Full text of DOI:10.1089/107555303322284820

THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 9, Number 4, 2003, pp. 529–538
©
Mary Ann Liebert, Inc.
Is Naturopathy as Effective as Conventional Therapy for
Treatment of Menopausal Symptoms?
1
2
3
ELAINE H. CRAMER, M.D., M.P.H., PAUL JONES, M.S., NORA L. KEENAN, Ph.D.,
and BETSY L. THOMPSON, M.D., M.S.P.H.2
ABSTRACT
Background: Although the use of alternative medicine in the United States is increasing, no pub-
lished studies have documented the effectiveness of naturopathy for treatment of menopausal
symptoms compared to women receiving conventional therapy in the clinical setting.
Objective: To compare naturopathic therapy with conventional medical therapy for treatment
of selected menopausal symptoms.
Design: A retrospective cohort study, using abstracted data from medical charts.
Setting: One natural medicine and six conventional medical clinics at Community Health Cen-
ters of King County, Washington, from November 1, 1996, through July 31, 1998.
Patients: Women aged 40 years of age or more with a diagnosis of menopausal symptoms
documented by a naturopathic or conventional physician.
Main outcome measures: Improvement in selected menopausal symptoms.
Results: In univariate analyses, patients treated with naturopathy for menopausal symptoms
reported higher monthly incomes ($1848.00 versus $853.60), were less likely to be smokers (11.4%
versus 41.9%), exercised more frequently, and reported higher frequencies of decreased energy
(
41.8% versus 24.4%), insomnia (57.0% versus 33.1%), and hot flashes (69.6% versus 55.6%) at
baseline than those who received conventional treatment. In multivariate analyses, patients
treated with naturopathy were approximately seven times more likely than conventionally
treated patients to report improvement for insomnia (odds ratio [OR], 6.77; 95% confidence in-
terval [CI], 1.71, 26.63) and decreased energy (OR, 6.55; 95% CI, 0.96, 44.74). Naturopathy pa-
tients reported improvement for anxiety (OR, 1.27; 95% CI, 0.63, 2.56), hot flashes (OR, 1.40; 95%
CI, 0.68, 2.88), menstrual changes (OR, 0.98; 95% CI, 0.43, 2.24), and vaginal dryness (OR, 0.91;
9
5% CI, 0.21, 3.96) about as frequently as patients who were treated conventionally.
Conclusions: Naturopathy appears to be an effective alternative for relief of specific
menopausal symptoms compared to conventional therapy.
INTRODUCTION
menopausal and perimenopausal symptoms
Belchetz, 1994). However, postmenopausal
(
ormone replacement therapy (HRT) is bleeding related to HRT has been reported to
the most common and most effective result in discontinuation of use in as many as
pharmacotherapy for treating patients with 70% of women who initiate therapy (Ravnikar,
H
1
Vessel Sanitation Program, Centers for Disease Control and Prevention, Atlanta, GA.
2
Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA.
3
National Center for Chronic Disease Prevention and Health Promotions, Centers for Disease Control and Preven-
tion, Atlanta, GA.
This work was supported in part by the Office of Alternative Medicine, National Institutes of Health, Bethesda, MD.
5
29

5
30
CRAMER ET AL.
1
987). Contraindications to usage (e.g., such as evaluated the effectiveness of using an aggre-
uterine or vaginal bleeding [Spencer et al., gate system of naturopathy for treating meno-
997], coagulation defects, histories of en- pausal symptoms, especially when used in the
dometrial cancer, or deep venous thrombosis clinical setting.
Loose-Mitchell and Stancel, 2001]), and epi- In this study we estimated changes in
1
[
demiologic evidence suggesting an association menopausal symptoms among women treated
between estrogen therapy and breast cancer with the aggregate system of naturopathy com-
(
Colditz et al., 1990, 1995; Steinberg et al., 1991; pared to women treated conventionally. Be-
Stevenson, 1996), are among the reasons that cause naturopathy encompasses several thera-
women pursue alternative therapies for symp- peutic modalities, we also sought to describe
tomatic relief (Follingstad, 1978).
the diversity of therapeutic regimens among
Naturopathic medicine, a comprehensive users of naturopathy.
