Better Guidance on Alternative Therapies Needed.

WASHINGTON -- Feeling hamstrung by the lack of solid scientific data on alternative "therapies" for menopausal symptoms, physicians attending an international symposium on women's health and menopause pressed a National Institutes of Health investigator for better guidance on the issue.

Christine Goertz, Ph.D., program director of NIH's National Center for Complementary and Alternative Medicine, Bethesda, Md., gave a brief presentation on the five alternative therapies physicians are most likely to encounter in managing their menopausal patients. Her statement that her office was still compiling a fact sheet on such treatments elicited groans from the audience, and her advice to watch the center's Web site for updates on the fact sheet brought a flurry of shouted requests for the Web address (http://nccam.nih.gov).

Physicians in the audience lined up 10 deep at two microphones during the question-and-answer session after Dr. Goertz's presentation to get more specific answers on the efficacy and safety of an array of alternative therapies used by their patients. They were disappointed to hear that most of the compounds in question haven't been adequately studied.

"With many of these therapies, what we don't know is much more significant than what we do know. One thing we do know is that so many women are using them, many of your patients probably are," she said at the meeting, which was sponsored by the National Institutes of Health, the International Menopause Society, and the North American Menopause Society.

Although "there are no good figures" on actual use rates, more than 100 new products to treat menopausal symptoms came onto the U.S. market in 1998, and one "probably conservative" estimate placed the amount spent on complementary and alternative treatments for menopausal symptoms at $600 million in 1999.

Dr. Goertz discussed the current state of scientific evidence for the following alternative therapies:

* Phytoestrogens. These natural plant sterols show activity similar to that of estrogen. This group includes isoflavones, found in soybeans and legumes; lignans, found in flaxseed oil, whole grains, fruits, and vegetables; and coumestans, found in clover seeds and bean sprouts. By far the most commonly used are soy phytoestrogens.