Complementary and Complementary and Alternative Medicine in Alternative Medicine in

Women’s HealthWomen’s Health

Elise Henry, MDElise Henry, MD

CAM in Women’s HealthCAM in Women’s Health• OverviewOverview• Nausea and vomiting in pregnancyNausea and vomiting in pregnancy• Labor & Delivery Labor & Delivery • MenopauseMenopause

Overview of CAMOverview of CAM

Overview of CAMOverview of CAM• Types of CAMTypes of CAM• Basic Science?Basic Science?• ScreeningScreening• CounselingCounseling

Gaudet, T, MD Clinical Updates in Gaudet, T, MD Clinical Updates in Women's Health: Complementary anWomen's Health: Complementary and Alternative Medicine Vol III, No. 5d Alternative Medicine Vol III, No. 5, Oct 2004. , Oct 2004.

Types of CAMTypes of CAM• Biologically Based TherapiesBiologically Based Therapies• Manipulative-Based TherapiesManipulative-Based Therapies• Mind Body-Based TherapiesMind Body-Based Therapies• Energy-Based TherapiesEnergy-Based Therapies• Therapies Based in Complete Therapies Based in Complete

SystemsSystems

Biologically Based TherapiesBiologically Based Therapies• Botanical or herbal therapiesBotanical or herbal therapies• Studied extensively in EuropeStudied extensively in Europe• Large multicenter trialsLarge multicenter trials• Botanicals are the active components…Botanicals are the active components…

– 25% of Rx drugs25% of Rx drugs– 60% of OTC drug60% of OTC drug

• Not regulated by the FDANot regulated by the FDA• Known or potential drug interactions existKnown or potential drug interactions exist

Potential Interactions with Potential Interactions with DrugsDrugsAnticoagulantAnticoagulantss

Dong QuaiDong Quai ↑ ↑ risk of bleedingrisk of bleeding

Garlic, Garlic, GinsengGinsengGinger, Ginger, GinkgoGinkgo

“ “ ““

St. John’s St. John’s WortWort

↓ ↓ effectivenesseffectiveness

AnticonvulsanAnticonvulsantsts

Evening Evening Primrose OilPrimrose Oil

↓ ↓ seizure seizure thresholdthreshold

AntidepressanAntidepressantsts

GinsengGinseng ↑ ↑ effect of MAO-Ieffect of MAO-I

St. John’s St. John’s WortWort

with MAO-with MAO-I=I=↑BP↑BP

HypoglycemicHypoglycemicss

Aloe, Aloe, GinsengGinseng

↑ ↑ hypoglycemiahypoglycemia

Manipulative-Based Manipulative-Based TherapiesTherapies

• ChiropracticChiropractic• Massage TherapyMassage Therapy

ChiropracticChiropractic• Relationship between structure and functionRelationship between structure and function• Manipulative therapyManipulative therapy• Licensed to:Licensed to:

– Manipulate and align the spineManipulate and align the spine– Take medical historiesTake medical histories– Perform physical examinationsPerform physical examinations– Order tests and X-raysOrder tests and X-rays

• Risks and complicationsRisks and complications

Massage TherapyMassage Therapy• Manipulation of the soft tissuesManipulation of the soft tissues• Types of massage therapyTypes of massage therapy

Deep Tissue MassageDeep Tissue Massage• Focuses on the Focuses on the

deeper layers of deeper layers of muscle tissuemuscle tissue

• Release chronic Release chronic patterns of tension, patterns of tension, remove toxins and remove toxins and soothe musclesoothe muscle

• Corrective and Corrective and therapeutictherapeutic

Swedish MassageSwedish Massage• Relax muscles by:Relax muscles by:

– Applying pressure Applying pressure against deeper against deeper muscles and bonesmuscles and bones

– Rubbing in the same Rubbing in the same direction as the flow direction as the flow of blood returning to of blood returning to the heartthe heart