system of health care that integrates traditional
natural therapeutics with modern medical di-
agnostics and standards of care (National In-
MATERIALS AND METHODS
stitutes of Health, 1997) uses several modalities
e.g., dietary manipulation, exercise, vitamins,
(
Setting
In this retrospective cohort study, we com-
homeopathy, nutritional supplementation,
acupuncture (National Institutes of Health,
1
997), relaxation techniques (Irvin et al., 1996), pared patients treated for menopausal symp-
lifestyle changes, and naturopathic pharma- toms at the naturopathy clinic of Community
cotherapy) for treatment of menopausal symp- Health Centers of King County (CHCKC),
toms. Naturopathic pharmacotherapy pri- Washington, to a stratified random sample of
marily relies on the use of phytoestrogens, patients treated at the six conventional clinics
naturally occurring sterols of plant origin ex- of CHCKC from November 1996 through July
hibiting weekly estrogenic and antiestrogenic 1998.
properties, rather than conventional HRT,
Each clinic of CHCKC provides compre-
which is commonly derived from the urine of hensive family medical care and dental care
pregnant mares (conjugated equine estrogens) and serves as a dispensary of CHCKC for-
or synthesized in a laboratory (ethinyl estra- mulary medications. Services offered at the
diol). Phytoestrogens include the isoflavones naturopathy clinic include acupuncture and
genistein and daidzein, which are highly con- naturopathy, as well as conventional family
centrated in foods such as soy and tofu; and the medicine. Physicians who provide conven-
lignans that are found in whole-grain cereals, tional care are general or family practitioners.
seeds, and nuts and are found in phytomedic- Naturopathic providers are licensed natur-
inals (e.g., black cohosh, dong quai, ginseng, opaths in the state of Washington. During the
licorice, wild yam, medicago, and chasteberry study period, three naturopaths rendered ser-
fruit [Foster, 1993; Seidl et al., 1998; Soffa, vice at the naturopathic clinic. At each of the
1
996). Published studies support the efficacy six conventional clinics, three physicians pro-
of dietary soy supplementation, menopausal vided care.
isoflavone-containing food products and di-
Both insured and uninsured patients have
etary soy bars, and phytomedicinals to reduce equal access to care at the naturopathy and
the frequency of hot flashes in women (Alber- conventional clinics at CHCKC. Patient fees
tazzi et al., 1998; Aldercreutz et al., 1997; An- at CHCKC come primarily from Medicaid
derson et al., 1995; Anonymous, 1996; Eden et and from out-of-pocket payments made by
al., 1997a, 1997b; Liske, 1998; Murkies et al., patients according to a sliding fee schedule,
1
995; Nagata et al., 1997; Tham et al., 1998; which provides discounts according to fam-
Wilcox, 1997; Woods et al., 1996). Despite these ily size and income. Approximately 46% of
studies of the effectiveness of a single thera- CHCKC’s patients are uninsured and have
peutic component of naturopathy, none has family incomes less than 200% of the federal

NATUROPATHY FOR MENOPAUSE
531
poverty line. Another 40% of CHCKC’s pa- outpatient claims, the ICD-9-CM codes most
tients have Medicaid coverage.
commonly associated with ICD-9-CM code 627
were also identified to capture additional pa-
tients with a documentation of menopausal
symptoms who were not primarily assigned
Study subjects
The study was restricted to female patients ICD-9-CM code 627. The MarketScan Database
aged 40 years of age or older with a docu- identified the ICD-9-CM codes most frequently
mented diagnosis by a naturopathic or associated with menopausal and postmeno-
conventional physician of menopause, peri- pausal symptoms (Table 1). Patients at CHCKC
menopause, perimenopausal, or menopausal with ICD-9-CM codes listed in Table 1 were
symptoms. Because of the intent to evaluate then identified and their charts were screened
symptom changes over time, patients with only for study eligibility. The ICD-9-CM coding
one visit for menopause-related symptoms methods were identical for naturopathic and
were excluded from the study.
conventional therapies. The protocol was ap-
Eligible patients were identified by two proved by the Centers for Disease Control
methods by using the CHCKC billing database. (CDC) institutional review board and CHCKC
First, patients assigned the diagnosis of meno- executive council.
