Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Menopausal Symptoms and Plant-Based Therapies

JAMA; 2016 Jun 21; Franco, Chowdhury, et al

Publish date:

Modest reductions in the frequency of hot flashes and vaginal dryness were associated with composite and specific phytoestrogen supplementation in women with menopausal symptoms. This according to a meta-analysis of 62 studies and 6,653 individual women who participated in clinical trials that assessed plant-based therapies and the presence of hot flashes, night sweats, and vaginal dryness. Researchers found:

• Use of phytoestrogens was associated with a decrease in the number of daily hot flashes (pooled mean difference of changes, -0.31) and vaginal dryness score (-0.31) between the treatment groups and placebo but not in the number of night sweats (-2.14).

• Individual phytoestrogen interventions such as dietary and supplemental soy isoflavones were associated with improvement in daily hot flashes (pooled mean difference of changes, -0.79) and vaginal dryness scored (-0.26).

• Several herb remedies, but not Chinese medicinal herbs, were associated with an overall decrease in the frequency of vasomotor symptoms.

Citation: Franco OH, Chowdhury R, Troup J, et al. Use of plant-based therapies and menopausal symptoms. A systematic review and meta-analysis. JAMA. 2016;315(23):2554-2563. doi:10.1001/jama.2016.8012.

Commentary: Fifty to eighty percent of menopausal women report hot flashes or night sweats. Controversy remains about the degree of benefit in symptoms vs risk of increasing the incidence of breast cancer and cardiovascular disease with estrogen replacement. Because of the desire for treatment along with the concern about potential risk, approximately half of all women use an alternative therapy for treatment of perimenopausal symptoms.1,2,3 This meta-analysis shows that phytoestrogens, likely due to their molecular similarity to estrogen, are associated with a modest reduction in menopausal symptoms. Among herbs, the commonly used black cohosh did not show any effect, nor did the less commonly used dong quai. This study gives us guidance with regard to efficacy, showing that phytoestrogens do provide benefit in decreasing menopausal symptoms, but leaves the area of risk still undetermined as the size and length of the studies assessed would not adequately examine risk. —Neil Skolnik, MD
1. Rossouw JE, Prentice RL, Manson JE, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA. 2007;297(13):1465-1477.

2. Beral V, Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet. 2003;362(9382):419-427.

3. Vashisht A, Domoney CL, Cronje W, Studd JW. Prevalence of and satisfaction with complementary therapies and hormone replacement therapy in a specialist menopause clinic. Climacteric. 2001;4(3):250-256.

This Week's Must Reads

Must Reads in Women's Health