Saturday, 27th May, 2017

Splashes from the fountain of youth

Clinical Application: Managing Menopausal Symptoms with Plant-Based Therapies

Jenna Troup, MPH

Between 50-82% of menopausal women report vasomotor symptoms like hot flashes or night sweats, and managing menopausal symptoms is notoriously difficult. Indeed, symptoms often last for around four years after a woman’s last menstrual period, which occurs at age 51 on average in Western countries but can vary widely depending on lifestyle and ethnicity.

Concerns among women and healthcare providers about potential adverse health outcomes have led many to use non-hormonal complementary therapies. Despite inconclusive evidence about potential negative health outcomes associated with HRT, 40-50% of women in Western countries use complementary therapies, including oral plant-based supplements and other treatments to manage menopausal symptoms.

A systematic review and meta-analysis published this week in the Journal of the American Medical Association (JAMA) by ErasmusAge and collaborators at Cambridge University found that in 62 trials including 6,653 menopausal women, some plant-based therapies such as phytoestrogens reduced the number of daily hot flashes and reduced vaginal dryness. In addition to phytoestrogens, soy isoflavones, and red clover, the study also assessed newer herbal remedies such as St. John’s Wort, flaxseed and ERr 731, and reported associations with reduction in menopausal symptoms, however the number of available studies was too small to draw any firm conclusion on these new therapies.

Overall Effect of Plant-Based Therapies on Hot Flashes

In the table below (recreated from data from the published paper as well as analyses not included in the publication), note the effects of a variety of plant-based supplements on hot flashes, night sweats, and vaginal dryness. The “mean difference” indicates the average difference in number of hot flashes in 24 hours, for example, between women who used the therapy and those who did not. In most cases, treatment was done for 12 weeks.

Overall Effect of plant-based therapies on Menopausal Symptoms

The Role of Hormone Replacement Therapy for Menopausal Symptoms

While healthcare providers and women experiencing the menopausal transition may have concerns about the risks associated with HRT or any therapy for menopausal symptoms, recent care guidelines have indicated that estrogen-only HRT has little or no increase in the risk of breast cancer, and that HRT with estrogen and progestogen/progesterone can be associated with an increase in the risk of breast cancer, but any increased risk reduces after stopping HRT.

The most recent guidelines on care for menopausal women, the 2015 National Institute for Health and Care Excellence Guidelines from the United Kingdom, indicate the following, among other recommendations that clinicians should take a personalized approach to recommending any therapy, whether it is hormonal or not, and that clinicians and patients should have a detailed discussion of the risks and benefits of all treatments.

They should also note that women with cardiovascular risk factors should not automatically be excluded from taking HRT. Women and healthcare providers should note that HRT does not increase cardiovascular disease risk when started in women under 60 years of age, and it does not affect the risk of dying from cardiovascular disease.

References

Franco OH, Chowdhury R, Troup J, et al. Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis. JAMA. 2016;315(23):2554-2563. doi:10.1001/jama.2016.8012.

Hasper I; Ventskovskiy BM; Rettenberger R; Heger PW; Riley DS; Kaszkin-Bettag M. Long-term Efficacy and Safety of the Special Extract ERr 731 of Rheum Rhaponticum in Perimenopausal Women with Menopausal Symptoms. Menopause. 2009;16(1):117-31. doi:10.1097/GME.0b013e3181806446.

Heger M; Ventskovskiy BM; Borzenko I; Kneis KC; Rettenberger R; Kaszkin-Bettag M; Heger PW. Efficacy and Safety of a Special Extract of Rheum Rhaponticum (ERr 731) in Perimenopausal Women with Climacteric Complaints: A 12-week Randomized, Double-Blind, Placebo-Controlled Trial. Menopause. 2006;13(5):744-59.

Muka T, Oliver-Williams C, Colpani V, Kunutsor S, Chowdhury S, Chowdhury R, et al. (2016) Association of Vasomotor and Other Menopausal Symptoms with Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis. PLoS ONE 11(6): e0157417. doi:10.1371/journal. pone.0157417.

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