pause or menopausal symptoms with Interna-
This case finding process identified 238 po-
tional Statistical Classification of Diseases, 9th tentially eligible naturopathic patients from
Revision Clinical Modifications (ICD-9-CM, November 1996, the month in which the clinic
1
991) diagnostic codes 627.0–627.9, “menopausal first opened, through July 1998; 79 of these met
and postmenopausal disorders,” were identi- the eligibility criteria and were included in the
fied. Second, using the MarketScan Encounter study; 159 naturopathic patients of those iden-
Database™ (Medstat, Ann Arbor, MI) of 1995 tified as eligible by the case-finding method
TABLE 1. ICD-9-CM CODES ASSOCIATED WITH MENOPAUSAL AND POSTMENOPAUSAL SYMPTOMS
USED IN CASE FINDING, COMMUNITY HEALTH CENTERS OF KING COUNTY, 1997–1998
2
2
6
6
6
6
6
6
6
6
6
6
6
6
6
6
56
72
10
11
14
15
16
18
20
21
22
23
24
25
26
27.0
Ovarian dysfunction
Lipid disorders
Benign mammary dysplasias
Other breast disorders
Inflammatory diseases of female pelvic organs
Inflammatory diseases of female pelvic organs
Inflammatory diseases of female pelvic organs
Genital prolapse
Noninflammatory disorders of ovary, fallopian tube, and broad ligament
Disorders of uterus not elsewhere classified
Noninflammatory disorders of the cervix
Noninflammatory disorders of the vagina
Noninflammatory disorders of the vulva and perineum
Pain and other symptoms associated with female genital organs
Disorders of menstruation and other abnormal bleeding from female genital tract
Menopausal and postmenopausal disorders
Premenopausal menorrhagia: excessive bleeding associated with onset of menopause
Menorrhagia: climacteric, menopausal, preclimacteric
Postmenopausal bleeding
Menopausal or female climacteric states, symptoms, such as flushing, sleeplessness,
headache, lack of concentration, associated with menopause
Postmenopausal atrophic vaginitis-Senile (atrophic) vaginitis
States associated with artificial menopause
Other specified menopausal and postmenopausal disorders
Excludes: premature menopause not otherwise specified (256.3)
Unspecified menopausal and postmenopausal disorder
Associated with anovulation, anovulatory cycle
6
6
27.1
27.2
6
6
6
27.3
27.4
27.8
6
6
27.9
28.0
ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modifications, 1991.

5
32
CRAMER ET AL.
had less than two visits documented in their data collection. Abstractors received ongoing
charts or were younger than 40 years of age and feedback during a 1-week training period. The
were therefore determined to be ineligible for first 12.5% (30) abstraction forms were reab-
further study; 67 of the 79 naturopathic patients stracted and reviewed to provide a basis for
included in the study were primarily assigned further training. To minimize bias, the abstrac-
ICD-9-CM code 627. To detect a 20% difference tors were not informed of the study question.
in symptom change between treatment groups, Quality control was further assured by com-
we needed 160 conventional patients to yield a paring 10% of abstraction forms to the com-
power of 80% and a Type I error of 5%. A to- puterized data file for accuracy. The keystroke
tal of 513 patients, stratified by the six conven- error rate was 0.017%. Data files were edited
tional clinics, were identified and their charts and checked for errors by using range and in-
were randomly screened until 160 eligible pa- ternal consistency checks.
tients were identified for inclusion. Eligibility
criteria for the conventional therapy group
Outcomes
were identical to those in the naturopathy
group.
Data recorded from charts included baseline
demographic characteristics, past medical his-
tories, health behaviors, recorded symptoms,
patient weight at each visit, and dose and du-
ration of selected naturopathic and conven-
tional treatments.
The primary outcomes of interest in this
analysis were the overall change in any of the
seven menopausal symptoms for each patient
during the study period. The symptoms were:
anxiety, decreased energy, hot flashes, insom-
nia, menstrual changes, urinary complaints,
and vaginal dryness. Symptom change for each
reported patient visit during the study period
was noted as: “new onset,” “improved,” “worse,”
Exposure categories
Naturopathic therapy was defined as an of-
fice consultation with a licensed naturopathic
physician, provided at the naturopathic clinic
of CHCKC. The naturopathic system of care,
similar to conventional medicine, varies widely
among providers in duration of office visits,
and varieties of pharmacotherapeutic and nat-
ural medicine treatment options. To evaluate
effectiveness in the clinical setting, we chose to
compare the comprehensive, aggregate system
of naturopathic care with conventional ther-
apy, rather than comparison of specific hor-
monal therapy regimens. Patients treated with
HRT who were seen by the naturopath were
considered as exposed to naturopathy if service
was provided solely by the licensed naturo-
pathic provider during the study period. Con-
ventional therapy was defined as an office
consultation solely with a licensed physician
during the study period, provided in one of the
six conventional clinics of CHCKC.