• Increase OIncrease O22 in blood in blood• Release toxinsRelease toxins

ReflexologyReflexology• Reflex areas on feet Reflex areas on feet

(and hands) (and hands) corresponding to all corresponding to all body partsbody parts

• Applying pressure to Applying pressure to specific areas can specific areas can affect internal organsaffect internal organs

• Holistic healing that Holistic healing that promotes good healthpromotes good health

Rolfing MassageRolfing Massage• Manipulation Manipulation

therapy of therapy of connective tissueconnective tissue

• Massage combined Massage combined with movement with movement techniques to techniques to improve postureimprove posture

• Restructure and Restructure and realign the bodyrealign the body

Massage TherapyMassage Therapy• Manipulation of the soft tissuesManipulation of the soft tissues• Types of massage therapy:Types of massage therapy:

– Deep tissueDeep tissue– SwedishSwedish– ReflexologyReflexology– RolfingRolfing

• Specific indications:Specific indications:– Acute low back painAcute low back pain– Lymphatic massage for lymphedema patientsLymphatic massage for lymphedema patients

• ContraindicationsContraindications

Mind-Body Based TherapiesMind-Body Based Therapies• HypnosisHypnosis• Meditation and Stress ReductionMeditation and Stress Reduction

HypnosisHypnosis• Induction of trance states and use of Induction of trance states and use of

therapeutic suggestionstherapeutic suggestions• Documented uses:Documented uses:

– Psychologic usesPsychologic uses– Pain controlPain control– Recovery from surgeryRecovery from surgery

• Negative effects during and after Negative effects during and after hypnosishypnosis

Meditation and Stress Meditation and Stress ReductionReduction

• Self-directed practice for relaxing the Self-directed practice for relaxing the body and calming the mindbody and calming the mind

• Origin- Eastern religious practicesOrigin- Eastern religious practices• Two types:Two types:

– Mindfulness-based stress reductionMindfulness-based stress reduction– Transcendental meditationTranscendental meditation

• May lead to “spiritual emergency”May lead to “spiritual emergency”

Energy-Based TherapiesEnergy-Based Therapies• Involve the use of energy fieldsInvolve the use of energy fields• Two types:Two types:

– Biofield therapy- affects energy fields that Biofield therapy- affects energy fields that purportedly surround and penetrate the purportedly surround and penetrate the human body, i.e. qi gong, therapeutic touch human body, i.e. qi gong, therapeutic touch

– Bioelectromagnetic-based therapy- Bioelectromagnetic-based therapy- unconventional use of electromagnetic unconventional use of electromagnetic fields, i.e. pulsed fields, magnetic fieldsfields, i.e. pulsed fields, magnetic fields

• Poorly researched and most diversePoorly researched and most diverse

Therapies Based in Complete Therapies Based in Complete SystemsSystems

• AcupunctureAcupuncture• HomeopathyHomeopathy• Naturopathic MedicineNaturopathic Medicine

AcupunctureAcupuncture• Stimulates specific anatomic points in the Stimulates specific anatomic points in the

body by puncturing the skinbody by puncturing the skin• 1997 NIH Consensus Panel1997 NIH Consensus Panel

– Convincing evidence in the treatment of Convincing evidence in the treatment of postoperative dental pain and N/Vpostoperative dental pain and N/V

– Promising areas with more research needed- Promising areas with more research needed- HA, low back pain, stroke, addiction, asthma, HA, low back pain, stroke, addiction, asthma, PMS, osteoarthritis, carpal tunnel syndrome, PMS, osteoarthritis, carpal tunnel syndrome, tennis elbowtennis elbow

Acupuncture. NIH Consens Statement 1997;15(5):1-34.Acupuncture. NIH Consens Statement 1997;15(5):1-34.

