Menopause is more than Hot Flashes: What is Missing in Homeopathic Research? A Narrative Review

Abstract

Background Menopausal complaints are frequently treated with homeopathy in daily practice worldwide. Recently, vasomotor symptoms have been understood to have implications as predictors of other important and long-term outcomes, causing increased risk of mortality and/or disability.

Methods A comprehensive search of the literature was conducted to investigate whether homeopathic treatments for menopausal women with vasomotor symptoms have a positive effect on other important health outcomes associated with menopause, such as cardiovascular disease, neurocognitive impairment, metabolic and mood disorders, or osteoporosis.

Results Though observational studies have shown encouraging results in reducing the severity and frequency of hot flashes in women treated with homeopathy, few randomized controlled trials have shown positive results. In most of the studies using homeopathy, the primary outcome is reduction in the frequency and severity of hot flashes, and other menopausal complaints are assessed secondarily as a part of the symptoms evaluated in the menopausal scales. Quality of life improves with homeopathic treatments for hot flashes, but there is scarce evidence of the effect of homeopathy on other health outcomes associated with menopause. Limited evidence exists in the case of menopausal women treated with individualized homeopathy for depression and metabolic disorders.

Conclusion A more comprehensive approach for treating menopause in routine homeopathic practice constitutes a valuable opportunity to increase knowledge and high-quality research in this field. Future homeopathic research for menopause should be focused on well-designed, double-blind, placebo-controlled, randomized trials as well as on pragmatic trials to show whether homeopathic treatments for vasomotor symptoms can also improve outcomes that are well-known to increase the risk of mortality and/or disability.

Keywords

homeopathy - menopause - climacteric - hot flashes - vasomotor symptoms - cardiovascular disease - metabolic disorders - depression

