FUNDO:
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.
MÉTODOS:
Este artigo analisa os suplementos botânicos e dietéticos comumente usados na menopausa (como black cohosh, trevo vermelho e produtos de soja), bem como os dados disponíveis sobre eficácia e segurança. Pesquisamos o banco de dados MEDLINE de 1966 a Dezembro 2004 usando termos relacionados a BDS e sintomas da menopausa para mulheres na perimenopausa ou na pós-menopausa. Resumos de reuniões relevantes, bem como livros de referência e sites sobre suplementos de ervas também foram pesquisados. Ensaios clínicos randomizados e controlados (ECRs) foram utilizados, se disponíveis; estudos abertos e estudos de grupos de comparação foram utilizados quando os ECRs não estavam disponíveis.
RESULTS AND 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.