry, Guy's Campus, King's College London, London, UK.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Gentry-Maharaj
authors.forename: Chloe
authors.initials: C
authors.lastname: Karpinskyj
authors.forename: Clara
authors.initials: C
authors.lastname: Glazer
authors.forename: Matthew
authors.initials: M
authors.lastname: Burnell
authors.forename: Andy
authors.initials: A
authors.lastname: Ryan
authors.forename: Lindsay
authors.initials: L
authors.lastname: Fraser
authors.forename: Anne
authors.initials: A
authors.lastname: Lanceley
authors.forename: Ian
authors.initials: I
authors.lastname: Jacobs
authors.forename: Myra S
authors.initials: MS
authors.lastname: Hunter
authors.forename: Usha
authors.initials: U
authors.lastname: Menon
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D000529:Complementary Therapies / Q000379:methods*; D015444:Exercise / Q000502:physiology; D005260:Female; D029001:Herbal Medicine / Q000379:methods*; D020249:Hormone Replacement Therapy; D019584:Hot Flashes / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013546:Sweating; D016896:Treatment Outcome; D006113:United Kingdom; D028761:Withholding Treatment