Management of perimenopause: Focus on alternative therapies

H.L. THACKER and D.L. BOOHER

ABSTRACT

A variety of herbs and other "natural alternative medicines" are marketed directly to consumers and sold over-the-counter as treatments for perimenopausal symptoms. Far from being innocuous placebos, many of these substances have real physiologic effects, including potential adverse effects and drug interactions. Yet they are largely untested and, by law, totally unregulated. This article reviews a few of the untested substances your patients may be taking, along with established treatments.

KEY POINTS

We try to discourage women from taking "natural" alternative medications, but failing this, we try to monitor their use.

Black cohosh may have actual estrogen-like activity; dong quai may not.

Many women are taking the androgen DHEA, but its safety and role are not known. If patients refuse to discontinue DHEA, we recommend liver function tests and monitoring serum levels of DHEA-S, lipids, and testosterone.

Different women experience perimenopause differently: some have vasomotor symptoms due to estradiol deficiency with resultant surges of luteinizing hormone, but others have surges of estradiol excess with resultant fluid retention. Progesterone deficiency may lead to irregular bleeding.

HOLLY L. THACKER, MD

Head, Section of Women’s Health, Department of General Internal Medicine, and associate director, Mature Women’s Menopause Program, Department of Gynecology and Obstetrics, Cleveland Clinic; assistant professor of internal medicine, Ohio State University

DELBERT L. BOOHER, MD

Director, Program for Mature Women, Department of Gynecology and Obstetrics, Cleveland Clinic; assistant professor of obstetrics and gynecology, Ohio State University

ADDRESS: Holly L. Thacker, MD, Department of General Internal Medicine, A91, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.

John D. Clough, M.D., editor-in-chief
Linda K. Hengstler, editor and publisher
Phillip E. Canuto, executive editor
Ray Borazanian, managing editor

The Cleveland Clinic Foundation
Cleveland Clinic Journal of Medicine, NA32
9500 Euclid Avenue
Cleveland, Ohio 44195

216.444.2661, FAX 216.444.9385, ccjm@ccf.org

This page maintained by the Division of Education, education@ccf.org. 4/99