• Risks and complicationsRisks and complications

HomeopathyHomeopathy• Small, highly diluted quantities of Small, highly diluted quantities of

medicinal substancesmedicinal substances• ““like cures like”like cures like”

Naturopathic MedicineNaturopathic Medicine• Emphasizes health restoration rather than Emphasizes health restoration rather than

disease treatmentdisease treatment• Array of healing practices:Array of healing practices:

– Diet and clinical nutritionDiet and clinical nutrition– HomeopathyHomeopathy– AcupunctureAcupuncture– Herbal medicineHerbal medicine– HydrotherapyHydrotherapy– Spinal and soft tissue manipulationSpinal and soft tissue manipulation

Basic Science?Basic Science?

Basic Science?Basic Science?• The Biomedical ModelThe Biomedical Model• Quality ControlQuality Control• Training and LicensureTraining and Licensure

The Biomedical ModelThe Biomedical Model1.1. Consistent with the biomedical modelConsistent with the biomedical model

– Biologically based therapies, i.e. botanicalsBiologically based therapies, i.e. botanicals2.2. Foundations are within the biomedical model, Foundations are within the biomedical model,

but propose mechanisms that extend beyondbut propose mechanisms that extend beyond– Manipulative-based therapies, i.e. chiropracticManipulative-based therapies, i.e. chiropractic– Mind body-based therapies, i.e. hypnosis, meditationMind body-based therapies, i.e. hypnosis, meditation

3.3. Foreign to biomedical modelForeign to biomedical model– Energy-based therapies, i.e. reiki, therapeutic touchEnergy-based therapies, i.e. reiki, therapeutic touch– Therapies based in complete systems, i.e. Therapies based in complete systems, i.e.

acupunctureacupuncture

Quality ControlQuality Control• The Federation of State Medical Boards has The Federation of State Medical Boards has

developed guidelines for CAM use in developed guidelines for CAM use in medical practices, 2002medical practices, 2002– Federation of State Medical Boards. Model guidelines for the use of Federation of State Medical Boards. Model guidelines for the use of

complementary and alternative therapies in medical practice. Dallas complementary and alternative therapies in medical practice. Dallas (TX): FSMB (TX): FSMB

– www.fsmb.orgwww.fsmb.org

• The Dietary Supplement Health and The Dietary Supplement Health and Education Act, 1994Education Act, 1994– Legal to make “structure/function” claimsLegal to make “structure/function” claims– Labels read “this product is not intended to Labels read “this product is not intended to

diagnose, treat, cure or prevent any disease”diagnose, treat, cure or prevent any disease”

Training and LicensureTraining and LicensureTherapyTherapy TrainingTraining LicensureLicensure

ChiropracticChiropractic 4 yr chiropractic 4 yr chiropractic collegecollege

National National (Council on (Council on Chiropractic Education)Chiropractic Education)

Massage Massage therapytherapy

500 in-class hrs500 in-class hrs,,Certification Certification examexam

StateState (National (National Certification Board for Certification Board for Therapeutic Massage)Therapeutic Massage)

AcupunctureAcupuncture 3-4yrs Oriental 3-4yrs Oriental medicinemedicine

StateState (Accreditation (Accreditation Commission for Commission for Acupuncture and Acupuncture and Oriental Medicine)Oriental Medicine)

Clinical hypnosisClinical hypnosis Basic- 40hrs Basic- 40hrs wrkshop, 20hrs wrkshop, 20hrs indiv. training, indiv. training, 2 yrs indep. 2 yrs indep. practice;practice;Advanced- 60hrs, Advanced- 60hrs, 5yrs5yrs

State State (The American (The American Society of Clinical Society of Clinical Hypnosis)Hypnosis)

ScreeningScreening

ScreeningScreening• Why screen?Why screen?

