Menopausal Women Don't Get Enough Guidance On Treatment Options, Stanford Survey

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Menopausal Women Don't Get Enough Guidance On Treatment Options,

Stanford Survey Shows

http://www.medicalnewstoday.com/medicalnews.php?newsid=45362

Few women are consulting their doctors before opting to use herbal

therapies and soy products to treat their menopausal symptoms,

researchers at the Stanford University School of Medicine have found.

The trend is of particular note because growing numbers of women are

turning to alternative therapies to relieve such symptoms as hot

flashes, headaches, mood swings and sleep disruptions because of

concerns about health risks associated with hormone therapy, which is

still considered the most effective way of treating such

difficulties. The researchers recommend that physicians learn more

about these products so that they can help their patients choose

safe, effective methods of treating their symptoms.

" We're not promoting the use of these alternative therapies, " said

lead author Jun Ma, MD, PhD, research associate at the Stanford

Prevention Research Center. " We're just saying that the demand for

these therapies is growing and that physicians should be prepared to

talk to their patients about it. "

The study appears in the May/June issue of The Journal of the North

American Menopause Society. The study was funded by GlaxoKline

Consumer Healthcare, which had no role in the study design, data

collection or preparation of the manuscript for publication. The

pharmaceutical company manufactures the herbal product RemiFemin

Menopause.

The study was based on a 2004 online survey of a random sample of 781

U.S. women between the ages of 40 and 60. Because the sample size was

small, Ma cautioned that the findings may not accurately represent

all women, but said the data provide useful insights into women's

attitudes toward menopause treatments and how much physician guidance

they have received in deciding which therapies to use.

Among the women surveyed, nine out of 10 reported having experienced

at least one menopausal symptom at some point. When it came to

treating their symptoms, 37 percent reported using hormone therapy

while slightly less than that - 31 percent - used herbal products.

Soy supplements were used by 13 percent.

What interested Ma and her colleagues was that three-quarters of the

women who had formerly taken hormone therapy said they stopped

primarily because of concern about potential risks. " A majority of

the women who had discontinued their hormone therapy were not on any

therapy - not because of lack of need or desire to continue, but

because they didn't know which therapy would best suit their clinical

needs, " Ma said.

The concerns about hormone therapy stem largely from the federally

funded Women's Health Initiative, a long-term study that turned the

conventional wisdom about hormone therapy on its head. For many

years, observational studies indicated that in addition to relieving

menopausal symptoms, hormone therapy helped protect women against

heart disease. However, the WHI found that neither estrogen nor the

combination of estrogen and progestin helped prevent heart disease.

Instead, although both forms of hormone therapy offered some benefits

in easing menopausal symptoms, they both posed substantial health

risks.

Despite these risks, hormone therapy is still considered the most

effective approach for treating menopausal symptoms. Women are

advised to use the lowest possible dose of hormones and to limit the

duration of the treatment in order to minimize the risks.

But the new study shows that many women are instead turning to herbal

and soy products to ease their menopausal symptoms. The most commonly

used herbal products reported by survey participants were ginkgo

biloba, ginseng, St. 's wort, black cohosh or a combination

product.

" The reduced use of menopausal hormone therapy, while an appropriate

response to the WHI findings, has left both patients and their

physicians in a difficult position, " said Randall S. Stafford, MD,

PhD, associate professor of medicine and senior author of the

study. " While other pharmaceuticals and alternative therapies are

available, many physicians are not fully prepared to discuss these

options, particularly given the limited data available about the

effectiveness of these options. "

Among the women who used herbal therapies, 55 percent chose the

products because of concerns about hormone therapy while 45 percent

said they wanted to use a natural remedy. But Ma said many women

mistakenly equate the term " natural " with " safe, " and falsely believe

that herbal products won't interact with other medications. " That

misperception really needs to be corrected, " she said.

In fact, herbal products may have side effects. For instance, some

studies have shown that St. 's wort interacts with selective

serotonin-reuptake inhibitors, which are the most commonly prescribed

class of antidepressants, and it is recommended that the two not be

combined.

Additionally, Ma said there is little in the way of high-quality data

on the efficacy of many of the alternative therapies, adding that

most of the data are limited to short-term use of the products.

The women in the study regarded physicians as their most-trusted

source of information about alternative therapies, yet many said they

didn't get enough guidance in choosing a remedy for their menopausal

symptoms. Nearly 75 percent of the women said that they - not their

doctors - initiated discussions about possible treatments for their

symptoms. And when it came to alternative therapies, 20 percent of

the women weren't confident in their doctors' ability to discuss the

treatments knowledgeably.

" Hormone therapy is unique in that patient preference is important in

deciding what therapy to use, " Ma said. " A balanced dialogue is

essential because it's a treatment decision that a physician should

make with a patient, not for a patient. "

Ma suggested that physicians know enough about alternative menopause

therapies to put them in four categories: those that have data

suggesting some effectiveness, those that have data demonstrating

concerns about side effects, those with neutral data and those

lacking any data.

" It's OK to tell patients that little is known about a product,

despite any anecdotal stories they may have heard. Anecdotal stories

should not be taken as a substitute for rigorous clinical evidence, "

Ma said.

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