Yale Nursing Researcher Explores Alternative Therapies For Menopausal Discomfort
New Haven, CT — May 30, 1998
Menopausal women who fear the ill effects of prescription estrogen are presented with myriad alternative therapies to manage their symptoms, but there is little objective information available about the efficacy and even the safety of these therapies.
Yale researcher Susan Cohen, director of the Yale School of Nursing's Adult Nurse Practitioner Program, is undertaking studies to explore two alternative therapies - acupuncture and the herb black cohosh. Cohen's research has been guided not by a particular interest in alternative medicine, but by her interest in women's health.
"Women have been told, 'Take your estrogen,' but they are clearly not comfortable doing that," said Cohen.
While estrogen can prevent osteoporosis and help relieve hot flashes and other discomforts associated with menopause, there is also a suspected relationship between the hormone in its prescription form and breast cancer. While most physicians will prescribe estrogen for menopausal women, less than half these women will fill their prescriptions, said Cohen. Within a year, some studies show, only 20 percent of the women for whom estrogen was prescribed will be taking the hormone.
Cohen describes estrogen as a "key" that fits into various "locks" in the body, known as estrogen receptors. When the key fits into the lock, many of the unpleasant side effects of menopause are relieved. But when the lock turns, more significant changes, some undesirable, take place. Advocates of plant-based estrogen or phytoestrogen, like that found in soy products, believe that alternative therapies are keys that fit into, but do not turn, the locked estrogen receptors.
In search of these "safe keys," some women turn to herbal therapies. But Cohen cautions that anyone can call his or herself an "herbalist." Great claims can be made by herbalists and the popular press, as is the case with St. John's Wort, touted as "Nature's Prozac," a safe, non-prescription anti-depressant. "St. John's Wort is a bad choice for people with severe clinical depression," said Cohen. "We need more good, scientific studies on herbal therapies."
Cohen has already worked with a graduate student on an encouraging pilot study of black cohosh and plans a larger study of the herb's effectiveness controlling hot flashes. The herb has been used for at least 300 years for the relief of "women's complaints" and is native to the eastern United States. In Germany, it is sold in pill form as a remedy for menopausal symptoms. Europe is generally ahead of the United States in the availability and understanding of herbal remedies, said Cohen. While herbs had long been the physician's prescriptive mainstay, sweeping turn-of-the-century changes in medical education in the United States caused most doctors to abandon traditional herbal remedies.
Acupuncture is a more regulated form of treatment. Acupuncturists are licensed, said Cohen, and so women can feel confident about exploring that option. But, more work needs to be done to test acupuncture's effectiveness in combating hot flashes and other menopausal discomforts, she added. Cohen is beginning a study of acupuncture's effectiveness in relieving menopausal symptoms in breast cancer survivors. Many breast cancer survivors cannot take or are afraid to take prescription estrogen. Chemotherapy can cause perimenopausal symptoms to occur at an earlier age and, some research suggests, can make symptom management more difficult.
Practitioners of Eastern medicine believed that the body's life force flows along defined meridians. If these meridians become blocked, illness occurs. Acupuncture is believe to clear the blockage. A more Western interpretation would be that acupuncture triggers reactions in the body that lead to the release of endorphins, the body's natural pain reliever. Though studies have confirmed acupuncture's utility in pain relief, Cohen said that more investigation must be done to determine what sites give relief for menopausal symptoms and how many treatments are necessary to see a benefit.
Menopause is a natural process, said Cohen, and not all women want or need interventions to control its symptoms. But the baby boomers entering menopause do face challenges that their mothers did not. "If you have a hot flash in the middle of an important business meeting, it may be a much bigger deal than if you have one while you're doing the laundry," she explained. In a culture that routinely medicates headaches and colds, the demand for interventions around menopause is predictable, Cohen added. "This is the first generation of women who have been able to control their fertility," she noted. Today's menopausal women expect to have more control over their bodies than their mothers did.
"I'd like to be able to offer these women alternatives that are well tested," said Cohen.
