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Concerned about the health risks of conventional hormone therapy, women suffering from the symptoms of menopause are looking elsewhere for relief.
But little is known about the risks and benefits of most alternatives, scientists said at a recent conference at the National Institutes of Health. (For more information, go online to consensus.nih.gov.)
A summary of their presentations about the latest research:
Bioidentical, or 'natural,' hormones: Treatment with these hormones, which include estradiol, progesterone and testosterone, is based on the concentration of hormones in a woman's saliva. There is little scientific information about their benefits or risks.
Antidepressants: Effexor appears to reduce hot flashes more than placebo pills for at least several months, but about 10% of study participants stopped taking it because of nausea and vomiting. Paxil appears to reduce hot flashes more than placebo, with an increase in nausea, insomnia, lethargy and constipation among women on a higher dose of the drug. Prozac appears to be more effective than placebo, but not as effective as Effexor or Paxil in reducing hot flashes.
Acupuncture: May be effective in reducing hot flashes in some women.
Red clover leaf: Supplements Promensil and Rimostil contain estrogens from this plant. Although it's rich in estrogens, it appears to be no more effective than placebo in reducing hot flashes.
Tibolone: Tibolone, a synthetic steroid, is not available in the USA, but it has been used in Europe and Canada to treat menopause symptoms and prevent osteoporosis for nearly 20 years. The relatively few studies suggest that it reduces hot flashes and sleep disturbances, but it has been linked to pain, weight gain, headache and vaginal bleeding. In addition, long-term effects on breast cancer, cardiovascular disease or fracture risk are unknown.
Black cohosh: The main ingredient in the supplement Remifemin. Studies have had mixed results about effectiveness in alleviating menopause symptoms, but it appears to be well-tolerated when taken up to six months.
Soy extract: Although studies of soy extract have been mixed, it appears to be more promising than soy foods in reducing hot flashes. However, the makeup of soy-extract supplements varies widely, so they may not all be equally effective. In addition, little is known about short- or long-term side effects.
Kava: There is little evidence that this plant reduces hot flashes, and the Food and Drug Administration issued a consumer advisory in 2002 about its link to liver damage. Some countries have banned supplements containing kava.
Paced respiration: This type of slow, deep breathing, which requires training, appears to significantly reduce frequency of hot flashes and possibly intensity with no known harmful effects.
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