– Women are the primary users of CAMWomen are the primary users of CAM– No. of visits to alternative care providers No. of visits to alternative care providers

exceeds that of primary care physiciansexceeds that of primary care physicians– Most patients do not disclose CAM useMost patients do not disclose CAM use– Potential harmful practices and productsPotential harmful practices and products– Potential interactions between effective Potential interactions between effective

CAM and conventional approachesCAM and conventional approaches

ScreeningScreening• How to screenHow to screen

– Integrate questions regarding CAM into Integrate questions regarding CAM into patient historypatient history•Add CAM questions to current intake formAdd CAM questions to current intake form•Provide patients with additional information Provide patients with additional information

sheet sheet – Follow-up questionnaire answers during Follow-up questionnaire answers during

office visitoffice visit– Elicit history of anything ingestibleElicit history of anything ingestible

CounselingCounseling

CounselingCounseling• Start honestlyStart honestly

– New territory in conventional medicineNew territory in conventional medicine– Physicians are not expertsPhysicians are not experts

• Integrating CAM and conventional Integrating CAM and conventional medicine medicine

1.1. Assess potential harmAssess potential harm2.2. Assess potential benefitAssess potential benefit3.3. Assess the quality of the product/providerAssess the quality of the product/provider4.4. Assess the integration with the conventional Assess the integration with the conventional

treatment plantreatment plan

NAUSEA AND VOMITING IN NAUSEA AND VOMITING IN PREGNANCYPREGNANCY

Nausea and vomiting in Nausea and vomiting in pregnancypregnancy

• Affects 50% or more of women in Western Affects 50% or more of women in Western societiessocieties

• Nonpharmacologic txments recommendedNonpharmacologic txments recommended– Dietary and lifestyle changeDietary and lifestyle change– Few women report complete reliefFew women report complete relief

• Many women seek alternative therapiesMany women seek alternative therapies– Critical period for embryogenesis Critical period for embryogenesis – Potential for adverse effects on fetal Potential for adverse effects on fetal

developmentdevelopment

Nausea and vomiting in Nausea and vomiting in pregnancypregnancy

• AcupressureAcupressure• GingerGinger• Vitamin B6Vitamin B6

AcupressureAcupressure• Acupressure Acupressure → release → release

of opioid peptides → of opioid peptides → activates hypothalamus activates hypothalamus and pituitary gland → and pituitary gland → modifies blood flow → modifies blood flow → alters immune system → alters immune system → affects secretion of affects secretion of neurotransmitters and neurotransmitters and neurohormonesneurohormones

• Acustimulation- applying Acustimulation- applying a mild electrical current to a mild electrical current to acupuncture pointsacupuncture points

AcupressureAcupressure• Neiguan (P6) pointNeiguan (P6) point

– volar surface of the volar surface of the forearm, three forearm, three fingerbreadths fingerbreadths above the wristabove the wrist

• Traditional Chinese Traditional Chinese medicine believes medicine believes relief of N/V occurs relief of N/V occurs at P6 pointat P6 point

AcupressureAcupressure• Considerations in evaluating studiesConsiderations in evaluating studies

– Double-blinded study is difficultDouble-blinded study is difficult– Small sample sizesSmall sample sizes– Lack of adequate control conditionsLack of adequate control conditions– Spontaneous resolution of N/V in Spontaneous resolution of N/V in

pregnancy around 12-14 weekspregnancy around 12-14 weeks

AcupressureAcupressure• Dundee et al, 1988 (P<.005)Dundee et al, 1988 (P<.005)

– Reported “severe” or “troublesome” nauseaReported “severe” or “troublesome” nausea•24%24% using P6 acupressureusing P6 acupressure•37% using Sham point acupressure37% using Sham point acupressure•56% using no intervention56% using no intervention

• DeAloysio et al, 1992 (P<.05)DeAloysio et al, 1992 (P<.05)– Reduction or elimination of symptomsReduction or elimination of symptoms

•65-69% using accupressure65-69% using accupressure•29-31% using placebo29-31% using placebo

AcupressureAcupressure• O’Brien et al, 1996 O’Brien et al, 1996

– No differences in nausea or vomiting No differences in nausea or vomiting associated with intervention or placebo associated with intervention or placebo

• Evans et al, 1993 (P<.05)Evans et al, 1993 (P<.05)– Improvement in symptoms of N/VImprovement in symptoms of N/V

•87% of experimental group87% of experimental group•43% of controls43% of controls

