YOUNG-WOMEN Messages for June, 2001: ACOG Statement on Herbal and alternative therapies for

ACOG Statement on Herbal and alternative therapies for

From: Braun (anonymous@obgyn.net)
Sat, 02 Jun 2001 18:04:27 -0500

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ACOG NEWS RELEASE For Release: May 31, 2001

It's "Buyer Beware" with Alternative Botanical Treatments for Menopausal Symptoms, Says ACOG

WASHINGTON, DC -- In response to the ever-increasing number of women using herbal or other alternatives to conventional hormone replacement therapy (HRT), The American College of Obstetricians and Gynecologists (ACOG) has issued a new Practice Bulletin, "Use of Botanicals for Management of Menopausal Symptoms."

ACOG says that while some botanicals may offer some symptom relief, there is no mandatory regulation of the majority of botanical products, resulting in a lack of standardization among products.

Consumers cannot be assured of any particular product's actual content and efficacy. More importantly, this lack of quality control may result in contamination, adulteration, or misidentification of plant products that may ultimately harm the consumer. Many alternative therapies that are promoted and touted as substitutes for HRT, in fact, do not offer any substantiated health benefits.

Fewer than one in three menopausal women choose traditional HRT, due to a lack of confidence in its benefits, fear of increased risk of breast cancer, and/or its side effects. Many women perceive "natural" treatments as safe and effective despite the lack of adequate scientific studies proving either. According to ACOG, the number and sophistication of most studies on alternative therapies, including botanicals, do not meet the current standards of evidence-based recommendations. ACOG also cautions that "natural" does not mean safe or effective, and that potentially dangerous or lethal drug-herb interactions can occur.

The new document provides recommendations to ob-gyns for advising their patients on the purported efficacy and potential adverse effects of some of these botanical treatments. Addressed in the document are such popular alternative therapies as soy, Black cohosh, wild yam, and Dong Quai, among others. Based on its review of the limited studies available, ACOG determined that:

Soy and isoflavones may be helpful in the short term (2 years or less) for menopausal symptoms such as hot flashes and night sweats. While safe in dietary amounts, the consumption of extraordinary amounts of soy and isoflavone supplements may interact with estrogen and may be harmful to women with a history of estrogen-dependent cancer and possibly to other women as well.

Black cohosh may be helpful in the very short term (6 months or less) for treatment of hot flashes and night sweats. Based on the lack of bioavailability, the hormones in wild and Mexican yam would not be expected to have any therapeutic efficacy in women. Wild yam extracts are neither estrogenic nor progestational. There are no published reports demonstrating the efficacy of wild yam cream.

The benefit of Dong Quai, a Chinese herb, cannot be substantiated on the available evidence. It is potentially toxic and there is some concern that consumption may increase the risk of sun exposure-related skin cancers.

ACOG recommends that ob-gyns ask each patient about her use of herbal therapies and dietary supplements and document this in the patient's chart. All adverse events and outcomes should also be documented in the patient's chart and reported to the US Food and Drug Administration, and the patient should be advised to discontinue the therapy. ACOG advises counseling patients in a balanced manner about the risks and benefits of both conventional therapies and alternative interventions.

# # #

R. Daniel Braun, MD

A zygote is a gamete's way of producing more gametes. Lazarus Long

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