“
resolved,” or “unchanged,” on the basis of
provider documentation in chart progress
notes. The method of ascertainment of symp-
tom change did not differ by type or location
of clinic.
For each menopausal symptom reported,
the aggregate system of naturopathy was
compared to the aggregate system of conven-
tional care, regardless of the specific therapy
used. Because individual menopausal and
postmenopausal symptoms reported by pa-
tients may not be independent, may be age-
related, or may differ in severity, the study
Data collection
Data abstraction forms were developed on was designed to evaluate individual symp-
the basis of a preliminary screen of 40 charts toms rather than a summary measure of over-
to determine available information about re- all change.
ported symptoms, as documented by pro-
In a separate analysis, we evaluated whether
viders. Abstractions of medical charts were differences in specific hormonal therapy regi-
performed onsite at each of the seven clinics of mens between the two systems of care were
CHCKC. Abstractors were trained by the prin- associated with differences in symptom im-
cipal investigator and were provided with ab- provement. Thus, we compared the effects of
straction guidelines to ensure standardized phytoestrogens to conventional estrogens and

NATUROPATHY FOR MENOPAUSE
533
naturopathic progestogens with conventional
progestogens.
A statistical model was derived to best char-
acterize the probability of improvement in a
specific menopausal symptom while control-
ling for other potential risk factors, autocorre-
lation, and heterogeneity of variance. Based on
Statistical analysis
Baseline characteristics of study participants, the assumption of constant correlation within
including past medical history, health behav- clusters of repeated measures of menopausal
iors, menopausal symptoms, and treatment symptoms, an exchangeable correlation work-
data were described by means, standard errors, ing structure was used. The exposure variables
and ranges of values for continuous variables were treated as independent variables in re-
(
e.g., age and income), and by frequencies and gression models by using the PROC GENMOD
percentiles for categorical variables (e.g., race). procedure for repeated measures in SAS (SAS
We decided a priori that two variables—age at Institute, Cary, NC). To derive a reduced model
baseline visit and weight—would be retained that best characterized the probability of symp-
in the multivariate models because of their po- tom improvement, a sequential backward elim-
tential to confound the outcome-exposure rela- ination procedure was performed. Confound-
tionship. These covariates as well as covariates ing variables were retained in the model if the
with cell sizes larger than 5, identified as sig- b coefficient for exposure was changed by 10%
nificant in univariate analyses with a p value # or more.
0
.05, were included in multivariate regression
models.
To test for differences in baseline character-
RESULTS
istics and therapies between treatment groups,
we used a two-tailed t test for continuous data
Patients receiving naturopathic treatment dif-
2
and a x test or Fisher’s exact test for categori- fered at baseline from those receiving conven-
cal data. Multivariate analyses were performed tional treatment (Table 2). They had higher in-
by using Generalized Estimating Equations comes, were less frequently smokers, were more
(
GEE) to evaluate changes in menopausal likely to participate in a regular exercise pro-
symptoms. Statistical computations were per- gram, and reported higher frequencies of de-
formed by using SAS software (SAS Institute creased energy, insomnia, and hot flashes. The
Inc., Cary, NC).
majority of patients receiving naturopathy were
For each reported symptom, a binary re- treated with black cohosh and were dispensed
sponse was used in the analysis, coded 1 for a single or multiple vitamin supplement. The
symptoms reported improved or resolved and majority of patients receiving conventional
0
for symptoms reported no change or worse. treatment received conjugated or esterified es-
For example, a woman who visited her doctor trogens (Table 3). Of patients who were treated
three times during the study period, reported with naturopathic methods, one third received
recent onset of insomnia at her first visit. The concurrent HRT. Patients who attended con-
binary code assigned to that visit was 0. She re- ventional clinics were more likely to receive an-
turned the next month to her physician and re- tidepressant and antihypertensive therapy.
ported an improvement in her sleep distur-
In an unadjusted analysis, patients treated
bance; Her subsequent visit was coded as 1. In with naturopathy were more likely to experi-
follow-up the next month, she reported once ence an improvement in energy level and in-
again that she was having trouble sleeping and somnia than conventionally treated patients
it was worse; she was assigned a binary code (Table 4). When adjusted for age, weight, smok-
of 0 for the final visit. For each symptom, all ing status, regular exercise program, monthly
binary responses, representing all office visits income, and antihypertensive therapy, by re-
for an individual, were included in the analy- peated measures analysis, patients treated with
sis. Individuals with less than two office visits naturopathy were about seven times more
for a specific symptom were excluded from the likely to experience an improvement in energy
analysis for that symptom.
level and insomnia than conventionally treated

5
34
CRAMER ET AL.
