Lack of data to support herbals for menopause symptoms, confirms panel
including hormone therapies that can pose a risk, an expert panel
called by the US government said this week.
However it advised that although there are a number of published studies on a variety of botanicals, "most have important limitations that make their findings unclear".
The 12-member panel, asked by the US National Institutes of Health to review the status of menopause treatment, said that the tendency among women and their doctors to medicalize menopause could lead to overuse of treatment approaches that are known to carry serious risks.
"For women who don't have very serious symptoms, waiting it out may be the best strategy," said Dr Carol M. Mangione of the University of California, Los Angeles, who chaired the panel.
The experts noted however that distinguishing symptoms associated with menopause from those that are simply the result of ageing is important.
"We found very few symptoms that are tied to the natural fluctuations in hormone levels during menopause, and this distinction may have serious implications for women's treatment decisions," added Dr Mangione.
Hot flashes, night sweats and vaginal dryness are strongly associated with menopause and there is also evidence linking sleep disturbances, the panel reported. But it found less evidence that menopause leads to mood swings, difficulty thinking, back pain and tiredness.
Supporting previous advice issued elsewhere, including in the UK, the panel stressed that women should consider carefully before deciding on treatment such as hormone therapy.
Many women have instead turned to natural remedies, with suppliers of soy phytoestrogens and herbals like black cohosh reporting good growth in the wake of studies showing the negative effects of hormone therapies.
But the NIH panel warned that the study of botanicals as treatments for hot flashes is still in its infancy. It claimed that many of these products are not standardized.
"There are major methodological problems associated with studying products that are not standardized. Basic research on dosing, factors that affect the metabolic processes of these products, and mechanisms of action is needed for this area of investigation to move forward on a solid foundation," said the panel.
Several studies of soy extracts suggested that they may have some mitigating effect on hot flashes, but for black cohosh, the most studied botanical product, there is little evidence for its efficacy.
But methodological issues compromise much of the existing research, and ongoing NIH trials should provide helpful data, concluded the panel.
