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Which complementary medicines work for menopause?

Professor of complementary medicine Edzard Ernst and colleagues continue our series on which complementary therapies work, which don’t and which might cause harm in treating menopausal symptoms

Professor of complementary medicine Edzard Ernst and colleagues continue our series on which complementary therapies work, which don't and which might cause harm in treating menopausal symptoms

The physiological end of regular menstruations is often accompanied by mood changes, hot flushes, night sweats, insomnia, vaginal dryness, decreased libido, impairment of cognitive function, and other symptoms.

The exact cause of most of these complaints is still not completely understood. Concerns about HRT have recently emerged and many women are keen to try complementary therapies for controlling these troublesome symptoms. Herbal supplements and homeopathy seem particularly popular.
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Clinical bottom line

Likely to be beneficial

Ginkgo (Ginkgo biloba) Data suggest that it improves cognitive function in menopausal women but no effect on menopause-associated depression.

Red clover (Trifolium pratense) Seems to reduce the frequency of hot flushes.

St John's wort (Hypericum perforatum) Seems to improve mild-to-moderate depression.

• Relaxation Preliminary data imply positive effects on hot flushes but it is unclear which type of relaxation is best.

Trade-off between benefits and harms

Black cohosh (Actaea racemosa) Seems to reduce depression and improve sleep quality but data on vasomotor symptoms are contradictory and it has been associated with liver damage.

• Kava (Piper methysticum) Seems to reduce anxiety but has been associated with liver damage.

Unknown effectiveness

• Acupuncture Results are contradictory for symptom control.

• Fennel (Foeniculum vulgare), a pollen extract Reduces hot flushes, according to preliminary data.

• Osteopathy Not enough data available for hot flushes.

• Soy/phytoestrogens Data highly contradictory for symptom improvement.

• Vitamin E Data contradictory.

Unlikely to be beneficial

• Ginseng (Panax ginseng) No improvement of quality of life, hot flushes or vaginal cytology.

Likely to be ineffective or harmful

• Dong quai (Angelica sinensis): No evidence of effectiveness.

• Evening primrose (Oenothera biennis) oil: no evidence of effectiveness for bone density, hot flushes.

• Kudzu (Pueraria lobata) No evidence of effectiveness.

• Wild yam (Dioscorea villosa) No evidence of effectiveness.

Conclusions

Ginkgo, red clover, St John's wort, relaxation, black cohosh and kava may be effective in relieving menopause-associated symptoms such as hot flushes and depression.

Black cohosh and kava have been associated with liver damage. Interactions of St John's wort need to be considered. None of the other treatments are burdened with serious risks.

The risk-benefit balance for ginkgo, red clover, St John's wort and relaxation is likely to be positive.

Conventional HRT is supported by stronger evidence than complementary and alternative therapies for controlling menopausal symptoms.

Professor Edzard Ernst is professor of complementary medicine at Peninsula Medical School, Universities of Exeter and Plymouth.

Dr Max Pittler is senior research fellow in complementary medicine.

Barbara Wider is research fellow in complementary medicine.

Kate Boddy is information officer in complementary medicine.

This is an extract from the Oxford Handbook of Complementary Medicine, which offers evidence-based analysis of therapies www.oup.com/uk ISBN 978-0-19-920677-3

Evidence St John's Wort could be a useful herbal remedy for treating depression in menopausal women St John's Wort could be a useful herbal remedy for treating depression in menopausal women

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