TABLE 2. BASELINE CHARACTERISTICS OF PATIENTS REPORTING MENOPAUSAL SYMPTOMS
BY CLINIC TYPE, COMMUNITY HEALTH CENTERS OF KING COUNTY, 1997–1998
Naturopathic
patients n 5 79
(%)a
Conventional
patients n 5 160
(%)
p valueb
Patient characteristics
c
Age (mean 6 SE)
Monthly income (mean 6 SE)
Office visits to provider (mean 6 SE)
Race
51.7 6 0.75
1848 6 209
5.9 6 0.60
50.7 6 0.55
853.6 6 54
6.3 6 0.32
0.292
c
, 0.001
0.515
0.739
White
58 (73.4)
6 (7.6)
7 (8.9)
6 (7.6)
111 (69.3)
10 (6.3)
9 (5.6)
Hispanic
Black
Asian
27 (16.9)
Lifestyle/risk factors
Smoking Status
Nonsmokerd
0.001
0.052
34 (43.0)
19 (24.1)
16 (20.3)
9 (11.4)
44 (27.5)
34 (21.3)
12 (7.5)
67 (41.9)
45 (28.1)
Never
Former
Current
Regular exercise program
Medical history
Hysterectomy
Diabetes mellitus
Hypertension
History of breast cancer
Family history of breast cancer
Menopausal Symptoms
Anxiety
Decreased energy
Hot flashes
Insomnia
35 (44.3)
30 (38.0)
4 (5.1)
15 (19.0)
3 (3.8)
11 (13.9)
52 (32.5)
8 (5.0)
32 (20.0)
4 (2.5)
23 (14.4)
0.379
0.991
0.835
0.682e
0.941
61 (77.2)
33 (41.8)
55 (69.6)
45 (57.0)
35 (44.3)
23 (29.1)
13 (16.5)
88 (55.0)
39 (24.4)
89 (55.6)
53 (33.1)
83 (51.9)
52 (32.5)
29 (18.1)
0.100
0.006
0.038
0.001
0.271
0.596
0.750
Menstrual changes
Urinary complaints
Vaginal dryness
a
Numbers may not add to 100% because of missing values.
b
c
2
x test of proportions unless otherwise noted.
Student’s t test.
d
No additional information available.
Fisher’s exact test.
e
SE, standard error.
patients (Table 5). Only the improvement in in- characteristics and medication use by patients
somnia was statistically significant. Patients treated with two distinct systems of care for
treated with naturopathy improved about as menopausal symptoms in the clinical setting.
frequently as patients who were treated con- In addition, in an effort to compare meno-
ventionally for four (anxiety, hot flashes, men- pausal symptom changes, we attempted to ad-
strual changes, vaginal dryness) of the seven dress the substantial differences between the
menopausal symptoms evaluated. Naturo- users of naturopathic and conventional treat-
pathic patients reported less improvement for ments by regression analysis.
urinary complaints, although this finding was
not statistically significant.
