Herbal Product Use and Menopause Symptom Relief in Primary Care Patients: A MetroNet Study

Rhonda K. Dailey, M.D., Anne Victoria Neale, Ph.D., M.P.H., Justin Northrup, M.P.T., Patricia West, Ph.D., R.N., Kendra L. Schwartz, M.D., M.S.P.H.

Disclosures
In This Article

Abstract and Introduction

Objectives: The four study objectives were to determine (1) the prevalence of use of four herbal product types promoted to reduce menopause symptoms (phytoestrogens, St. John's wort, Ginkgo biloba, and ginseng) among primary care patients approaching or in menopause, (2) the extent to which women who use these types of herbal products report menopauserelated symptoms compared with herbal product nonusers, (3) the frequency of reported symptom reduction after use, and (4) if use was disclosed to their physicians.
Methods: A crosssection of ethnically diverse women 40-55 years of age (35.5% African American, 60.2% Caucasian) who were recruited from eight primary care centers in Michigan to complete a selfreport survey. The questionnaire included demographic items, health history, recent use of four herbal product types purported to relieve menopause symptoms and perception of symptom improvement, and interest in additional herbal product information.
Results: Of 397 women, 24.9% reported taking, in the previous 6 months, at least one of the four study herbs. Herbal product use did not vary by patient demographics or health characteristics. Herbal product users reported more menopause symptoms than nonusers, and 68% of the users said that the herbs improved their symptoms; 56.4% said that their physician was aware of their herbal product use.
Conclusions: Primary care patients experiencing common menopausal symptoms are likely to use herbal products that are purported to provide menopause symptom relief, and many believe that these products improve their menopausal symptoms. Healthcare providers should be aware of patient's positive attitude, use patterns, and lack of disclosure of use of herbal medicines. Inquiry of herbal product use is another way for physicians to learn about patient selfmedication of bothersome symptoms.

Natural menopause is defined as the point when menstruation ceases and is confirmed by and absence of a menstrual period in 12 consecutive months, excluding other obvious pathological or physiological causes. Induced menopause follows either surgical removal of both ovaries or ovarian damage by other medical means, such as chemotherapy.[1,2] Menopause often is associated with a variety of symptoms, including hot flashes, night sweats, palpitations, insomnia, depression, memory or concentration difficulties, and vaginal dryness.[3,4] Worldwide, natural menopause occurs between the ages of 45 and 55.[2] In the United States, the average age of onset of natural menopause is 51 years.[5] Currently, there are 32.6 million U.S. women who are 40-55 years of age,[6] and an estimated 75% of these will experience menopauserelated symptoms.[7] Until recently, the conventional treatment for menopausal symptoms was hormone replacement therapy (HRT). Studies have reported that 20% of eligible women are prescribed HRT, but up to 50% of these women discontinue treatment within 1 year because of fear of cancer or other concerns, such as vaginal bleeding, weight gain, or taking a daily pill.[8,9] In addition, the results of a recent and widely publicized randomized controlled trial concluded that the increased risks of combined HRT outweigh its benefits.[10]

Women for whom HRT is not advised and others who prefer not to use HRT may seek complementary or alternative medicine (CAM) sources for menopause symptom relief. CAM sources include physical approaches to menopause symptom relief (exercise, acupuncture, massage therapy), nutritional supplements (vitamin E, evening primrose oil), homeopathic remedies (lachesis, pulsatilla, sepia), and herbal remedies.[11,12] According to the results of the 1997 menopause survey from the North American Menopause Society (NAMS), 27% of women age 45-60 years took an herbal product for relief of menopause symptoms.[13] Four popular herbal remedies for menopause and their purported benefit are phytoestrogens (found in black cohosh and soy foods containing isoflavones) for vasomotor symptom relief,[4,11,14,15] St. John's wort to reduce depression and anxiety,[12,14,16] ginseng to reduce fatigue and hot flashes and to increase libido,[4,14,17] and Ginkgo biloba to improve memory loss and mental performance.[4,12,14]

Several investigators have described CAM use and knowledge among men and women in the general population,[18,19,20,21,22,23] specialist ambulatory care clinics,[24,25] or family practice clinics.[26,27,28,29,30] Although there are several reviews[4,11,12,15] and a study[31] that address common CAM treatments and herbal medications used by women to treat menopause symptoms, they did not focus on such use in primary care patients and did not reach a conclusion regarding perceived efficacy of herbal products for menopause symptom relief. The specific aims of our study were to determine (1) the prevalence of use of four herbal product types promoted to reduce menopause symptoms (phytoestrogens, St. John's wort, Ginkgo biloba, and ginseng) among primary care patients approaching or in menopause, (2) the extent to which women who use these herbal product types experience menopause symptoms compared with herbal product nonusers, (3) the frequency of reported symptom reduction after use, and (4) if use was disclosed to their physicians.

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