A Consensus on Menopause

Taking responsibility for one’s health or establishing the credibility of a product, service, or practitioner is not an easy task. However, it is now becoming easier to access information on the effectiveness of some herbal and natural remedies such as Remifemin, from Enzymatic Therapy.

The Consensus on Menopause and Osteoporosis produced by the Society of Obstetricians and Gynecologists of Canada (SOGC) in 1998 is Canada’s most reliable source of information. This Consensus summarized the research on menopause and osteoporosis that has been done since its first Menopause Consensus in 1994.

The consensus panel included a broad range of interested parties (gynecologists, endocrinologists, a family physician, nurse, pharmacists, cardiologist and members of the public). Each panel member had chapters to research and write. The panel members met four times during the year to discuss their findings until a general consensus was reached.

Funding was under the umbrella of Unrestricted Educational Grants; 12 pharmaceutical companies world-wide funded these grants. The members of the study were not paid for their work, only compensated for their expenses.

Dr Suzanne Montemuro is a family practitioner. She was asked be a participant on the consensus panel because of her interest in alternative treatments for menopause and her extensive public speaking experience to both doctors and the general public about menopause.

Montemuro explains that the Consensus covered a broad range of topics pertinent to aging women’s health: menopause symptom relief, psychosexual concerns, heart disease, osteoporosis, cancer, hormone replacement therapy, complementary treatments, hormones and "the brain," patient evaluation and decision making. Montemuro and two other participants were asked to write the chapter on complementary approaches to the treatment of menopause.

Key Points

An important aspect of the consensus, for both physicians and the public, was evaluating the research into the beneficial effects of natural therapies on menopausal symptoms. The most widely used natural alternative menopause therapy is Remifemin. It’s been used in Germany since 1960s but has only been available in health food stores in Canada for the past four years.

Montemuro contacted Schaper & Brummer, the manufacturers of Remifemin in Germany, to obtain the studies on this herbal remedy. The main active ingredient is an extract of one species of Black Cohosh (Cimicifuga racemosa). As with many herbal-based therapies, there is uncertainty as to how Remifemin functions in the body. Research suggests that Remifemin may act as a tissue-specific estrogen, binding to certain receptors responsible for hot flashes.

Estrogens are not all similar in their actions. A class of estrogens known as selective estrogen receptor modulators (SERMS) has recently been discovered. These medications work like estrogen on certain tissues and like anti-estrogen on others. It is thought that Remifemin may also be a "SERM-like" product, acting like estrogen specifically in the brain to relieve hot flushes and mood disturbances during menopause. It does not prevent vaginal dryness.

No studies have been done on its effect on osteoporosis or the heart. It does not cause vaginal bleeding, and does not appear to thicken the vaginal lining. The effect of Remifemin on breast tissue has not been fully researched. To date laboratory studies suggest that Remifemin inhibits breast cancer cell lines. Further studies are needed to clarify these issues and to prove its long term safety especially in women with special problems (like breast cancer). The side effects in some participants were mild gastrointestinal upset. It may also lower blood pressure.

The German E Commission (a compendium of useful herbal remedies) reviewed studies on Remifemin in 1990 and approved its use in Germany for six-month periods. There were no good long-term studies at that time. Ongoing studies are now underway and are needed to prove its long-term effectiveness.

In clinical practice, when Remifemin is beneficial, women choose to continue using it as long as they need it.

In the past, a physician’s first reaction has often been that of skepticism to the use of herbal medicine, sometimes justifiably, due to lack of information and his limited knowledge knowledge in this area. Medical journals are now beginning to inform doctors of biological options and medical schools are starting to incorporate information about biological medicine into their curriculums. The public is very interested in good quality information about herbal treatments. Menopause is an excellent area in which to examine the effectiveness of various herbal alternatives.

The hope is that physicians will now turn to the SOGC guidelines which have been published in the Society of Obstetricians and Gynecologist Journal.

This journal is sent to doctors and is available at hospitals and on the web site. The guidelines have opened up the field of menopause to give women choices of herbal supplements, hormone replacement therapy, lifestyle and diet. These choices are bringing positive responses around the world.