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Case History

image A 54-year-old woman comes complaining of hot flushes. She does not wish to take hormone replacement therapy (HRT) and wants to discuss alternative and complementary therapies.

What is available and what is the evidence of efficacy?

What are the safety issues?

Are there interactions with standard medication?


image Many women wish to use alternative and complementary therapies in the belief that they are safer and 'more natural' following media scares and uncertainties regarding oestrogen-based HRT.1,2 Although individual trials suggest benefits from certain therapies (Table 17.1), data are insufficient to support the effectiveness of any complementary and alternative therapy for the management of menopausal symptoms.3

Table 17.1Alternative and complementary therapies for the management of menopausal symptoms

What is available and what is the evidence of efficacy?


Phytoestrogens are plant substances that have effects similar to those of oestrogens. The role of phyto-oestrogens has stimulated considerable interest, as women from populations that consume a diet high in isoflavones, such as the Japanese, are reported to have fewer hot flushes.4,5 The most important groups are called isoflavones and lignans. The major isoflavones are genistein and daidzein. The major lignans are enterolactone and enterodiol. Isoflavones are found mainly in soybeans, chickpeas and red clover. Oilseeds such as flaxseed are rich in lignans, and lignans are also found in cereal bran, whole cereals, vegetables, legumes and fruit. The evidence from randomized placebo-controlled trials for soy and derivatives of red clover is conflicting.6

Herbal remedies

A wide variety of herbal remedies exist but little is known about efficacy, safety and toxicity.

Black cohosh is used widely to alleviate menopausal symptoms. Results from placebo-controlled trials or comparison with conjugated equine oestrogens are conflicting.6

Evening primrose oil is rich in gamma-linolenic acid. One small, placebo-controlled, randomized trial showed it to be ineffective for treating hot flushes.1,2

Dong quai is used commonly in traditional Chinese medicine. It was not found to be superior to placebo in a randomized trial.1,2

Ginkgo biloba is widely used, but little evidence shows that it improves menopausal symptoms.

Ginseng is used extensively in eastern Asia but randomized trial data do not show it to be superior to placebo.1,2

Other herbs. St John's wort, agnus castus, liquorice root, valerian root and wild yam cream are also ...

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