Concern over the adverse effects associated with traditional HRT has led to an increase in demand for alternative treatments.
Evidence set out in the new opinion paper written by the Scientific Advisory Committee of the Royal College of Obstetricians and Gynaecologists, examines some of these alternatives to HRT, highlighting studies conducted, possible benefits of treatments, but also harm that can be caused if they are taken without guidance.
Richard Warren, Honorary Secretary of the Royal College of Obstetricians and Gynaecologists says “The current interest and enthusiasm directed towards alternative treatments for menopausal symptoms is understandable, but the full risks and benefits of these alternatives are still unknown.”
Each case needs to be considered individually, in women with specific risk factors, a clinician should weigh up the advantages and disadvantages of alternative therapies compared to those of traditional HRT. Interactions with commonly used medications such as warfarin and anti-depressants can cause potentially fatal results.
Over 200 preparations exist but valuable scientific research has only been conducted on a few. Some treatments do not have sufficient scientific evidence to support their claims of relieving menopausal symptoms or of being able to equal the benefits of conventional therapies.
The overall effectiveness of alternative preparations indicates a 50-60% reduction in symptoms, considerably lower than the efficacy of traditional HRT which has 80-90% reduction in symptoms. However it is worth noting that some of the better researched preparations such as soy and red clover may have beneficial effects, not only on symptom relief but also on the skeleton and cardiovascular system. In terms of complementary interventions homeopathy also had encouraging results in the small scale trials that have been conducted. More research with well designed clinical trials are needed.
Further studies are required to assess long term safety and to research interactions with other medications. Some herbal preparations contain estrogenic compounds which may be of concern for women with hormone dependent disease such as breast cancer. The herb black cohosh has been linked to liver toxicity and in one instance a patient subsequently required a liver transplantation after a severe adverse reaction. Concern also surrounds the possibility of contaminants in the preparations of these products.
The European Union Directive has made progress in tightening safety and standards, making it mandatory for herbs to be registered, although the lack of supporting research data and evidence has so far held back licences; once granted, patients and health professionals will be able to have greater confidence in these products.
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