Learn about alternatives to HRT, such as lifestyle changes, other medications or herbal remedies for menopausal symptoms, herbal remedies · Other medications for. Women at the end of their reproductive age often complain of climacteric symptoms that can sometimes be quite debilitating. Physiological changes due to estrogen deficiency have received worldwide attention in search of an acceptable and safe measure to improve the quality of life of women suffering from these conditions. Hormone replacement therapy (HRT) used to be the primary treatment for symptoms of menopause.
Lately, there has been concern about its possible adverse effects, since they increase the risk of breast cancer, heart disease, etc. Complementary Alternative Medicine (CAM) plays an important role in alleviating these climacteric symptoms, especially in women with contraindications for hormonal therapy and those who are concerned about its adverse effects. It is important for women to know these complementary and alternative medicine techniques to provide them with options that allow them to improve their quality of life. This article explores other pharmacological and non-pharmacological measures as alternatives to hormone replacement therapy (HRT), to evaluate their usefulness and reliability based on available scientific evidence.
Climacteric symptoms are physiological events caused by poor ovarian function in many women over the age of 40. Almost 20% of them consider it intolerable. 1, 2 Hot flashes usually disappear within a year after the onset of menopause; but around a third of women suffer for a longer period of up to three or four years, 3, 4 For decades, hormone replacement therapy (HRT) has been recognized as the best treatment for menopause-related problems, especially hot flashes and vaginal dryness. Recently, there are concerns about their safety when a Women's Health Initiative (WHI) study reported a possible association between their use and an increased risk of heart disease and breast cancer, even though they are beneficial in reducing the risk of osteoporosis and endometrial and colorectal fractures and cancers.5 Currently, alternatives to HRT are considered an attractive option, although there is no substantial evidence of their benefits in relieving vasomotor symptoms due to menopause.
A study conducted in Bologna found that more than 30% of women with menopausal symptoms are taking complementary alternative medicine (CAM) and a quarter of them had used more than one product. It was also reported that 90% of doctors did not request information about its use in these MCAs. 6 There is concern that HRT may increase the risk of ischemic stroke in postmenopausal women, especially those at high risk of suffering from cardiovascular diseases. There is no evidence that HRT is useful for the primary or secondary prevention of stroke or coronary heart disease, 13,14 Although the absolute risk of developing breast cancer with HRT is small, this risk may increase if HRT is used for more than five years. WHI researchers reported a significant 26% increase in the relative risk of invasive breast cancer in women between 50 and 79 years of age who were treated with combined oral conjugated equine estradiol plus medroxyprogesterone acetate, compared to those who received placebo.5 Dementia is another age-related condition that affects quality of life.
A meta-analysis showed that women receiving hormone therapy improved verbal memory, motor speed, alertness and reasoning, but were not protected against the development of dementia. 15 In fact, HRT improves the deterioration of cognitive function if used after age 65, 16 neuroendocrine agents interfere with the adrenergic and neurosynaptic pathways to alleviate hot flashes and has been scientifically proven to be effective. Drugs such as methyldopa and veralipride significantly reduce symptoms, but can cause headaches as a side effect. 20 Clonidine (an α-adrenergic receptor agonist) is also effective, but is associated with difficulty sleeping. 21 75 mg of venlafaxine per day has been shown to reduce menopausal symptoms (61%) compared to placebo (20%).
However, follow-up studies showed that its effect had worn off after 12 weeks of use. It has side effects on the gastrointestinal and central nervous systems. Other drugs, such as paroxetine (25 mg per day) or fluoxetine, also showed similar effects, although for a shorter period four to six weeks. Side effects include possible sexual dysfunction, 22, 23 More women are turning to complementary and alternative medicine for the treatment of menopausal symptoms, although there is little scientific evidence to support the efficacy of its use.
