Menopausal women who fear the ill effects of prescription estrogen have a choice of alternative methods to manage their symptoms, but there is little objective information about the efficacy or safety of these therapies. Yale researcher Susan Cohen is hoping to change that.
Cohen, associate professor and director of the School of Nursing's adult nurse practitioner program, is studying two promising alternative therapies - acupuncture and the herb known as black cohosh.
While estrogen is known to prevent osteoporosis and relieve hot flashes and other discomforts associated with menopause, there is a suspected relationship between the hormone in its prescription form and breast cancer. Most physicians prescribe estrogen for menopausal women, but fewer than half fill their prescriptions, says Cohen. Within a year, only 20 percent of the women for whom estrogen was prescribed actually take the hormone, according to some studies.
"Women have been told, 'Take your estrogen,' but they are clearly not comfortable doing that," says Cohen.
Cohen describes estrogen as a "key" that fits into various "locks" in the body known as estrogen receptors. When the key fits into the lock, many of the unpleasant side effects of menopause are relieved. But when that lock "turns" additional changes -- some undesirable -- may also take place.
Advocates of plant-based estrogen or phytoestrogen believe that alternative therapies are keys that fit, but do not turn, the locked receptors.
In search of these "safe keys," some women use herbal therapies. But, Cohen cautions, anyone can call himself an "herbalist" and make exaggerated and unfounded claims.
Cohen and a graduate student have been working on a pilot study of black cohosh, and she plans a larger study of its effectiveness in controlling hot flashes. The herb, native to the eastern United States, has been used for at least 300 years for the relief of "women's complaints." In Germany, it is sold in pill form as a remedy for menopausal symptoms, points out Cohen, noting that Europe is generally ahead of the United States in the availability and understanding of herbal remedies. In fact, herbs used to be the physician's prescriptive mainstay, until sweeping turn-of-the-century changes in medical education in the United States caused most doctors to abandon traditional remedies, she explains.
Acupuncture is a more regulated form of treatment, notes Cohen. Because acupuncturists are licensed, women can feel confident about the safety of that option, she says, but more work needs to be done to test acupuncture's effectiveness in combating hot flashes and other menopausal discomforts. Cohen is beginning a study of acupuncture's effectiveness in relieving menopausal symptoms in breast cancer survivors, many of whom cannot take prescription estrogen because chemotherapy can cause perimenopausal symptoms to occur and, according to some researchers, make symptom management more difficult.
Practitioners of Eastern medicine hold that the body's life force flows along defined meridians and that if these meridians become blocked, illness occurs. Acupuncture, they believe, clears those blockages. Some Western health practitioners suggest that acupuncture triggers reactions in the body that lead to the release of endorphins, which are natural pain relievers. Though studies have confirmed acupuncture's utility in pain relief, notes Cohen, more investigation needs to be done to determine what sites give relief for specific symptoms and how many treatments are necessary to see a benefit.
Menopause is a natural process, says Cohen, and not all women want
or need intervention to control its symptoms. However, she points out,
baby boomers entering menopause face challenges that their mothers did
not, and today's women expect to have more control over their bodies than
their mothers did. In a culture that routinely medicates headaches and
colds, the demand for interventions around menopause is predictable, Cohen
adds, saying, "This is the first generation of women who have been able to
control their fertility."
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