herbal treatment of menopause - julia green
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Changing With Herbs
Randomised, controlled pilot study of the
effectiveness of treatment of menopausalproblems by medical herbalists
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Background
More research on herbs than any
other form of CAM
mostly on single plants and extracts
little on synergy
almost none on practitioner based
herbal therapy
examine the whole package of care
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What is Herbal Medicine ?
Use of PLANTS as medicine 30-35% of drugs based on plant compounds
(aspirin, contraceptive pill, digoxin, gaviscon, ephedrine, morphine)
oldest form of medicine: herbal from China
2500BC
Probably most common form of medicine
world-wide (WHO) more modern research into herbal medicine
than any other CAM therapy
herbalists use whole plant extracts rather
than isolated plant chemicals
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Why Herbal Treatment of the
menopause? Common reason for consulting
herbalist (Beatty and Denham survey)
evidence from RCTs of effectiveness
of single plant extracts (soy, black
cohosh, red clover, sage,) at
alleviating symptoms it fits well into herbalists
multifaceted, holistic approach
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Who could benefit from herbal
treatment of the menopause? Women not wishing to take HRT
women who cannot tolerate HRT side
effects
women for whom HRT is
contraindicated e.g with personal or
family history of breast cancer or
thrombosis
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CONSULTATION WITH A
HERBAL PRACTITIONER Series of consultations throughout the
treatment process comprising:
full medical and drug history appropriate physical examinations
diagnosis
nutritional and lifestyle advice individualised care plan
prescription of individually formulated
herbal remedies adapted at eachconsultation.
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How do we view the
menopause?
Pennell Report
A natural life
event
experiencedby nearly all
women
around 50. It
is part of thenormal ageing
process
Caused by failure of
endocrine organs
which leads eventuallyto accelerated
frequency of illness,
disease and disability.
It is amenable totreatment through HRT
and other therapies
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Menopause May be problem free - natural event
some women have symptoms
for some these cause problems
permanent cessation of periods
average age UK 51 large range of ages
may also follow hysterectomy
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Menopausal symptoms
Vasomotor : hot flushes, night sweats,
palpitations
somatic: headaches, joint aches, vaginaldryness, tingling and numbness, breast
tenderness, breathing difficulties,
mental: tiredness, difficulty sleeping, poor
memory and concentration, mood swings,panic attacks, anxiety, depression, loss of
libido
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Method 1 randomised, controlled trial, using
outcomes measures.
This method was chosen after
consultation with patients,
practitioners, academics, GPs and
statisticians. Suitable for examining a holistic
package of care, which is part of a
complex system of treatment
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Method 2subjects: 45 women volunteers aged 45-59
from one Bristol GP practice, with self
defined menopausal problems
block randomised with
twice as many control as
intervention patients
Treatment group (n=15)
6 appointments in 5 months
with NIMH herbalist
outcomes measures by postat designated time points
Control group (n=30)
wait 4 months for treatment
outcomes measures by
post at designated timepoints
then offered treatment
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Outcome measures Greene Climacteric scale.
validated scale, easy to use.
Mymop2
patient centred scale which
includes a quality of life element
Hot flush visual analogue scale
(VAS).
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Inclusion / exclusion criteria
Aged 45-59
not had a period for 3 months
suffering menopausal problems for 3months or more
not in the last 3 months had HRT or other
hormone treatment, taken tamoxifen or
had general anaesthetic no other CAM treatment for menopause
no current psychiatric treatment
not advised by Dr to take HRT because of
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Funding
National Institute of Medical
Herbalists
National Institute of Medical
Herbalists Education Fund
Research Sponsor University of
Central Lancashire
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GP practice of 5000 252 letters to women 45-59 not on HRT
161 replies (64%)
of these 161, 45 recruited
116 excluded
1 met criteria and wanted to enter butwas number 46, so too late!
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Herbal treatment of the menopause recruitment
GP practice of 5000
Data search for women age 45-59 not on HRT
252
send letters inviting these women to participate
161 replies
telephone these women and discuss inclusion/ exclusion criteria
45 entered into trial 116 excludedcomplete baseline outcome measuresblock randomised to
15 treatment 30 control
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Reasons for exclusion of 116
82 still menstruating
18 with no symptoms
9 on hormone therapy (HRT, mirena coil, minipill )
2 natural progesterone cream
1 tamoxifen trial
2 osteoporosis
4 psychiatric treatment or medication
6 couldnt cope with project (MRSA, ME, MS, allergies,chemotherapy, pituitary adenoma)
12 CAM therapy (9 herbal, 2 homeopathic, 1 acupuncture)
3 move away
3 lose touch
1 wanted to enter but was number 46!
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Details of 45 recruits
12 on medication(thyroxine,
analgesics, diuretics,
inhalers, antacids)
8 on supplements 21 had been offered
HRT
10 had taken HRT
but stopped becauseof side effects or
been on 9 yrs and
told to stop
Of those declining HRTreasons given
4 could cope with
symptoms
4 not want to interfere witha natural process
5 not want long term
medication
6 had side effects 2 concerned with safety
1 FH breast Ca
1 concerned about pregnant
mares used to produce
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Recruits experience of herbal
medicine
31/45 had taken herbal medicines in
some form before
(69%)
13/45 had consulted a herbalist before
(29%)
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Recruits expectations on entry n=45
27 expected some improvement in symptoms
10 had no expectations
5 expected at least no harm 4 expected a holistic approach and lifestyle
change
1 expected a better sense of wellbeing
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Current status of trial
Treatment
(n=15)
12 completed 2 ongoing
1dropped out
(6 operationson leg,
MRSA)
Controls (n=30)
28 complete all questionnaires
27 request treatment
20 take up treatment 8 completed treatment
9 ongoing
8 drop out (dislike taste, difficult
to fit in appointments andlifestyle advice, not want to do
questionnaires, taking Chinese
herbs, hormone treatment, ?)
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Mymop 2 activities chosen by 45 recruits
Activities affected by menopause Number of women
selecting this n=45
%
Exercise (walking, jogging,
cycling, gym, yoga, jiving, skiing,
exercise class, general)
14 31%
Work both paid, gardening and
housework
12 27%
Going out, socialising, making
contact
8 18%
Concentrating on writing,
performing or creating art
4 9%
Confidence loss 3 7%
Sex 3 7%
No activity affected 1 3%
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Life gets in the way !
Various issues have complicated the lives of the
women taking part and therefore the project e.g.:
hospital admissions (meningitis, MRSA, fractures, car
crash)
family issues (partners cancer returns, death ofparent, mother with Alzheimer's, divorce, moving
house, holidays)
Christmas, hottest summer for 500 years
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I found this study interesting and put many
suggestions into practiceI did feel better on
the herbal medicine and hot flushes
disappeared..my blood pressure also came
down
I have valued the supportI have decided to
continue with herbal medicinewhy does it have to taste so horrible?
I found the herbalist very supportive..the
remedy has been effective
Feedbac
k
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Thanks to the team!
Julia Green
Sue Hawkey
Alison Denham
Herbalists: Ann Freeman, Sue
Redfern, Margaret Macmillan
Jennifer Ingram
Rosemary Greenwood
The Spence Group Practice