Abstract
For the purpose of this chapter, we operationally define alternative therapies (ATs) as medical interventions which are not usually used in conventional medicine. Other terms frequently employed to describe this sector include complementary, holistic, folk, traditional, natural or integrative (integrated) therapies/medicine.
Prevalence of Alternative Therapies: Use by Menopausal Women
For the purpose of this chapter, we operationally define alternative therapies (ATs) as medical interventions which are not usually used in conventional medicine. Other terms frequently employed to describe this sector include complementary, holistic, folk, traditional, natural or integrative (integrated) therapies/medicine.
Our systematic review (SR) of 26 surveys including 32 465 menopausal women found that on average 50.5 per cent of them reported using ATs specifically for their menopausal symptoms [1]. The 12-month prevalence of use was on average 47.7 per cent (range: 33.1–56.2). Nearly one-third of the surveyed women declared themselves to be current/regular AT users. Fifty-five per cent did not disclose their use of ATs to their conventional health care team. The majority of women sought information about ATs from the Internet, i.e. doctors or other health care professionals were often not considered as a source of information about ATs. The most popular AT was herbal medicine, followed by relaxation therapies and yoga. Alternative therapies were perceived as effective by 60.5 per cent of all women using them (range: 42–98.8).
Expectations of Patients Using Alternative Therapies
For many health care professionals, this popularity of ATs is somewhat puzzling. They point out that conventional medicine is today more effective than it ever has been, and that turning to uncertain alternatives is therefore less than rational. The reasons for the present boom in ATs are certainly not easy to define, and numerous factors are likely to play a role:
Incessant media hype
Disappointment with conventional medicine
Fear of side effects / hope for a cure without risk
Affluence
In this context, it is relevant to ask what patients expect from ATs. We have attempted to answer this question by conducting a systematic review of all 73 surveys that addressed this issue [2]. A wide range of expectations emerged. In order of prevalence, they included:
Hope to influence the natural history of the disease
Disease prevention and health/general well-being promotion
Being in control over one’s health
Symptom relief; boosting the immune system
Emotional support
Holistic care
Improving quality of life
Relief of side effects of conventional medicine
Good therapeutic relationship
Obtaining information
Supporting the natural healing process
Claims Made by Proponents of Alternative Therapies
Many patients with menopausal symptoms search the Internet in the hope of finding a safe and effective treatment for their condition. A woman using the Google search engine for ‘alternative treatments for menopause’ would currently be inundated by more than 5 million websites. Disappointingly, very few of these sources offer reliable information. Many seem to promote unproven or disproven treatments and some even discourage the use of proven conventional therapies.
Further evidence seems to confirm the assumption that women are frequently misled: after identifying the seven best-selling lay books on ATs, we assessed which treatments their authors recommended for a range of specific conditions. For menopausal symptoms, they advised 68 different ATs. There was very little consensus amongst the seven authors as to which treatments were recommendable, and the vast majority of the recommended therapies were not supported by sound evidence [3].
The Evidence for Alternative Therapies
Effectiveness
In an overview of the evidence from Systematic Reviews, randomized controlled trials (RCTs) and epidemiologic studies of ATs for the management of menopausal symptoms, we attempted to assess the existing data critically [4]. We found that some promising evidence was available for phytosterols and phytostanols for reducing increased low-density lipoprotein (LDL) and total cholesterol levels in postmenopausal women. Similarly, regular fibre intake seemed to be effective in reducing serum total cholesterol in hypercholesterolemic postmenopausal women. Black cohosh seemed to be effective therapy for relieving menopausal symptoms, primarily hot flashes, in early menopause. Phytoestrogens, including isoflavones and lignans, appeared to have only minimal effect on hot flashes but may have other positive health effects, e.g. on plasma lipid levels and bone loss [5]. Promising evidence also existed for the effectiveness of vitamin K, a combination of calcium and vitamin D as well as for a combination of walking combined with other weight-bearing exercise in reducing bone mineral density loss and the incidence of osteoporosis/fractures in postmenopausal women [6, 7]. In premenopausal women, encouraging evidence for the effectiveness of vitamin B6 supplementation has been found [8].
Relaxation therapies seem to have positive effects on menopausal symptoms [3]. For other commonly used ATs including probiotics, prebiotics, acupuncture, homeopathy and dehydroepiandrosterone sulfate (DHEA-S), placebo-controlled RCTs are scarce and the evidence was thus unconvincing [3]. Similarly, there is insufficient evidence for the effectiveness of other popular modalities such as yoga [4] or ginseng [9]. Our findings were confirmed in more recent reviews.1
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