Publication History

Received: 13 March 2021

Accepted: 15 June 2021

Article published online:
11 October 2021

• References

• 1 Doubova SV, Espinosa-Alarcón P, Flores-Hernández S, Infante C, Pérez-Cuevas R. Integrative health care model for climacteric stage women: design of the intervention. BMC Womens Health 2011; 11: 6
• 2 Harlow SD, Gass M, Hall JE. et al; STRAW 10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause 2012; 19: 387-395
• 3 Davis SR, Lambrinoudaki I, Lumsden M. et al. Menopause. Nat Rev Dis Primers 2015; 1: 15004
• 4 Thurston RC. Vasomotor symptoms: natural history, physiology, and links with cardiovascular health. Climacteric 2018; 21: 96-100
• 5 Williams RE, Kalilani L, DiBenedetti DB. et al. Frequency and severity of vasomotor symptoms among peri- and postmenopausal women in the United States. Climacteric 2008; 11: 32-43
• 6 Tepper PG, Brooks MM, Randolph Jr JF. et al. Characterizing the trajectories of vasomotor symptoms across the menopausal transition. Menopause 2016; 23: 1067-1074
• 7 Rossouw JE, Prentice RL, Manson JE. et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 2007; 297: 1465-1477
• 8 Huang AJ, Sawaya GF, Vittinghoff E, Lin F, Grady D. Hot flushes, coronary heart disease, and hormone therapy in postmenopausal women. Menopause 2009; 16: 639-643
• 9 Thurston RC, Sutton-Tyrrell K, Everson-Rose SA, Hess R, Matthews KA. Hot flashes and subclinical cardiovascular disease: findings from the Study of Women's Health Across the Nation Heart Study. Circulation 2008; 118: 1234-1240
• 10 Jackson EA, El Khoudary SR, Crawford SL. et al. Hot flash frequency and blood pressure: data from the Study of Women's Health Across the Nation. J Womens Health 2016; 25: 1204-1209
• 11 Thurston RC, El Khoudary SR, Sutton-Tyrrell K. et al. Vasomotor symptoms and lipid profiles in women transitioning through menopause. Obstet Gynecol 2012; 119: 753-761
• 12 Thurston RC, El Khoudary SR, Sutton-Tyrrell K. et al. Vasomotor symptoms and insulin resistance in the study of women's health across the nation. J Clin Endocrinol Metab 2012; 97: 3487-3494
• 13 Gray KE, Katon JG, LeBlanc ES. et al. Vasomotor symptom characteristics: are they risk factors for incident diabetes?. Menopause 2018; 25: 520-530
• 14 Thurston RC, Aizenstein HJ, Derby CA, Sejdić E, Maki PM. Menopausal hot flashes and white matter hyperintensities. Menopause 2016; 23: 27-32
• 15 Thurston RC, Maki PM, Derby CA, Sejdić E, Aizenstein HJ. Menopausal hot flashes and the default mode network. Fertil Steril 2015; 103: 1572-1578.e1
• 16 Bromberger JT, Harlow S, Avis N, Kravitz HM, Cordal A. Racial/ethnic differences in the prevalence of depressive symptoms among middle-aged women: The Study of Women's Health Across the Nation (SWAN). Am J Public Health 2004; 94: 1378-1385
• 17 Bromberger JT, Schott L, Kravitz HM, Joffe H. Risk factors for major depression during midlife among a community sample of women with and without prior major depression: Are they the same or different?. Psychol Med 2015; 45: 1653-1664
• 18 Freeman EW, Sammel MD, Lin H, Nelson DB. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry 2006; 63: 375-382
• 19 Soares CN. Depression and Menopause: Current Knowledge and Clinical Recommendations for a Critical Window. Psychiatr Clin North Am 2017; 40: 239-254
• 20 World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Report of a WHO study group [meeting held in Rome from 22 to 25 June 1992]‎. World Health Organization; 1994 https://apps.who.int/iris/handle/10665/39142
• 21 Sowers MR, Jannausch M, McConnell D. et al. Hormone predictors of bone mineral density changes during the menopausal transition. J Clin Endocrinol Metab 2006; 91: 1261-1267
• 22 The Women's Health Initiative Study Group. Design of the Women's Health Initiative clinical trial and observational study. Control Clin Trials 1998; 19: 61-109
• 23 Crandall CJ, Aragaki A, Cauley JA. et al. Associations of menopausal vasomotor symptoms with fracture incidence. J Clin Endocrinol Metab 2015; 100: 524-534
• 24 Shifren JL. Genitourinary Syndrome of Menopause. Clin Obstet Gynecol 2018; 61: 508-516
• 25 Palma F, Volpe A, Villa P, Cagnacci A. Writing group of AGATA study. Vaginal atrophy of women in postmenopause. Results from a multicentric observational study: The AGATA study. Maturitas 2016; 83: 40-44
• 26 Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus 2020; 12: e7586