This study provides evidence that patients
treated with the aggregate system of natur-
opathy for menopausal symptoms experience
symptom relief that is at least as effective as
conventional therapy for most symptoms. Pa-
tients treated for insomnia and decreased en-
DISCUSSION
By these methods, we were relatively easily ergy may be more likely to improve than their
able to characterize the differences in baseline conventionally treated counterparts. In our

NATUROPATHY FOR MENOPAUSE
535
TABLE 3. SELECTED MEDICATION USE BY PATIENTS TREATED FOR MENOPAUSAL SYMPTOMS,
BY CLINIC TYPE, COMMUNITY HEALTH CENTERS OF KING COUNTY, 1997–1998
Naturopathic
patients
n 5 79 (%)
Conventional
patients
n 5 160 (%)
p valuea
Medication
Naturopathic hormone replacement preparations
b
Plant-derived estrogen
22 (27.8)
27 (34.1)
20 (25.3)
2 (1.3)
2 (1.3)
0
—
—
—
c
Natural progesterone
Combined phytoestrogen/natural progesterone
Other Naturopathic Preparations:
Remifemin (Black cohosh)
48 (60.7)
1 (1.3)
3 (3.8)
5 (6.3)
14 (17.7)
48 (60.7)
47 (59.4)
22 (27.8)
8 (5.0)
0
0
5 (3.1)
2 (1.3)
7 (4.3)
19 (11.9)
2 (1.3)
, 0.001
—
—
,0.246
—
, 0.001
, 0.001
—
Licorice (Glycyrrhiza glabra)
Dong quai (Angelica sinensis)
St. John’s Wort (Hypericum perforatum)
Kava kava (Piper methysticum)
Multiple vitamin supplement
Single vitamin supplement
Vitamin E supplement
Conventional hormone replacement therapy (HRT)
d
Conjugated or Esterified Estrogen
24 (30.3)
11 (13.9)
9 (11.3)
120 (75.0)
78 (48.7)
75 (46.8)
, 0.001
, 0.001
, 0.001
e
Synthetic Progestogen
Combined estrogen/progestogen
Related prescription therapy
Antidepressantf
8 (10.1)
8 (10.1)
57 (35.6)
35 (21.8)
, 0.001
,0.026
Antihypertensiveg
Dietary modification
Oats, soy, or flaxseed enhanced diet
44 (55.6)
10 (6.3)
, 0.001
a
x2 test of proportions.
b
Plant-derived estradiol (10%): estrone (10%): estriol (80%) preparation prepared by a naturopathic pharmacist.
Oral micronized progesterone.
c
d
Conjugated estrogens, piperazine estrone sulfate, esterified estrone, micronized estradiol, estradiol, or transder-
mal patch.
e
Medroxyprogesterone acetate.
f
Amitryptyline, fluoxetine HCl, or paroxetine.
g
HCl Spironolactone, hydroclorothiazide, atenolol, furosemide, lisinopril, propranolol, verapamil, or enalapril.
study setting, the six conventional clinics of ications, we were also able to ascertain the type
CHCKC provided an opportunity to use a com- and quantity of medications prescribed for
parison cohort with administrative and con- each study patient.
textual similarities to the CHCKC naturopathy
In the clinical setting where this study was
clinic. Because each of the CHCKCs provides conducted, use of an HRT preparation was a
patients with a dispensary of formulary med- component of naturopathic care for one third
TABLE 4. PATIENTS REPORTING IMPROVEMENT IN SPECIFIC MENOPAUSAL SYMPTOMS, NATUROPATHIC VERSUS
CONVENTIONAL THERAPY, COMMUNITY HEALTH CENTERS OF KING COUNTY, 1997–1998
Patients treated with naturopathy,
# improved/# reporting symptoms, (%)
Patients treated conventionally
# improved/# reporting symptoms, (%)
p valuea
Symptoms
Anxiety
28/61 (45.5)
12/33 (36.4)
25/55 (45.4)
17/45 (37.8)
9/35 (25.7)
3/23 (13.0)
4/13 (30.7)
29/88 (32.9)
6/39 (15.4)
27/89 (30.3)
9/53 (17.0)
28/83 (33.7)
8/52 (15.4)
4/29 (13.7)
0.110
0.039
0.067
0.019
0.373
0.787
0.238
Decreased energy
Hot flashes
Insomnia
Menstrual changes
Urinary complaints
Vaginal dryness
ax2 test of proportions.

5
36
CRAMER ET AL.
TABLE 5. UNADJUSTED AND ADJUSTED ODDS OF IMPROVEMENT IN MENOPAUSAL SYMPTOMS, NATUROPATHIC VERSUS
CONVENTIONAL THERAPY, COMMUNITY HEALTH CENTERS OF KING COUNTY, 1997–1998
a
Symptoms
Crude OR (95% CI)
p value
Adjusted OR (95% CI)
p value
Anxiety
1.41 (0.89, 2.25)
2.46 (0.86, 7.03)
1.50 (0.90, 2.51)
2.18 (1.92, 2.47)
0.74 (0.34, 1.58)
0.64 (0.22, 1.83)
2.59 (0.77, 8.67)
0.129
0.093
0.119
0.119
0.431
0.402
0.124
1.27 (0.63, 2.56)
6.55 (0.96, 44.74)
1.40 (0.68, 2.88)
6.77 (1.71, 26.63)
0.98 (0.43, 2.24)
0.18 (0.01, 2.26)
0.91 (0.21, 3.96)
0.500
0.056
0.359
0.006
0.973
0.182
0.910
Decreased Energy
Hot Flashes
Insomnia
Menstrual Changes
Urinary Complaints
Vaginal Dryness
aAdjusted for age, weight, smoking status, monthly income, regular exercise program, antihypertensive therapy.
