The role of complementary and alternative medicine in management of menopausal symptoms

Complementary and alternative medicine (CAM) has been defined by the National Center for Complementary and Alternative Medicine (NCCAM) as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine" [1]. Eisenberg et al [2] has defined CAM as "Interventions neither taught widely in medical schools nor generally available in US hospitals." NCCAM has classified CAM therapies into five domains: alternative medical systems, mind-body interventions, biologically based therapies, manipulative and body-based methods, and energy therapies (Box 1) [1]. What is considered "CAM" versus "conventional" is not universally agreed on, however, and is constantly evolving as CAM therapies become adopted into mainstream medical care. This is evident in the NCCAM categories, because many clinicians would consider patient support groups and cognitive-behavioral therapy as an accepted and routine part of health care. CAM therapies are widely used among women (Fredi Kronenberg, PhD, personal communication, 2004) [3] and are particularly promoted and used for menopausal symptoms, despite a relative paucity of scientific literature supporting safety and efficacy of such use. With the establishment of NCCAM and greater attention from the scientific community, CAM therapies increasingly are being examined in properly conducted randomized controlled trials (RCTs). This article builds on the review of Kronenberg and Fugh-Berman [4], published in 2002, and reviews studies of CAM therapies for menopausal symptoms, specifically vasomotor symptoms. A Medline search was conducted for January 2002 to February 2004 under the terms hot flash/flush, menopause, and climacteric, combined with phytoestrogens, alternative medicine, herbal medicine, traditional medicine, traditional Chinese medicine (TCM), Ayurveda, naturopathy, chiropractic, osteopathy, massage, yoga, relaxation therapy, homeopathy, aromatherapy, and therapeutic touch. From this search, RCTs of CAM therapies for with well-designed RCTs currently in progress. It is hoped that the results of these studies will increase the choices available for all menopausal women.