Yale Nursing Researcher Explores Alternative Therapies For Menopausal Discomfort

Many menopausal women fear the ill effects of prescription estrogen. Physicians routinely prescribe the hormone for their patients, but fewer than half fill the prescriptions, says Yale researcher Susan Cohen. Within a year, only 20 percent of the women for whom estrogen was prescribed actually take the hormone, according to some studies.

Other methods to manage the symptoms of menopause exist, but there is little objective information about the efficacy and even the safety of these therapies.

Cohen is hoping to change that. An associate professor and director of the Yale School of Nursing’s Adult Nurse Practitioner Program, she is studying two promising alternative therapies P- acupuncture and the herb, black cohosh.

“Women have been told, ‘Take your estrogen,’ but they are clearly not comfortable doing that,” she says. While estrogen is known to prevent osteoporosis and relieve hot flashes and other discomforts associated with menopause, there is a suspected relationship between the hormone in its prescription form and breast cancer. Cohen describes estrogen as a key that fits into various locks in the body, known as estrogen receptors. When the key fits into the lock, many of the unpleasant side effects of menopause are relieved. But when the lock turns, additional changes – some undesirable – take place. Advocates of plant-based estrogen, or phytoestrogen, believe that alternative therapies are keys that fit, but do not turn, the locked receptors.

In search of these “safe keys,” some women use herbal therapies. But, Cohen cautions, anyone can call him/herself an “herbalist” and make exaggerated and unfounded claims.

Cohen and a graduate student have been working on an encouraging pilot study of black cohosh, and she plans a larger study of its effectiveness in controlling hot flashes. The herb, native to the eastern United States, has been used for at least 300 years for the relief of “women’s complaints.” In Germany, it is sold in pill form as a remedy for menopausal symptoms. Europe is generally ahead of the United States in the availability and understanding of herbal remedies, says Cohen. Herbs used to be the physician’s prescriptive mainstay, until sweeping turn-of-the-century changes in medical education in the United States caused most doctors to abandon traditional remedies.

Acupuncture is a more regulated form of treatment. Acupuncturists are licensed, Cohen notes, so women can feel confident about the safety of that option. But more work needs to be done to test acupuncture’s effectiveness in combating hot flashes and other menopausal discomforts, she adds. Cohen is beginning a study of acupuncture’s effectiveness in relieving menopausal symptoms in breast cancer survivors. Many breast cancer survivors cannot take, or are afraid to take, prescription estrogen. Chemotherapy can cause menopause-like symptoms to occur, and, some research suggests, make symptom management more difficult.

Practitioners of Eastern medicine hold that the body’s life force flows along defined meridians. If these meridians become blocked, illness occurs. Acupuncture is believed to clear blockages. According to Western thinking, acupuncture triggers reactions in the body that lead to the release of endorphins, which are natural pain relievers. Though studies have confirmed acupuncture’s utility in pain relief, more investigation needs to be done to determine what sites give relief for specific symptoms and how many treatments are necessary to see a benefit.

Menopause is a natural process, says Cohen, and not all women want or need intervention to control its symptoms. But baby boomers entering menopause face challenges that their mothers did not, and today’s women expect to have more control over their bodies than their mothers did. In a culture that routinely medicates headaches and colds, the demand for relief of menopausal discomforts is predictable, she notes, adding, “This is the first generation of women who have been able to control their fertility.”

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Gila Reinstein: gila.reinstein@yale.edu, 203-432-1325