OR, odds ratio; CI, confidence interval.
of women. Although HRT is also prescribed by took 60 g of soy protein daily experienced a
conventional physicians, other elements of the 45% reduction in the number of hot flashes
aggregate system of naturopathy further dif- compared to a 30% reduction within the
ferentiate it from conventional therapy. These placebo group (Albertazzi et al., 1998). Differ-
treatment options include the use of a spectrum ences in improvement in energy level and in-
of plant-derived estrogens, phytomedicinals, somnia may be caused by lifestyle factors,
lifestyle changes, dietary modification, mind– dietary preferences, or the use of concurrent
body techniques, and the encounter with the therapies such as kava-kava extract, which has
naturopathic provider in addition to the option been reported to have anxiolytic properties.
of using HRT. In a separate analysis, to test the A randomized, double-blinded, placebo-con-
hypothesis that HRT use alone was responsi- trolled, multicenter trial of kava-kava extract
ble for comparability in symptom improve- determined that patients with anxiety disor-
ment between the two groups we compared the ders experienced significant reductions in
subset of naturopathy patients treated with Hamilton Anxiety Scale (HAMA) scores (Volz
plant-derived estrogens and phytoprogeste- et al., 1997).
rones to the subset of conventional patients
Although our study does not provide com-
treated with estrogen and progestogen prepa- prehensive information about the reasons why
rations, respectively. There were no significant patients seek naturopathic treatment of
differences in symptom improvement among menopausal symptoms, we did find baseline
patients treated by phytoestrogens compared differences between patients treated with
to conventional estrogens, or naturopathic naturopathy and those treated conventionally.
progesterones compared with conventional Patients treated with naturopathy tended to
progestogens (data not shown).
participate more frequently in a regular exer-
Findings from this study of comparable cise routine, were less likely to be current
symptom relief between the two therapy smokers, and had higher monthly incomes.
groups are consistent with other studies of This finding is consistent with a national sur-
comparison of specific naturopathic pharma- vey of alternative medicine use in the United
cotherapy to conventional therapy. Studies of States, which found that 72% of patients using
dietary supplementation with phytoestrogens alternative medicine have annual incomes
have shown reduction in hot flashes among greater than $20,000 per year (Eisenberg et al.,
some women. A double-blinded, randomized 1998). Although fear of increased risk of breast
trial of daily dietary supplementation of soy cancer related to use of conjugated and esteri-
flour compared to wheat flour found a 40% fied estrogens might result in a greater pre-
compared with a 25% reduction in symptoms valence of patients with personal or family
in the soy and wheat flour groups, respectively histories of breast cancer among users of natur-
(
Murkies et al., 1995). Another double-blinded, opathy, there were no differences in breast can-
multicenter, randomized placebo-controlled cer histories between the two groups.
trial found that postmenopausal women who This investigation posed many analytic chal-

NATUROPATHY FOR MENOPAUSE
537
lenges and led to several study limitations. By
their nature, menopause symptoms regress
spontaneously. Without a placebo group it is
ACKNOWLEDGMENTS
The authors are grateful to Tom Trompeter,
impossible to establish the proportion of symp- M.P.A., Cindy Breed, N.D., Martin P. Ross,
tom regression that is the result of therapy over M.D., Jo Abraham, Augusto Romano, L.Ac.,
time. The women in the naturopathy treatment Alonzo Plough, Ph.D., Joseph Pizzorno, N.D.,
group were a full year older than those in the Benedict I. Truman, M.D., M.P.H., Stephanie
conventional therapy group. Because we do not Zaza, M.D., M.P.H., Lori Hutwagner, M.S.,
know the duration of menopause symptoms Robert Hahn, Ph.D., Wayne Jonas, M.D., and
or whether women were perimenopausal or Walter Willett, M.D., for their assistance in plan-
menopausal, it is impossible from this study to ning, conducting, and reviewing this study.
establish whether the women in the naturopa-
thy group were further along in their trajectory
through menopause. Also, there were more
smokers in the conventional therapy group and
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