GingerGinger• Remedy employed Remedy employed

for nausea in for nausea in traditional culturestraditional cultures

• Efficacy due to Efficacy due to aromatic, aromatic, carminative, and carminative, and absorbent absorbent propertiesproperties

GingerGinger• Fischer-Rasmussen et al, 1991 Fischer-Rasmussen et al, 1991

(P=.035)(P=.035)– Reduced the degree of nauseaReduced the degree of nausea– Reduced the number of attacks of Reduced the number of attacks of

vomitingvomiting• Vutyavanich et al, 2001Vutyavanich et al, 2001

– Significant improvement in nausea and Significant improvement in nausea and vomitingvomiting

Vitamin B6Vitamin B6• Thought to bind Thought to bind

estrogen & estrogen & progesterone progesterone receptorsreceptors

• First evaluated in First evaluated in the 1940’sthe 1940’s

• Peripheral Peripheral neuropathies may neuropathies may occur at ≥200 mg/doccur at ≥200 mg/d

Vitamin B6Vitamin B6

• Included in original formulation of Included in original formulation of BendectinBendectin– 10 mg of doxylamine & 10 mg of pyridoxine10 mg of doxylamine & 10 mg of pyridoxine– Withdrawn from the market in 1983Withdrawn from the market in 1983

• Seto et al, 1997 (meta-analysis)- review Seto et al, 1997 (meta-analysis)- review of more than 200,000 first trimester of more than 200,000 first trimester exposures to Hexposures to H1 1 receptor blockers receptor blockers

Vitamin B6Vitamin B6• Sahakian et al, 1991Sahakian et al, 1991

– Minimal effect- mild nausea symptomsMinimal effect- mild nausea symptoms– Significant effect- severe nausea symptoms Significant effect- severe nausea symptoms

(P<.01)(P<.01)– Significant overall reduction in vomiting Significant overall reduction in vomiting

(P<.05)(P<.05)• Vutyavanich et al, 1995 (P<.001)Vutyavanich et al, 1995 (P<.001)

– Significant decrease in nauseaSignificant decrease in nausea– Nonsignificant trend towards reduction in Nonsignificant trend towards reduction in

vomiting episodesvomiting episodes

Summary-Summary-Nausea and vomiting in Nausea and vomiting in

pregnancypregnancy• AcupressureAcupressure

– Appears to be the most-studied treatmentAppears to be the most-studied treatment• Poor methodologic qualityPoor methodologic quality• Placebo effectPlacebo effect

– Simple and inexpensive- commercially available wrist Simple and inexpensive- commercially available wrist bandsbands

– Little risk of adverse effectLittle risk of adverse effect• GingerGinger

– Improvement seen with 250mg QIDImprovement seen with 250mg QID– Investigation of sex steroid differentiationInvestigation of sex steroid differentiation

• Vitamin B6Vitamin B6– Benefits noted at 30-75mg dailyBenefits noted at 30-75mg daily– Allegations against Bendectin have not been supportedAllegations against Bendectin have not been supported

LABOR AND DELIVERYLABOR AND DELIVERY

Labor and DeliveryLabor and Delivery• AcupunctureAcupuncture• HypnosisHypnosis• MassageMassage

AcupunctureAcupuncture• Pain relief in laborPain relief in labor• Cervical ripening, Cervical ripening,

induction of labor, induction of labor, augmentation of augmentation of laborlabor

• Sole method of Sole method of anesthesia for anesthesia for cesarean sections cesarean sections in China in China

AcupunctureAcupuncture• Ramnero et al, 2002Ramnero et al, 2002

– Pain intensity equal between 2 groupsPain intensity equal between 2 groups– Significantly reduced need for epidural Significantly reduced need for epidural

analgesia in acupuncture groupanalgesia in acupuncture group• Skilnand et al, 2002Skilnand et al, 2002

