Calcium, Black Cohosh Are Top HT Alternatives


NEW ORLEANS — Among women who have discontinued hormone therapy for vasomotor symptoms, black cohosh and multivitamins with calcium were two of the most common substitutes, according to survey data from more than 500 women.

Elizabeth M. Kupferer, Ph.D., sent questionnaires primarily to a convenience sample of women selected from a general mailing list obtained from a marketing company. She also recruited women through advertisements and flyers placed at health providers' offices, a weight-loss program, and a grocery store in the Austin, Tex., area.

Eligible women were over age 40 years, were menopausal, and had been prescribed and had taken hormone therapy for at least 3 months before discontinuing. The surveys were mailed back to Dr. Kupferer, a nurse practitioner and faculty member at the University of Texas at Austin. She presented her results at the annual meeting of the American College of Obstetricians and Gynecologists.

Questionnaires were sent to 2,550 women; 563 were included in the final analysis. Surveys were completed in December 2006. The participants were from every state except Hawaii and were primarily white. The mean age was 58 years, with a range of 40–82 years. Sixty-eight percent (382) had a high school diploma and 41% had a household income of $30,000 or less.

Most women who reported menopause type had a natural menopause; about a third (193) had surgical menopause.

Three-quarters of the respondents said they had vasomotor symptoms before they started HT. Eighty percent had a return of symptoms after discontinuing.

Of the 563 participants, 252 (45%) said they had used an alternative to treat those symptoms. Those most likely to use alternative therapies were aged 40–50 years, were less than 5 years after menopause onset, and had medically induced menopause.

The most common choice of therapy was multivitamins with calcium; use was reported by 59% of the respondents. No. 2 was black cohosh (46%), followed by soy supplements and food (42%), antidepressants (32%), meditation and relaxation (26%), evening primrose oil (17%), and blood pressure medications (14%). Some respondents said they used more than one choice of therapy.

Women also reported using homeopathy (12%), red clover (8%), antiepileptic medications (8%), traditional Chinese medicine (3%), acupuncture (2%), Ayurvedic medicine (0.2%), and a variety of other supplements.

Only 6% of women said they were using bioidentical hormones.

Women were asked to comment on effectiveness of their therapy of choice. Given the small numbers in some categories, it was not possible to say definitively which worked best, said Dr. Kupferer in an interview. But overall, survey respondents perceived antidepressants to be one of the most effective methods, followed by homeopathy, meditation and relaxation, evening primrose, blood pressure medications, black cohosh, soy products, and multivitamins and calcium.

Dr. Kupferer said she hopes to explore more about women's use of alternative therapies, especially among lower-income and minority populations.

She disclosed that she is currently a medical science liaison at Duramed Research Inc.'s contraceptive division, but that her work on the survey was completed before she accepted the position.

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