herbal treatment of menopause - julia green

8/14/2019 Herbal Treatment of Menopause - Julia Green

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Changing With Herbs

Randomised, controlled pilot study of the

effectiveness of treatment of menopausalproblems by medical herbalists


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Background

More research on herbs than any

other form of CAM

mostly on single plants and extracts

little on synergy

almost none on practitioner based

herbal therapy

examine the whole package of care


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What is Herbal Medicine ?

Use of PLANTS as medicine 30-35% of drugs based on plant compounds

(aspirin, contraceptive pill, digoxin, gaviscon, ephedrine, morphine)

oldest form of medicine: herbal from China

2500BC

Probably most common form of medicine

world-wide (WHO) more modern research into herbal medicine

than any other CAM therapy

herbalists use whole plant extracts rather

than isolated plant chemicals


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Why Herbal Treatment of the

menopause? Common reason for consulting

herbalist (Beatty and Denham survey)

evidence from RCTs of effectiveness

of single plant extracts (soy, black

cohosh, red clover, sage,) at

alleviating symptoms it fits well into herbalists

multifaceted, holistic approach


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Who could benefit from herbal

treatment of the menopause? Women not wishing to take HRT

women who cannot tolerate HRT side

effects

women for whom HRT is

contraindicated e.g with personal or

family history of breast cancer or

thrombosis


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CONSULTATION WITH A

HERBAL PRACTITIONER Series of consultations throughout the

treatment process comprising:

full medical and drug history appropriate physical examinations

diagnosis

nutritional and lifestyle advice individualised care plan

prescription of individually formulated

herbal remedies adapted at eachconsultation.


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How do we view the

menopause?

Pennell Report

A natural life

event

experiencedby nearly all

women

around 50. It

is part of thenormal ageing

process

Caused by failure of

endocrine organs

which leads eventuallyto accelerated

frequency of illness,

disease and disability.

It is amenable totreatment through HRT

and other therapies


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Menopause May be problem free - natural event

some women have symptoms

for some these cause problems

permanent cessation of periods

average age UK 51 large range of ages

may also follow hysterectomy


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Menopausal symptoms

Vasomotor : hot flushes, night sweats,

palpitations

somatic: headaches, joint aches, vaginaldryness, tingling and numbness, breast

tenderness, breathing difficulties,

mental: tiredness, difficulty sleeping, poor

memory and concentration, mood swings,panic attacks, anxiety, depression, loss of

libido


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Method 1 randomised, controlled trial, using

outcomes measures.

This method was chosen after

consultation with patients,

practitioners, academics, GPs and

statisticians. Suitable for examining a holistic

package of care, which is part of a

complex system of treatment


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Method 2subjects: 45 women volunteers aged 45-59

from one Bristol GP practice, with self

defined menopausal problems

block randomised with

twice as many control as

intervention patients

Treatment group (n=15)

6 appointments in 5 months

with NIMH herbalist

outcomes measures by postat designated time points

Control group (n=30)

wait 4 months for treatment

outcomes measures by

post at designated timepoints

then offered treatment


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Outcome measures Greene Climacteric scale.

validated scale, easy to use.

Mymop2

patient centred scale which

includes a quality of life element

Hot flush visual analogue scale

(VAS).


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Inclusion / exclusion criteria

Aged 45-59

not had a period for 3 months

suffering menopausal problems for 3months or more

not in the last 3 months had HRT or other

hormone treatment, taken tamoxifen or

had general anaesthetic no other CAM treatment for menopause

no current psychiatric treatment

not advised by Dr to take HRT because of


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Funding

National Institute of Medical

Herbalists

National Institute of Medical

Herbalists Education Fund

Research Sponsor University of

Central Lancashire


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GP practice of 5000 252 letters to women 45-59 not on HRT

161 replies (64%)

of these 161, 45 recruited

116 excluded

1 met criteria and wanted to enter butwas number 46, so too late!


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Herbal treatment of the menopause recruitment

GP practice of 5000

Data search for women age 45-59 not on HRT

252

send letters inviting these women to participate

161 replies

telephone these women and discuss inclusion/ exclusion criteria

45 entered into trial 116 excludedcomplete baseline outcome measuresblock randomised to

15 treatment 30 control


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Reasons for exclusion of 116

82 still menstruating

18 with no symptoms

9 on hormone therapy (HRT, mirena coil, minipill )

2 natural progesterone cream

1 tamoxifen trial

2 osteoporosis

4 psychiatric treatment or medication

6 couldnt cope with project (MRSA, ME, MS, allergies,chemotherapy, pituitary adenoma)

12 CAM therapy (9 herbal, 2 homeopathic, 1 acupuncture)

3 move away

3 lose touch

1 wanted to enter but was number 46!


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Details of 45 recruits

12 on medication(thyroxine,

analgesics, diuretics,

inhalers, antacids)

8 on supplements 21 had been offered

HRT

10 had taken HRT

but stopped becauseof side effects or

been on 9 yrs and

told to stop

Of those declining HRTreasons given

4 could cope with

symptoms

4 not want to interfere witha natural process

5 not want long term

medication

6 had side effects 2 concerned with safety

1 FH breast Ca

1 concerned about pregnant

mares used to produce


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Recruits experience of herbal

medicine

31/45 had taken herbal medicines in

some form before

(69%)

13/45 had consulted a herbalist before

(29%)


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Recruits expectations on entry n=45

27 expected some improvement in symptoms

10 had no expectations

5 expected at least no harm 4 expected a holistic approach and lifestyle

change

1 expected a better sense of wellbeing


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Current status of trial

Treatment

(n=15)

12 completed 2 ongoing

1dropped out

(6 operationson leg,

MRSA)

Controls (n=30)

28 complete all questionnaires

27 request treatment

20 take up treatment 8 completed treatment

9 ongoing

8 drop out (dislike taste, difficult

to fit in appointments andlifestyle advice, not want to do

questionnaires, taking Chinese

herbs, hormone treatment, ?)


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Mymop 2 activities chosen by 45 recruits

Activities affected by menopause Number of women

selecting this n=45

%

Exercise (walking, jogging,

cycling, gym, yoga, jiving, skiing,

exercise class, general)

14 31%

Work both paid, gardening and

housework

12 27%

Going out, socialising, making

contact

8 18%

Concentrating on writing,

performing or creating art

4 9%

Confidence loss 3 7%

Sex 3 7%

No activity affected 1 3%


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Life gets in the way !

Various issues have complicated the lives of the

women taking part and therefore the project e.g.:

hospital admissions (meningitis, MRSA, fractures, car

crash)

family issues (partners cancer returns, death ofparent, mother with Alzheimer's, divorce, moving

house, holidays)

Christmas, hottest summer for 500 years


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I found this study interesting and put many

suggestions into practiceI did feel better on

the herbal medicine and hot flushes

disappeared..my blood pressure also came

down

I have valued the supportI have decided to

continue with herbal medicinewhy does it have to taste so horrible?

I found the herbalist very supportive..the

remedy has been effective

Feedbac

k


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Thanks to the team!

Julia Green

Sue Hawkey

Alison Denham

Herbalists: Ann Freeman, Sue

Redfern, Margaret Macmillan

Jennifer Ingram

Rosemary Greenwood

The Spence Group Practice

herbal treatment of menopause - julia green

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