Many small trials have demonstrated some significant effects of herbal products such as black cohosh, ginseng, dong quai, vitamin E, evening primrose oil, isoflavins in red clover, or phytoestrogens in soy supplements. However, the results of these studies, especially those of phytoestrogens, isoflavins and black cohosh, are contradictory 24,25 In a systematic review conducted by Kronnenberg and others. However, black cohosh (also popularly known as remifemine) seems to be a popular treatment for hot flashes. 26 Several small, controlled clinical trials have demonstrated that using black cohosh or remifemine for more than two to eight months may alleviate symptoms associated with low estrogen levels. However, care must be taken with its long-term use in humans, since no data has been collected or established on its possible adverse effects.
26 Clinical trials comparing estrogens with black cohosh preparations have demonstrated a low incidence of adverse effects associated with black cohosh; the main adverse effects observed were headaches, gastric discomfort, heaviness in the legs and weight problems, 27 the American College of Obstetrics and Gynecology (ACOG) has recommended short-term use of black cohosh (six months) for the treatment of menopausal symptoms, 28 red clover The extract contains isoflavones that are reported to be quite effective in reducing more severe hot flashes in some women. Unfortunately, most clinical studies failed to obtain significant differences compared to women treated with a placebo. There was no clear evidence about the best dosage and type of red clover products to be used, as the available data was limited.29 The ACOG has recommended the use of soy supplements for a short period (two years or less). It should be used with caution in women with potential estrogen-dependent diseases due to their estrogen-like effect on the reproductive system.
29 In countries such as Japan, Korea and China, it has been proposed that the high intake of soy products containing natural phytoestrogens or products containing isoflavones is one of the reasons for the low prevalence of menopausal symptoms among women in these countries 30. The use of soy products has become more popular in the United States, despite clinical evidence that their effectiveness is minimal. Comparing their effectiveness is difficult due to the short duration of research studies and the wide variety of soy products tested. However, many studies have shown that the beneficial effects of soy products on menopausal symptoms were seen after at least six weeks of use. Ginseng was found to improve women's psychological well-being, although it had no significant effect on improving menopause-related symptoms.31 Long-term use of ginseng could likely result in hypertension, edema, diarrhea, skin rashes, insomnia, depression, and amenorrhea, 31, 32 Despite strong evidence about the efficacy of HRT in relieving menopausal symptoms, many women (more than 90% in some Western countries) are seeking alternative therapy.
Non-pharmacological measures, such as regular exercise, balanced diet, relaxation therapy, yoga, meditation and spiritual guidance, although they may be useful for people, have not been scientifically proven effective. Non-hormonal pharmacological agents, such as antidepressants, are increasingly being used in women with severe climacteric symptoms that interfere with their quality of life. For mild climacteric symptoms, complementary and alternative medicine that has been proven to be effective, although without solid evidence, can help. The most common and popular alternative medicine uses black cohosh, soy products (contains phytoestrogens) and red clover (contains isoflavones), but keep in mind that they are not without side effects. The choice of treatment should take into account each woman's current and past medical history, concomitant medication, the type, severity and duration of climacteric symptoms, and the impact of symptoms on quality of life.
The risks and benefits of the various treatment options need to be clearly explained to you. Treatment should be reevaluated periodically, as vasomotor symptoms related to menopause will disappear over time without the need for any intervention in most women. National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894. You missed our webinar “What are the alternatives to HRT?” - you can see it here. Despite strong evidence of the efficacy of hormone therapy in relieving menopausal symptoms, many women (more than 90% in some Western countries) seek alternative therapy.
This is exactly what we discussed at this brilliant, live and free event with our panel of experts, where the co-founder of My Menopause Center, Dr. Clare Spencer, spoke about the prescriptive HRT alternatives you can get from your GP. Dr. Carolyn Eddleston, a former GP turned acupuncturist, spoke about the power of acupuncture to help alleviate symptoms, while Davide Ferrilli, a pharmacist, herbalist and nutrition expert, helped us navigate the often confusing world of herbal treatments and supplements.
Don Quai is one of the first alternative therapies to which potentially adverse effects have been attributed, since it potentiates the effects of the anticoagulant, warfarin. For decades, hormone replacement therapy (HRT) has been recognized as the best treatment for menopause-related problems, especially hot flashes and vaginal dryness. This is not an obvious improvement over the treatment effects achieved with whole soybeans and suggests that the effect of these compounds is small.