– Benefits for real acupuncture treatmentBenefits for real acupuncture treatment• Significantly lower pain scores at 30, 60, 120 minutes Significantly lower pain scores at 30, 60, 120 minutes

and 2 hours postpartumand 2 hours postpartum• Significantly less need for epidural analgesia and IM Significantly less need for epidural analgesia and IM

pain medicinepain medicine

HypnosisHypnosis

HypnosisHypnosis• Freeman et al, 1986Freeman et al, 1986

– No significant differences between 2 groupsNo significant differences between 2 groups– No significant difference in use of analgesiaNo significant difference in use of analgesia

• Harmon et al, 1990Harmon et al, 1990– Significant improvement of all 5 subscales Significant improvement of all 5 subscales

the MPQ in hypnosis groupthe MPQ in hypnosis group– Less pain medications needed by hypnosis Less pain medications needed by hypnosis

groupgroup

MassageMassage

MassageMassage• Field et al, 1997Field et al, 1997

– Massage group- pain reduced from Massage group- pain reduced from 5.05.0→3.5→3.5

– Control group- pain increased from 4.3→5.0Control group- pain increased from 4.3→5.0– Statistical analysis unclearStatistical analysis unclear

• Chang et al, 2002Chang et al, 2002– Lower PBI & PPI scores in the massage Lower PBI & PPI scores in the massage

group in all three phases of laborgroup in all three phases of labor

Summary- Summary- Labor and Delivery Labor and Delivery

• Insufficient evidence for the efficacy Insufficient evidence for the efficacy of these CAM therapies for labor pain of these CAM therapies for labor pain reliefrelief

• Other CAM therapies under Other CAM therapies under investigation:investigation:– BiofeedbackBiofeedback– Intracutaneous injections of sterile waterIntracutaneous injections of sterile water– Respiratory autogenic training Respiratory autogenic training

MENOPAUSEMENOPAUSE

MenopauseMenopause• 80% of American women use 80% of American women use

nonprescription therapies to help nonprescription therapies to help manage menopausal symptomsmanage menopausal symptoms

• Common beliefs- natural hormones:Common beliefs- natural hormones:– Safer, cause fewer side effects and are Safer, cause fewer side effects and are

equal/more effectiveequal/more effective– More effective for long-term protection More effective for long-term protection

of bones and lipidsof bones and lipids

MenopauseMenopause• BotanicalsBotanicals• AcupunctureAcupuncture• Mind-body techniqueMind-body technique

BotanicalsBotanicals• SoySoy• Red cloverRed clover• Black cohoshBlack cohosh

SoySoy• PhytoestrogenPhytoestrogen• Studies compare food Studies compare food

vs. isoflavone extractsvs. isoflavone extracts• Peri- and Peri- and

postmenopausalpostmenopausal• Breast cancer patientsBreast cancer patients• Entry criteria and Entry criteria and

endpointsendpoints

SoySoy• Faure et al, 2002Faure et al, 2002

– ITT analysis: significant decrease in hot flash ITT analysis: significant decrease in hot flash frequency in soy groupfrequency in soy group

• Penotti et al, 2003Penotti et al, 2003– No significant differences between groupsNo significant differences between groups

• Burke et al, 2003Burke et al, 2003– No significant differences between groupsNo significant differences between groups

• Nikander et al, 2003Nikander et al, 2003– No significant differences between groupsNo significant differences between groups

Red clover (Trifolium Red clover (Trifolium pratense)pratense)

• Member of legume Member of legume familyfamily

• PhytoestrogenPhytoestrogen• ““Clover syndrome”Clover syndrome”

Red cloverRed clover• Jeri, 2002Jeri, 2002

– Significant reduction in number and Significant reduction in number and severity of hot flashes in treatment groupseverity of hot flashes in treatment group

• Van de Weijer et al, 2002Van de Weijer et al, 2002– Significant decrease in hot flashes in Significant decrease in hot flashes in

treatment grouptreatment group• Tice et al, 2003Tice et al, 2003

– No significant differences between groups No significant differences between groups

Black cohosh Black cohosh (Cimicifuga racemosa)(Cimicifuga racemosa)

