Does scientific evidence support the use of non‐prescription supplements for treatment of acute menopausal symptoms such as hot flushes?

Abstract

Abstract (Nutr Diet 2005;62:138–151) The objective of the present review was to critically evaluate the scientific evidence for efficacy of non‐prescription supplements (NPS) available for treatment of acute menopausal symptoms; and where available, to identify constituents, specify dosage, propose mechanisms and indicate safety concerns. A Medline search identified 24 clinical trials assessing efficacy of seven NPS for treatment of hot flushes in symptomatic menopausal women; 19 were randomised placebo‐controlled trials. Articles were located on black cohosh, dong quai, evening primrose oil, ginseng, isoflavonoid phytoestrogens (from red clover or soy) and sage. Evidence for each NPS was tabulated according to study design and menopausal outcomes. Findings from 13 randomised placebo‐controlled trials, using isoflavonoids from red clover or soy, demonstrated significant efficacy for six studies (46%) with reductions in moderate to severe flushes by 10–44% compared with placebo; seven studies (54%) reported no significant improvements. In vitro studies indicate that isoflavonoids have significant oestrogenic activity, providing a supporting mechanism. One controlled trial reported that an extract of sage and alfalfa significantly reduced severe hot flushes by 60% compared with placebo. Two controlled trials reported that black cohosh improved overall menopause symptom scores; however, no data were available specifically on hot flushes. In conclusion, evidence from a small number of placebo‐controlled trials suggested that further research is warranted to test efficacy of red clover, soy, sage and black cohosh for treatment of hot flushes in menopausal women. To date, controlled trials do not support use of dong quai, evening primrose oil and ginseng for treatment of hot flushes.