More women than ever may now look for other ways to ease menopausal symptoms after last week's news that long-term hormone therapy increases slightly the risk of heart attacks, strokes and breast cancer.
One of the most likely options, experts say, will be natural therapies.
Already, more than 30% of women say they use herbs and other supplements, according to the North American Menopause Society. And doctors say an estimated half of all menopausal women refuse hormone therapy when their doctors suggest it.
"Anything that raises the risk of breast cancer is going to be of concern to women," said Dr. Mary Hardy, medical director of the Cedars-Sinai Integrative Medicine Program.
Experts last week cautioned the estimated 6 million women taking estrogen and progesterone to discuss their regimen with their personal physicians before making changes. But Hardy predicts that some women will be quick to drop hormones and turn to natural alternatives.
"The women who stop taking hormones and develop [menopause] symptoms are going to say, 'So what do I do now?' " she said.
A majority of women experience at least some discomfort during menopause--the time during which the body's natural production of estrogen ceases--and an estimated 5% to 15% have severe symptoms that can include hot flashes, night sweats, insomnia, fatigue, irritability, urinary tract infections, incontinence, mood swings, thinning hair and skin, vaginal dryness and low libido.
Natural remedies may alleviate some of those discomforts without the attendant risks linked to hormones, experts say. But before rushing to the health food store, women should be aware that natural remedies also have a downside. Among them:
* There is scant scientific evidence on the risks and benefits of most natural remedies.
* Studies on herbal supplements typically have examined only short-term use.
* Natural cures--including exercise, stress-reduction techniques and dietary supplements--tend to work best for mild to moderate symptoms.
* Any benefits gained will usually be apparent only after several months of use.
* Because dietary supplements are largely unregulated by the federal government, there is no guarantee that the products contain the ingredients listed or are free of adulterations.
* Some herbs may interact with medications to cause serious side effects. Some herbs, such as dong quai, may also be toxic.
"As dire as the [hormone study] data may sound, at least we have data, whereas there are no substantive data regarding any alternatives," said Dr. Maida Taylor, associate clinical professor at UC San Francisco and a senior clinical research physician for Eli Lilly & Co.
Last year, the American College of Obstetricians and Gynecologists warned doctors that, when it comes to easing menopausal symptoms, there is little evidence supporting the use of the majority of products, including such popular remedies as dong quai, evening primrose, wild yam and Mexican yam, valerian root and chasteberry.
The report cautioned that natural does not mean safe or effective. For example, both dong quai and valerian have been linked to serious side effects, said Taylor, who wrote the report.
According to the report, the most helpful natural supplements for menopause appear to be black cohosh, isoflavones (estrogen-like plant compounds called phytoestrogens) and St. John's wort.
Black cohosh, which is the active ingredient in the menopause remedy RemiFemin, has been shown to ease hot flashes and night sweats. Isoflavones found in soy and some grains may alleviate hot flashes and could provide some protection against osteoporosis and heart disease. St. John's wort has shown some impact in easing mild depression.
In addition, red clover may reduce hot flashes and night sweats. Calcium is considered useful for protection against osteoporosis, and the amino acid SAM-e may help with depression.
Some doctors say natural remedies address at least some common symptoms of menopause. Dr. Neil Hirschenbein, who runs a practice specializing in conventional and alternative medicine in San Diego, said herbs can be as effective as and safer than synthetic hormones.
He often prescribes herbs such as black cohosh, and encourages women to alter their diets to add more soy and flaxseed.
"There are things people can do in terms of what they eat and don't eat," he said. "There are also benefits from exercise in treating menopausal symptoms. There are a lot of natural things people can do."
But the American College of Obstetricians and Gynecologists report cautions that even these products may be of little value for long-term use. It recommends using black cohosh for six months or fewer, and notes that long-term use of isoflavone supplements may be harmful to women with a history of estrogen-dependent cancer.