• No phytoestrogensNo phytoestrogens• Traditionally used Traditionally used

for both PMS and for both PMS and menopausemenopause

• Inhibits LH in ratsInhibits LH in rats• LH most likely LH most likely

decreased via decreased via neurotransmittersneurotransmitters

Black cohoshBlack cohosh• Stoll, 1987Stoll, 1987

– Significant symptom improvement in black cohosh groupSignificant symptom improvement in black cohosh group– No improvement with placebo group or estrogen No improvement with placebo group or estrogen

treatment armtreatment arm• Jacobsen et al, 2001Jacobsen et al, 2001

– No significant differences between groups in frequency No significant differences between groups in frequency and intensity of hot flashesand intensity of hot flashes

• Wuttke et al, 2003Wuttke et al, 2003– Black cohosh as effective as conjugated estrogens in Black cohosh as effective as conjugated estrogens in

symptom improvementsymptom improvement– No significant differences between groups No significant differences between groups

BotanicalsBotanicals• Other botanicals used for menopause Other botanicals used for menopause

and undergoing research:and undergoing research:– Dong quaiDong quai– MelatoninMelatonin– St. John’s WortSt. John’s Wort– Vitamin EVitamin E

AcupunctureAcupuncture

AcupunctureAcupuncture• Sandberg et al, 2002Sandberg et al, 2002

– No significant differences in reduction of No significant differences in reduction of symptoms between groupssymptoms between groups

– Mood symptoms improved in Mood symptoms improved in electroacupuncture groupelectroacupuncture group

• Cohen et al, 2003Cohen et al, 2003– Significant reduction in hot flash Significant reduction in hot flash

severity in acupuncture groupseverity in acupuncture group

Mind-body techniquesMind-body techniques• Paced respirationsPaced respirations• Relaxation trainingRelaxation training• BiofeedbackBiofeedback

Mind-body techniquesMind-body techniques• Freedman et al, 1992Freedman et al, 1992

– Significant decline in frequency of hot Significant decline in frequency of hot flashes with paced respirationsflashes with paced respirations

• Irvin et al, 1996 and Domar et al, 1997Irvin et al, 1996 and Domar et al, 1997– Significant reduction in hot flash number in Significant reduction in hot flash number in

relaxation grouprelaxation group– Significant reduction in hot flash intensity Significant reduction in hot flash intensity

in relaxation groupin relaxation group

Mind-body techniquesMind-body techniques• Other areas of research:Other areas of research:

– Magnetic therapyMagnetic therapy– ReflexologyReflexology– HomeopathyHomeopathy

Summary- MenopauseSummary- Menopause• Quality & number of studies improvingQuality & number of studies improving• Highest quality Soy & Black cohosh studies Highest quality Soy & Black cohosh studies

have had primarily nonsignificant resultshave had primarily nonsignificant results• Red clover- positive results in 2 small trialsRed clover- positive results in 2 small trials• Nonbotanical therpies, i.e. acupuncture Nonbotanical therpies, i.e. acupuncture

and mind-bodyand mind-body– Have shown some positive resultsHave shown some positive results– Numbers are still insufficient to draw conclusionNumbers are still insufficient to draw conclusion

SummarySummary• Screening for CAM useScreening for CAM use• Counseling- protocol for integrating CAM with Counseling- protocol for integrating CAM with

conventional medicineconventional medicine• Nausea and vomiting in pregnancyNausea and vomiting in pregnancy

– Acupressure- inexpensive, little riskAcupressure- inexpensive, little risk– Ginger & vitamin B6- benefits notedGinger & vitamin B6- benefits noted

• Labor and deliveryLabor and delivery– Acupuncture & hypnosis- insufficient evidenceAcupuncture & hypnosis- insufficient evidence– Massage- inexpensive, little riskMassage- inexpensive, little risk

• MenopauseMenopause– Soy and black cohosh showed nonsignificant resultsSoy and black cohosh showed nonsignificant results– Acupuncture & mind body- insufficient evidenceAcupuncture & mind body- insufficient evidence

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