Selected herbal dietary supplements used to manage climacteric (menopausal-type) symptoms. (Medication Minute).

All one needs to do is look at the growing shelf space in the local pharmacy allocated to herbal dietary supplements to sense the magnitude of the current interest in complementary (alternative) therapies. Of the patients who use conventional medicine, one-third also incorporate herbal therapies. Many report that they have not shared this information with their health care provider. In 1997, herbals netted a $3.2 billion business with a 25% annual growth (Donley, 1999). This growth of herbal supplements parallels a skyrocketing growth in the FDA-regulated pharmaceutical industry. Nurses, like other health care professionals, need to seek ongoing education about herbal therapies and existing scientific evidence relating to efficacy, safety and major adverse side effects, drug and/or diet interactions (DIs), indications, and contraindications as applied to their patients. Often users of herbs are health conscious and are knowledgeable about herbals. Nurses can assist by providing them with the most accurate information available.

Patients reach for additional therapy in the form of herbal dietary supplements because they experience side effects or lack of efficacy from traditional medicines. Furthermore, herbals provide an avenue of hope for some whose condition seems beyond the realm of hope. The perimenopausal or menopausal period exemplifies a time some persons seek therapy from the plant world.

Perimenopausal/Menopausal Symptoms

The average age of menopause is around 51 and is marked by cessation of menses for 1 year and a follicle stimulating hormone (FSH) serum level greater than 40 IU/ml as ovarian function is lost. The periodic shedding of uterine lining ceases as does the rhythmic release of oocytes. Perimenopause starts between 45 and 49 years of age and lasts for 4 to 5 years and is characterized by bleeding abnormalities, mental depression, sexual dysfunction, vasomotor symptoms (hot flashes), night sweats, and reduced sleep (Dell & Stewart, 2001). This period is also referred to as the climacteric meaning the period covering perimenopausal symptoms through postmenopausal time when some lingering penmenopausal symptoms may still be present.

Vasomotor symptoms have been studied the most regarding symptom reduction by nonhormonal intervention (Rawlins & Taylor, 2001). Women often seek such natural alternatives to cope with menopausal symptoms instead of or in addition to hormone replacement or other traditional medicine options and the nurse must develop an ongoing knowledge of such therapies.

Common penimenopausal/menopausal (climactenic) symptoms include:

* Irregular uterine bleeding.

* Hot flashes.

* Vaginal and urinary tract changes.

* Decreased libido.

* Mood changes and depression.

* Impaired memory and concentration.

* Skin changes.

* Dental changes.

Long-term conditions associated with perimenopausal/menopause include:

* Increased risk of cardiovascular disease.

* Increased risk of osteoporosis.

Many patients who inquire about herbal supplements and their uses for menopause will be exploring options other than conventional hormone-replacement therapy with prescription medicines. It is always important to know what your patients' primary concerns are so that you are able to best educate them about their options. They could be looking for an alternative to prescription hormone replacement for relief from the classic symptoms of menopause as discussed earlier. They could have tried the prescription medications and did not like them, or they could have contraindications to prescription therapy. Many women now know that with menopause there is an increased risk of osteoporosis and cardiovascular disease, and this fact could be their primary concern. Also, if they have been told that they cannot use prescription hormone replacement, they will want to know if they are also contraindicated from using herbal products.

Many herbal supplements that appear to be effective in treating the conditions associated with menopause contain plant chemicals called phytoestrogens. Phytoestrogens are a diverse chemical group of plant constituents that possess estrogenic activity. They lack the steroidal structure of estrogens and are not converted into estrogen by the body. They function as either partial agonists or as antagonists of estradiol at the estrogen receptor. They competitively bind to estrogen receptors making the receptors unavailable to more potent estrogens. Their estrogenic effects are weak but they can reduce menopausal symptoms when used regularly. Phytoestrogens are widely used by perimenopausal/menopausal women and have been marketed to have cholesterol-lowering, anticarcinogenic, antiproliferative, osteoporosis preventative, and hormone-altering effects (Tham, Gardener, & Haskell, 1998). They have been isolated from more than 300 plants, including apples,…