Natural health products are gaining in popularity; seventy-one per cent of Canadians are now using them in some form. NHPs are regulated by Health Canada and include vitamin and mineral supplements, herbal and other plant-based health products, traditional medicines, homeopathic medicines and various other products. The products are becoming widely used without professional guidamce by perimenopausal and postmenopausal women. Physicians are often unaware of their patients’ supplement use.
The popularity of natural health products for treating menopausal symptoms can be traced back to Women’s Health Initiative data from June 2002. This large study was designed to obtain medical information about the major health problems of older women. Researchers found subjects who took estrogen plus progestin therapy experienced an increased risk of breast cancer, stroke and coronary heart disease.
After the results were released, use of hormone therapy decreased significantly, leading to increased interest in effective and safe complementary and alternative therapies to treat menopausal symptoms. Menopausal and postmenopausal women are believed to have taken to using natural health products such as black cohosh and phytoestrogens to relieve specific menopause symptoms and/or to improve general well-being.
There is little evidence to show whether consumers thoroughly investigate the safety and efficacy of the products they use. It is felt that women often rely on their friends’ experiences with natural health products when considering treatment options. Research on this topic is warranted due to the potentially harmful pharmacological effects of these products, particularly in the case of individuals who are at risk for interactions between natural health products and prescription medications.
A study was recently undertaken by Victoria General Hospital’s Mature Women’s Centre to determine what factors help motivate postmenopausal women to use herbal supplements, the perceived benefits and risks that women derive from such products and women’s willingness to discuss the NHP use with their physicians.
Thirty-eight perimenopausal and postmenopausal female patients at the hospital’s Mature Women’s Centre participated in the study. The results suggest women with abnormally severe menopausal symptomsl are no more likely to use natural health products than women with milder menopausal symptoms. The most common motivator for using the products among the women surveyed was to improve general well-being, not to alleviate bothersome symptoms. The most common sources of information influencing their decisions were friends, the Internet and health food stores.
Of the participants surveyed, 63 per cent thought natural health products could have either mild or serious side effects, though the same percentage did not know which specific side effects could arise from use of the products. Sixty-six per cent of the participants felt their physicians were open-minded to the discussion and use of natural health products. Twenty-three of the 38 participants felt comfortable discussing natural health products with their physicians, while only eight indicated their physicians ask about their use of them. The three most common products reported by women in this study were black cohosh, evening primrose and St. John’s wort.
Information received from sources such as friends, the Internet or health food stores may be informal and anecdotal, rather than evidence-based. Women in this study indicated physicians were among the most reliable sources of natural health product information. Health care providers are being urged to inform women about possible side effects, interactions and contra-indications when educating them about the products.
The study’s results indicate that many women lack basic information about natural health products. Determining women’s perceived benefit and risk in consuming these supplements may help health care providers guide women in the safe use of herbal products.
Publication of a recent study on the early use of estrogen could bring reduced reliance on natural health products for menopausal symptoms. Findings of the Kronos study, announced at an international menopause conference, suggest estrogen/progesterone treatment started soon after menopause appears to be safe, relieves many symptoms of menopause and improves mood, bone density and several indicators of cardiovascular risk.
These findings should be reassuring to women taking hormone therapy for short-term treatment of menopausal symptoms.
Shauna Leeson is a clinical research co-ordinator in the Mature Women’s Centre at Victoria General Hospital. To support patient care at the Vic, please contact Victoria General Hospital Foundation at 204-477-3513 or online at www.thevicfoundation.ca.