In 1997, about 42 percent of U.S. adults used some type of alternative therapy, for a total expenditure of $27 billion. Acupuncture and several dietary supplements, such as soy, isoflavone, and black cohosh, have been advocated for treatment of menopausal symptoms, but the extent of their use in the general population is unknown. Newton and colleagues surveyed women enrolled in a large managed-care health plan to assess the prevalence of alternative treatments for menopausal symptoms and the characteristics of women who chose such therapies.

As part of a large study of menopause and hormone replacement therapy (HRT), the authors surveyed 886 women 45 to 65 years of age who had been plan members for at least two years. The women were asked about their beliefs and attitudes toward HRT, menopausal symptoms, use of alternative therapies, and interactions with health care providers. Perceived risk of osteoporosis, coronary heart disease, and breast cancer also was assessed. Specific questions about alternative therapies concerned the use of acupuncture, chiropractic therapy, relaxation therapy, massage, and stress management. Information also was gathered on demographic factors, height, weight, exercise habits, smoking, and alcohol use.

The majority of participants (90 percent) were white, and most (78 percent) had at least some college education. Overall, 76 percent of the women reported using at least one alternative therapy, and 22 percent reported using such therapies specifically for menopausal symptoms. Use was higher among the younger and better-educated women. Women who reported engaging in moderate to strenuous exercise and who did not smoke were more likely to report using alternative therapies.

The most commonly used therapies were stress management or relaxation techniques (43 percent); herbal, homeopathic, or naturopathic remedies (37 percent); chiropractic therapy (32 percent); massage therapy (30 percent); dietary soy (23 percent); and acupuncture (10 percent).

Nine percent of the women had consulted a homeopathic or naturopathic practitioner, and 5 percent had visited a herbalist. Herbal, homeopathic, or naturopathic remedies had been used specifically for menopausal symptoms by 13 percent of the women and 7 percent had used soy products. Up to 75 percent of the participants said the alternative therapies were very helpful. The strongest support was reported for chiropractic therapy, acupuncture, massage therapy, and stress management.

Nearly two thirds of the women favored natural therapies for menopause; 61 percent agreed with the statement that natural approaches were better than taking hormone pills. Nearly one half of the women who agreed with this statement were current HRT users. Use of stress-management techniques, massage therapy, chiropractic therapy, acupuncture, and soy products was greatly increased in women who reported sleep disturbances. Women with a history of breast cancer were six times more likely than other women to use soy products.

The authors conclude that use of alternative therapies among menopausal women—even those using HRT—is common. Some products, especially soy, appear to have particularly high use in the subset of women with a history of breast cancer.

editor's note: Recent study results concerning HRT may cause more women to turn to alternative therapies. Although patients have great faith in these remedies, the literature supporting their use is mixed. In particular, the lack of standardization of products makes giving advice a complex task. An upcoming AAFP Home Study Self-Assessment Monograph on the health of women in midlife reviews this topic.—a.d.w.