Complementary medicines and alternative therapies for early menopause

I think – there’s not really evidence for most of them but I think the important thing is not to be judgemental and make sure there’s nothing harmful. And some of the things, I think, people do find helpful. So I’m generally pretty frank because I don’t want people feeling they have to spend lots of money on those things, because they are very expensive.

But, you know, if something’s helping them and it’s not harming I don’t have a problem with that. Some women do like to try herbal therapies for hot flushes, and there’s mixed evidence around those. I think you have to be a bit careful with certain cancers. So I think for breast cancer you’d still be a bit reluctant perhaps to use some of the herbal therapies because you don’t really know what their effect might be.

I say, “Look, I don’t think there’s any evidence for acupuncture in terms of” – because often when I see women they’re using it to try and restore their ovaries rather than just for symptom relief. There’s not been good evidence for acupuncture or massage for symptom relief. But they certainly can make you feel better generally, they’re pleasant experiences. There’s nothing wrong with that so long as you don’t think that it’s going to make your ovaries work again.

How do you kind of talk to them about the possibilities of using alternative therapies and also using ‘Western medicine’?

I guess that’s a bit easier for me because I’m really familiar with the evidence in both camps. So I spend a lot of time looking at them, what works and what doesn’t for hot flushes, for example. And unfortunately not much really works, there’s isoflavones but, they might carry a little bit of a risk as well.

So it’s really being honest with women and saying, “Well, you need to make an informed choice. So what you’ve heard from friends and, the internet and, controversial books and controversial doctors even, that it may not be true. So let’s actually look at what’s going to be relevant for you and the evidence is that it is safe and there’s no evidence that these others things are safer.”

I’m quite happy for women to try certain things like, you know, meditation and the mind-body therapies can help. Acupuncture.

So when I say integrative background, it means that I’m willing to consider and offer to women all appropriate therapies, all available therapies that are appropriate so not just limited to what I’ve learnt in medical school. But I am a doctor first so I have to cover all of that first and the others I see more as adjunctive therapies and they’re never alternative therapies but they are other things that may help in conjunction with what I would normally do in usual care.

So I think it’s more the openness, if women come in and say, “Look, I heard about trying black cohosh or whatever it is or some maca powder”, people come in with all kinds of things – I think the main thing for them is that I’m not going to have this really negative reaction and so they feel comfortable in talking to me and so we usually come to a reasonable decision together.

But if they mention it to some other doctors, they’ve had a really hostile reaction, often made to feel stupid or that their opinion is not valid at all and I don’t think that’s in the spirit of shared decision-making. It’s more the paternalistic approach.

Alternative therapies, is this something that you recommend, or ask them to consider?

I don’t think you should ever rule them out. So we’ve done some research on alternative therapies here at our hospital. And by and large the treatment for vasomotor symptoms, that’s proven to be fairly unsatisfactory for hot flushes. We’ve also done some tests looking at the effect on bone, and again initially promising but then disappointing. On the other hand, I’ve been to meetings in Asia where alternative therapies, traditional Chinese medicine and so on have been shown to be very effective.

I’m not against people trying alternative therapies.

My big concerns with women who have premature ovarian insufficiency is that if they don’t get hormones, then their bones and their heart health are at risk. So I’d welcome them trying something for a short period of time, and if they say “Look, I feel great on this stuff,” then that’s fine by me. But I would say, “We really do need to watch these other important parameters for health, which we’ve never seen improve on the sort of complementary therapies that you’re using.” So I don’t rule them out, but I think we have to remember what place they have in the pantheon of treatments.

The thing about the menopause it’s a natural process. It’s not a disease. So we try and put the thing, “Well, if you don’t have to take anything you don’t want to take anything,” and there’s lots of natural things you can do. The black cohosh and red clover extracts haven’t been shown to have a lot of effect, but some people find that they do work. The same if it’s flushes the problem I often can use acupuncture, very simple acupuncture techniques using the wrist points and they get a switch effect and it turns it off. And after three treatments sometimes – it settles. So there’s a number of approaches you can use.

Do you have acupuncture services in town?

I’ve done it. I did a course back in the 1980s in [country name] and although I’m not a registered acupuncturist I regard it as part of my normal treatment. I do three treatments only and if it’s not enough then I’ll refer them on if they’re interested in that. But one of the things that we tell people about is it’s fine if you’re happy to do that.

But if you’re need to get that regularly it might not be appropriate because you’re spending a lot of time, spending money and we think there should be some sort of adjustment in your life or that you’re going to need to have a lot of treatment for. So that’s the approach we push. And we have a sort of a guide for people seeing non-traditional practitioners. If the first visit they say, “And when you come back for the next six times we’ll give you a discount and you have to sign up for eight visits,” it’s probably not going to be healthy treatment. And if people can get that through their head it’s a good idea. But some want that, that’s okay.

There are some naturopaths – so I’ve tried everything I can, I’m an expert, I can’t do anything – so, I have a couple of naturopaths that I will work with, and they believe that a combination of high protein diet and some herbs that they use may stimulate activity. So, when you’ve got nothing else up your sleeve, and these patients have all read about herbs, and I say, “There is no evidence base. Let me be very clear to you, there is no evidence base, but if you would like to do this for a couple of months, two or three months, there is no harm in doing it.” It’s not giving false hope, we’re very, very clear about the fact that there’s no evidence base but, people want to know you’ve tried everything.

I also, at that point, reinforce to the patient that there is a five percent chance of getting spontaneous activity at any time. My professional world is full of women who have had evidence of ovarian insufficiency and then had a good cycle and got a baby, do you know what I mean? Like there’s enough of that information to make it worthwhile.

So, I would say, go with the small chance that things will happen. If you want to try herbs, I can – and I only use one or two naturopaths that are not going to be there promising the world.

We talk about the short, medium and long-term strategies and how they can get through their day, and have sex, and what they want to do, and what different options there are. They might want to try herbs, then I’ll have to explain that there’s no good evidence about that in terms of bone density, but it’s worth – if they want to. Often they’ll want to try alternative strategies, not just to get pregnant, but actually for hormone replacement. So, yeah, that’s a long and involved and evolving discussion.

A lot of ladies say, “Oh well I want it to be natural,” but just because it’s natural doesn’t mean it’s good. I think it’s important that ladies understand that. That yes, natural is good but it may not help in the case of something like black cohosh that interferes with tamoxifen, so we really don’t want them taking that if they are on tamoxifen.

We try to suggest things like yoga, relaxation, those sorts of things that will help with their general wellbeing. Because, if people are well in themselves they are much more able to cope with life’s problems. So, we are very much looking at maintaining a healthy weight, eating a healthy diet, doing regular exercise.

You know a lot of people take comfort from them being non-prescription. “I don’t want to take a lot of drugs.” “Oh, it is a pill, but you don’t need a prescription, oh okay yeah.” They’re alright with that. They’ve had a lot of treatment for their cancer. And I think in general if you look in the community, people are embracing complementary therapies much more. I have a lot of people that go to the naturopath and they’re on XY and Z.