CONTEXTE:
Approximately two thirds of women who reach menopause develop menopausal symptoms, primarily hot flashes. Hormone therapy long was considered the first-line treatment for vasomotor symptoms. However, given the results of the Women’s Health Initiative (WHI), many women are reluctant to use exogenous hormones for symptomatic treatment and are turning to botanicals and dietary supplement (BDS) products for relief. Despite the fact that there is limited scientific evidence describing efficacy and long-term safety of such products, many women find these natural treatments appealing. Perimenopausal and postmenopausal women are among the highest users of these products, but 70% of women do not tell their healthcare providers about their use. Compounding this issue is the fact that few clinicians ask their patients about use of BDS, largely because they have not been exposed to alternative medical practices in their training and are unfamiliar with these products.
MÉTHODES:
Cet article passe en revue les plantes et les compléments alimentaires couramment utilisés lors de la ménopause (comme l'actée à grappes noires, le trèfle rouge et les produits à base de soja), ainsi que les données disponibles sur l'efficacité et la sécurité. Nous avons effectué une recherche dans la base de données MEDLINE de 1966 à décembre 2004 à l'aide de termes relatifs aux BDS et aux symptômes ménopausiques chez les femmes périménopausées ou ménopausées. Des résumés de réunions pertinentes ainsi que des ouvrages de référence et des sites Web sur les suppléments à base de plantes ont également été recherchés. Des essais contrôlés randomisés (ECR) ont été utilisés, le cas échéant; des essais ouverts et des études de groupes de comparaison ont été utilisés lorsque les ECR n'étaient pas disponibles.
RÉSULTATS ET CONCLUSIONS:
The evidence to date suggests that black cohosh is safe and effective for reducing menopausal symptoms, primarily hot flashes and possibly mood disorders. Phytoestrogen extracts, including soy foods and red clover, appear to have at best only minimal effect on menopausal symptoms but have positive health effects on plasma lipid concentrations and may reduce heart disease. St. John’s wort has been shown to improve mild to moderate depression in the general population and appears to show efficacy for mood disorders related to the menopausal transition. Other commonly used botanicals have limited evidence to demonstrate safety and efficacy for relief of symptoms related to menopause.
