Complementary medicines and therapies fall outside the remit of mainstream healthcare. However, over 50% of women turn to these treatments for the relief of symptoms related to the menopause. The most common choices include oral remedies, physical treatments and talking therapies. This article aims to balance some of the perceived benefits of these complementary medicines and therapies with how little is known about their true effectiveness and safety.

This article was included in issue 98 (Autumn 2023) of The Menopause Exchange newsletter.

Oral remedies
High street pharmacy shelves offer a cornucopia of “natural” oral treatments, including herbal remedies and homeopathy. UK spending on herbal products tops out at £40 million per year, and this is mostly self-prescribed or over the counter. With GP access difficulties, and women now empowered to individualise their menopause journey, it’s understandable how these have grown in popularity.

However, “natural” doesn’t always mean safe. Herbal products may be potent, may interact with other medicines and can be contaminated with ingredients that may be harmful. The scientific evidence is universally patchy, which means that as medical professionals we can’t say for certain whether they work or not.

When buying a herbal medicine, it’s advisable to look for the “THR” logo, which shows it has been rigorously examined for safety and pharmacological properties. If you’re considering this route, it may be wise to seek the advice of a suitably qualified herbalist. From a mainstream medicine point of view, let’s look at some of the most-used products.
Phytoestrogens are plant constituents that act as weak oestrogens in the body. They can be found in the diet in soy or flaxseeds or in products such as Red Clover. Despite wide usage and anecdotal evidence of their effectiveness, available medical evidence tells us that their use is no better than placebo for reducing hot flushes.
Black cohosh is the root of a herb from the buttercup family. It has a long tradition of use for hot flushes, mood and sleep problems at the menopause. However, evidence for its efficacy against hot flushes is inconsistent, and there are safety concerns including potential liver toxicity. Although it may not act like an oestrogen, as once thought, black cohosh must be avoided after breast cancer.
St John’s wort is derived from a flowering plant and is promoted for the relief of menopausal flushes, depression and anxiety. There’s uncertainty about appropriate doses and efficacy, and also serious interactions with other medicines, such as tamoxifen, anticoagulants (blood-thinners) and anticonvulsants (for epilepsy).
Homeopathic remedies use extremely diluted agents to treat “like with like”. Central to homeopathy is the belief that the body can heal itself. Many women find their therapeutic relationship with a homeopathist to be beneficial through the menopause. Whether homeopathic remedies perform better than placebo in clinical trials remains controversial. This is because there is insufficient and low-quality data. For this reason, homeopathy isn’t supported by NICE or the MHRA. It’s reassuring, however, that there are no known safety concerns. Many women continue to use homeopathy to support the menopause transition.

Physical therapies
These include acupuncture, reiki, shiatsu massage and reflexology. Many women will choose a “hands-on” approach to their menopause care. Unfortunately, physical therapies of this kind aren’t usually available on the NHS.
Acupuncture uses needles to stimulate specific points on the body. It’s a long-held healing tradition, but hasn’t stood up to the rigour of modern scientific methods. However, some small studies have shown a benefit when comparing real acupuncture to “sham” or pretend acupuncture for hot flushes, insomnia and mood swings.
Talking therapies
These non-medical interventions, including cognitive behavioural therapy and mindfulness, are generally endorsed by the mainstream medical profession.
Cognitive Behavioural Therapy (CBT) supports people to find practical ways to manage problems and develop strategies and coping skills. After having CBT, women may be better equipped to self-manage anxiety and stress, depressed mood, hot flushes, sleep problems and tiredness relating to menopause. CBT has a firm grounding in scientific rigour and is supported by NICE.
Mindfulness is a specific form of relaxation that focuses awareness on the present moment. It’s well grounded in modern academic and scientific methods, with no known harmful effects. Mindfulness is endorsed by the Royal College of General Practitioners. There are many free mindfulness apps and training options available.

Complementary practitioners often provide the essential continuity of care that’s lacking in an overburdened NHS. Many complementary medicines and therapies have been used successfully for thousands of years. However, as the menopause industry booms, it’s essential to make an informed choice, knowing the potential benefits and pitfalls of the medicine or therapy on offer. A natural remedy is not necessarily a safe one. The menopause is a transformative time and a perfect opportunity to make positive lifestyle changes. While the evidence remains patchy for complementary medicine and therapies, the benefits are irrefutable for embracing healthy living.

About the author
Dr Jane Davis is a GP from Cornwall with a special interest in women’s health. She’s a FSRH-registered trainer, BMS menopause specialist and PPMC tutor. She loves teaching and is a board member of the Primary Care Women’s Health Forum.

Created Autumn 2023
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Tags: acupuncture, black cohosh, cognitive behavioural therapy (CBT), complementary medicines & therapies, complementary practitioners, Homeopathic remedies, mindfulness, oral remedies, physical therapies, phytoestrogens, St John's wort, talking therapies