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Bitesize evidence: soy and black cohosh may reduce some menopausal symptoms

Q Which complementary and alternative medicine approaches are effective in reducing symptoms of menopause?

Synopsis

The goal of this systematic review was to

assemble all available clinical research evaluating any of the five categories of complementary and alternative medicine: biologically based (dietary supplements and vitamins), mind-body, energy, manipulative and body-based, and whole medical systems (such as ayurveda).

The review used the evidence report/

technology assessment methodology of the Agency for Healthcare Policy and Research. The authors searched multiple databases and reference lists of identified articles, contacted experts, and searched websites for randomised placebo-controlled trials and meta-analyses published in English. Much

of the literature on herbal therapies is

published in German, though it does not

appear that they excluded any applicable German-language studies. Two investigators independently evaluated the quality of the research using the criteria from the United States Preventive Services Task Force.

Although studies graded as poor quality found a benefit with soy supplements

(dietary, supplements or red clover), the effect on symptoms in fair or good studies was mixed, with some studies showing improvement in hot flushes. The largest study of black cohosh demonstrated a benefit in a

variety of menopausal symptoms. However, black cohosh has been linked in the UK to

abnormal liver function. Stress reduction, aerobic exercise and progressive muscle

relaxation were not effective in fair- or

poor-quality studies. One study of 10 treatments with low-force osteopathic manipulation showed a decrease in symptoms.

Neither reflexology nor magnet treatment were effective. Traditional Chinese medical herbs were also ineffective, as was acupuncture; ginseng produced improvement in mood and health scores but did not affect hot flushes.

Level of evidence

1a (see www.infopoems.com/levels.html)

Reference

Nedrow A et al. Complementary and alternative therapies for the management of menopause-related symptoms. Arch Intern Med 2006;166:1453-1465.

Bottom Line

There is no evidence of benefit of acupuncture, magnet therapy, stress reduction, exercise, progressive muscle relaxation or traditional Chinese herbal therapy on menopausal symptoms. Black cohosh, which has been associated with liver toxicity, and soy supplements may decrease hot flushes in some patients, and osteopathic manipulation was effective in one study.

This Patient Oriented Evidence that Matters (POEMs) is taken from InfoPOEMS/Inforetriever, a point of care evidence-based medicine tool, published by John Wiley. For more information

e-mail freynold@wiley.co.uk or visit www.infopoems.com

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