Because of the serious health risks menopausal hormone therapy (MHT) poses, many health care providers have become interested in complementary and alternative medicine (CAM) for the treatment of menopausal symptoms. The National Center for Complementary and Alternative Medicine (NCCAM) says that MHT remains the most effective therapy to date for relieving severe and long lasting symptoms of menopause, but in most cases the harm of taking it outweighs the benefits.

NCCAM says that some CAM therapies, while not as effective as MHT, do ease the discomfort and some mild to moderate side effects of menopause. However, some of these alternative treatments may pose other health risks. Because there is little research to support the effectiveness of these alternative therapies, NCCAM advises women to discuss them with their health care practitioner to help ensure safety and a comprehensive treatment plan.

The following are descriptions of six botanical products and DHEA (dehydroepiandrosterone), a dietary supplement from Medline Plus, along with findings from the 2005 National Institutes of Health (NIH) conference panel on their effectiveness. These botanical products are called phytoestrogens, made from plant extracts that may have an estrogen-like activity in the body.

Black Cohosh:

• Description. Black cohosh is an herb made from the root of a perennial plant. It is popular for the treatment of menopausal symptoms such as hot flashes, mood swings, palpitations, and vaginal dryness. It comes in tablet, dried rhizome (root) and tincture/liquid form.
• Effectiveness. Studies have mixed results. Initial research suggests that it may improve symptoms for up to six months but results are not conclusive. Recent studies reveal that black cohosh does not act like an estrogen as once thought. Well-designed studies examining black cohosh use for longer than six months are needed.
• Safety. Although it is relatively safe when taken in recommend doses for up to six months, some research suggests that it may cause liver problems. That association, however, has not been proven. High doses may cause headaches, dizziness, perspiration, visual disturbances, constipation, intestinal discomfort, loss of bone mass, irregular or slow heart beat, low blood pressure, nausea, and vomiting.

Red Clover:

• Description. Red clover is a popular legume with components called isoflavones (soy) that are said to reduce symptoms of menopause, particularly hot flashes. For thousands of years, Russian and Chinese practitioners have prescribed red clover tea for other conditions including asthma, kidney stones, and skin conditions.
• Effectiveness. Five controlled studies found mixed results; therefore, no conclusive evidence on red clover’s effectiveness exists.
• Safety. Women report few side effects, and no serious health problems have been discussed. However, animal studies have raised concerns that red clover might have harmful effects on hormone-sensitive tissue such as the breast or uterus.

Dong-Hai:

• Description.  Dong-hai, also know as Chinese Angelica, is the most popular plant in traditional Chinese, Korean, and Japanese medicine. Because it is used primarily for conditions in women such as painful menstruation, pelvic pain or recovery from childbirth, it is often called the “female ginseng.” It’s said to have estrogen-like activity and is used in combination with other traditional Chinese herbs for relief of menopausal symptoms. Its medicinal use is in the root, with preparations also in dried root slices, fluid extract/tincture, and topical treatments.
• Effectiveness.  Only one randomized clinical study has been done; researchers failed to find it useful in reducing menopause symptoms and showed that it may not have short-term estrogen effects on the body.  However, more studies are needed.
• Safety. Dong-hai can increase the risk of bleeding if it interacts with an anticoagulant drug (i.e. Coumadin). Other side effects may include increased sun sensitivity and gastrointestinal symptoms (with prolonged use), headaches, dizziness, abnormal heart rhythms, blood pressure abnormalities, and kidney problems. Also with prolonged use it may be carcinogenic.

Ginseng:

• Description. For more than 2,000 years, the roots of this slow-growing plant have been valued in Chinese medicine for variety of applications including cancer prevention, reducing symptoms of coronary heart disease, to lower high blood pressure, and to enhance the immune system.
• Effectiveness. The NIH conference panel concluded that ginseng may help improve some menopausal symptoms such as mood swings, sleep disturbances and one’s overall sense of well being. However, it has proved unhelpful for hot flashes.
• Safety. There are no reported side effects of ginseng used in recommended doses and serious side effects are rare. Long term use may be associated with skin rash, itching, diarrhea, sore throat, loss of appetite, headache, fever, anxiety, depression, rapid heart rate, and nausea/vomiting.

Kava:

• Description. Kava beverages, made from the dried roots of a shrub, have been used ceremonially and socially in the South Pacific, originating in Europe in the 1700s. It typically has been used to reduce stress and anxiety.
• Effectiveness. Early studies show that it might be effective in reducing stress and anxiety but no evidence shows that it decreases hot flashes.
• Safety. The United States Food and Drug Administration (FDA) warns patients and physicians that kava is toxic to the liver. Many natural medicine experts believe kava is still safe in short-term recommended doses but further studies are needed.

Soy:

• Description. Soy is a subtropical plant, native to southeastern Asia. It grows from one to five feet tall, forming three to five pods of four beans each. For 5,000 years, Asian countries have used it as a dietary staple. Soy was introduced to the United States in the 1800s. Soy contains “isoflavones” that have proposed estrogen-like effects on the body. It can be found in many soy-based products including tofu, milk, and yogurt.
• Effectiveness. The scientific evidence is mixed with several human trials suggesting that it is does reduce menopausal symptoms, but recent research reports no benefits. The studies suggest benefits overall, but again, more conclusive evidence is needed.
• Safety. Taken as a food or dietary supplement for a short period of time, it poses no serious risks. An area of concern is whether isoflavones pose an increased risk for breast, uterine, and ovarian cancers along with blood clots. Soy is often associated with the thickening of the lining in the uterus but early research suggests it does not cause the same thickening of the uterus as estrogens do. Therefore, it may not pose the same risks as menopausal replacement therapy (MHT).

DHEA (dehydroepiandrosterone):

• Description. DHEA is a hormone made in the body and secreted by the adrenal gland. It is changed in the body into the hormones estrogen and testosterone. DHEA levels in the body begin to decrease after age 30. It is also manufactured and sold as a dietary supplement.
• Effectiveness.  When applied topically as a cream it may improve vaginal pain and discomfort associated with menopause. The only randomized study showed no benefit for menopausal symptoms while small, nonrandomized studies did.  However, overall early evidence suggest that it may not be an effective treatment for hot flashes or other emotional conditions occurring during the time of menopause like depression, anxiety, irritability, decreased sex drive, etc.
• Safety. NCCAM does not recommend that consumers use over-the-counter DHEA supplements for any health concerns, including for menopausal symptoms because little is known about its long-term safety. Because DHEA is a hormone, it may cause an imbalance of other hormones in the body and may increase the risk for developing prostate, breast and ovarian cancer.

Sources: National Center For Complementary And Alternative Medicine (NCCAM); and Medline Plus.