Use of plant-based therapies and menopausal symptoms

1. This systematic review found that there was an association between overall phytoestrogen use and the degree of hot flashes and vaginal dryness in menopausal women.

2. There was no association between phytoestrogen use and night sweat symptoms, nor were there any significant associations between menopausal symptoms and the use of other complimentary therapies.

Evidence Rating Level: 3 (Average)

Study Rundown: Menopause is widely known to be associated with hot flashes, night sweats, and vaginal dryness. While medications, like hormone replacement therapy, can be used to reduce these symptoms of menopause, they are associated with significant negative health consequences. Thus as many as 40-50% of women in western nations choose to try complementary therapies—like plant-based medications including phytoestrogens, herbal remedies, and other medicinal herbs—to relieve their symptoms. Many randomized controlled trials have been performed to assess the safety and efficacy of these complimentary therapies, and this systematic review aimed to rigorously analyze the results in aggregate. The study found that there was an association between overall phytoestrogen use and the severity of vaginal dryness and the number of daily hot flashes. There was no association with phytoestrogens and the frequency of night sweats. Data from other forms of complimentary therapies were limited and robust conclusions could not be drawn.

While this study is the first to systematically review the literature on complimentary therapies and menopausal symptoms, it is limited in a few ways. As in all systematic reviews, publication bias and other unmeasured confounders may be affecting the final results. Additionally, the quality of included studies was mixed, and included a wide range of study populations and treatments. Overall, however, the study suggests that phytoestrogen supplementation may reduce the severity of some menopausal symptoms. The limitations mentioned warrant further, large-scale studies on this topic.

Click to read the study in JAMA

Relevant Reading: Dietary flour supplementation decreases post-menopausal hot flashes: effect of soy and wheat

In-Depth [meta-analysis]: This study aimed to quantify the effects of plant-based therapies on the reduction of menopausal symptoms. The primary outcome measure was the pooled mean change in frequency of menopausal symptoms. A total of 5218 studies were identified, and after exclusion criteria, 62 randomized control trials (from Europe, Asia-Pacific, and North America) were included, which, in aggregate, studied 6653 women with baseline ages between 18-75 years. Intervention duration lasted between 4 weeks to 2 years, but the majority had a 12 week intervention period. Six of the trials showed high risk of bias in 1 domain, 10 in 2 domains, 14 in 3 domains, and the remaining RCT’s showed high risk of bias in 4 or more domains. The analysis showed an association of overall phytoestrogen use with a decrease in the number of daily hot flashes (pooled mean difference of changes between treatment groups -1.31, 95%CI -2.02 to -0.61) and in vaginal dryness scores (pooled mean difference of changes between treatment groups -0.31, 95%CI -0.52 to -0.10). The use of phytoestrogens was not associated with significant changes in the 24-hour frequency of night sweats.

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