COLORADO SPRINGS — Just how popular are natural herbs, vitamins, and supplements for the treatment of menopausal symptoms?
Here's a clue: 5 of the top 10 best-selling herbal dietary products in the United States for 2007 are used predominantly by women with menopausal symptoms, Dr. Walter L. Larimore said at the annual conference of the Colorado Academy of Family Physicians.
Those products are soy (No. 1), ginkgo biloba (No. 4), black cohosh (No. 7), ginseng (No. 9), and St. John's wort (No. 10). In addition, 4 other products used primarily for menopausal symptoms round out the list of the top 20 best-selling natural products in 2007, the most recent year for which data are available: evening primrose oil (No. 12), valerian (No. 13), grape seed (No. 16), and red clover (No. 18), noted Dr. Larimore, a Colorado Springs family physician.
It's worth noting, however, that the sales volume for most of these products has been on the decline since 2001.
“Our patients are beginning to understand that natural doesn't mean safe, that there are contamination problems, and natural certainly doesn't necessarily mean inexpensive,” he said.
Natural medications are unregulated in the United States. As a result, the field of complementary and alternative medicine is “a Wild West arena,” according to the family physician.
“You have no way of knowing if substances will be the same from bottle to bottle or lot to lot, whether the bottle actually contains what the label says, if there's contamination, or if the product is bioabsorbable,” he continued.
The evidence base for the use of natural medications for meno-pausal symptoms is generally paltry. The studies are typically small and short. Expert opinion as to which products have a reasonable likelihood of being safe and effective often changes quickly in response to new data.
To keep current in the face of a daily barrage of patient inquiries about alternatives to hormone therapy for menopausal symptoms, Dr. Larimore recommended the use of two subscription-based Web sites that provide trustworthy information: the Natural Medicines Comprehensive Database (www.naturaldatabase.comwww.consumerlab.com
“I couldn't practice family medicine without them,” he said.
The Natural Medicines Comprehensive Database (NMCD) provides access to 5,700 monographs, including systematic reviews, meta-analyses, and detailed descriptions of any interactions an agent may have with prescription drugs or disease states.
ConsumerLab is an independent quality testing laboratory. ConsumerLab staff buy products off the shelf in stores, test them for strength, labeling accuracy, the presence of lead and other contaminants, and bioabsorption, then report which ones pass or fail. Subscribers have access to roughly 1,200 monographs.
“Anytime you recommend something to a patient—say, a calcium supplement—you can look up the monograph and see a list of the specific products that pass their tests,” Dr. Larimore said. “Print it out, hand it to your patient, and say, 'Buy the cheapest one.'”
Last fall, for example, ConsumerLab reported that three of five tested black cohosh products and two of three combined red clover/soy isoflavones products did not meet quality standards. And they named names.
Based on his synthesis of evidence from NMCD, the North American Menopause Society, the American College of Obstetricians and Gynecologists, and the Food and Drug Administration, Dr. Larimore created a list of recommended natural medications for menopausal symptoms. None of the natural products earned a “likely effective” rating. In the category of “possibly effective/likely safe,” however, he listed soy foods, soy protein, lifestyle changes, flaxseed, vitamin E, and pycnogenol.
Under the heading “possibly effective/possibly safe,” Dr. Larimore placed soy extracts and two German extracts of black cohosh sold in the United States under the brand names Remifemin and Klimadynon.
Because of insufficient evidence of safety and/or efficacy, no other natural medications that women are now taking for menopausal symptoms can reasonably be recommended, in his view.
Lack of regulation has made the field of complementary and alternative medicine 'a Wild West arena.'
Source DR. LARIMORE
Two German extracts of black cohosh (shown above) are “possibly effective/possibly safe.”
Source ©Elena Ray/Fotolia.com