• 27 Gold EB. The timing of the age at which natural menopause occurs. Obstet Gynecol Clin North Am 2011; 38: 425-440
• 28 Ferlay J, Soerjomataram I, Dikshit R. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359-E386
• 29 Carpenter JS, Rand KL. Modeling the hot flash experience in breast cancer survivors. Menopause 2008; 15: 469-475
• 30 Kotsopoulos J. Menopausal hormones: definitive evidence for breast cancer. Lancet 2019; 394 (10204): 1116-1118
• 31 Rossouw JE, Anderson GL, Prentice RL. et al; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002; 288: 321-333
• 32 Anderson GL, Limacher M, Assaf AR. et al; Women's Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA 2004; 291: 1701-1712
• 33 Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet 2019; 394 (10204): 1159-1168
• 34 Zhang S, Gong T-T, Liu F-H. et al. Global, Regional, and National Burden of Endometrial Cancer, 1990-2017: Results From the Global Burden of Disease Study, 2017. Front Oncol 2019; 9: 1440
• 35 Raglan O, Kalliala I, Markozannes G. et al. Risk factors for endometrial cancer: An umbrella review of the literature. Int J Cancer 2019; 145: 1719-1730
• 36 Beral V, Gaitskell K, Hermon C, Moser K, Reeves G, Peto R. Collaborative Group on Epidemiological Studies of Ovarian Cancer. Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies. Lancet 2015; 385 (9980): 1835-1842
• 37 Guernsey HN. The Application of the Principles and Practice of Homeopathy to Obstetrics and the Disorders Peculiar to Women and Young Children. Calcutta, India: Set, Dey & Co; 1866
• 38 Panozzo M, Rossi EG, Picchi M, Di Stefano M, Cervino Ch, Nurra L. Women and complementary medicine: Eleven years of experience at a homeopathic clinic for women in a public hospital. Eur J Integr Med 2016; 8: 423-431
• 39 Saha S, Koley M, Saha S, Singh R, Hossain MM, Pramanik I. Obstetrics and gynecology outpatient scenario of an Indian homeopathic hospital: A prospective, research-targeted study. J Tradit Complement Med 2015; 6: 168-171
• 40 Manchanda RK. Popularity, safety and quality of homoeopathic medicines. Indian J Res Homeopathy 2018; 12: 191-193
• 41 Clover A, Ratsey D. Homeopathic treatment of hot flushes: a pilot study. Homeopathy 2002; 91: 75-79
• 42 Macías-Cortés EDC, Llanes-González L, Aguilar-Faisal L, Asbun-Bojalil J. Response to Individualized Homeopathic Treatment for Depression in Climacteric Women with History of Domestic Violence, Marital Dissatisfaction or Sexual Abuse: Results from the HOMDEP-MENOP Study. Homeopathy 2018; 107: 202-208
• 43 Buhling KJ, Daniels BV, Studnitz FS, Eulenburg C, Mueck AO. The use of complementary and alternative medicine by women transitioning through menopause in Germany: results of a survey of women aged 45-60 years. Complement Ther Med 2014; 22: 94-98
• 44 Teut M, Lüdtke R, Schnabel K, Willich SN, Witt CM. Homeopathic treatment of elderly patients – a prospective observational study with follow-up over a two year period. BMC Geriatr 2010; 10: 10
• 45 Spence DS, Thompson EA, Barron SJ. Homeopathic treatment for chronic disease: a 6-year, university-hospital outpatient observational study. J Altern Complement Med 2005; 11: 793-798
• 46 Baethge C, Goldbeck-Wood S, Mertens S. SANRA-a scale for the quality assessment of narrative review articles. Res Integr Peer Rev 2019; 4: 5
• 47 Andrade DCDS, Carmona F, Angelucci MA, Martinez EZ, Pereira AMS. Efficacy of a Homeopathic Medicine of Capsicum frutescens L. (Solanaceae) in the Treatment of Hot Flashes in Menopausal Women: A Phase-2 Randomized Controlled Trial. Homeopathy 2019; 108: 102-107
• 48 Mahesh S, Denisova T, Gerasimova L, Pakhmutova N, Mallappa M, Vithoulkas G. Multimorbidity after Surgical Menopause Treated with Individualized Classical Homeopathy: A Case Report. Clin Med Insights Case Rep 2020; 13: 1179547620965560
• 49 Bordet MF, Colas A, Marijnen P, Masson J, Trichard M. Treating hot flushes in menopausal women with homeopathic treatment – results of an observational study. Homeopathy 2008; 97: 10-15
• 50 Ruiz-Mandujano ME, García-Vivas J, Luna-Reséndiz R, Ochoa-Bernal F, Sánchez-Monroy V. Evaluación del Tratamiento Homeopático de Mujeres en Climaterio entre los 45 y 60 años con la Menopause Rating Scale (MRS). La Homeopatía de México 2019; 88: 28-35
• 51 Gupta J, Kulshreshtha D, Lamba CD. et al. Homoeopathic medicine–Sepia for the management of menopausal symptoms: A multicentric, randomised, double-blind placebo-controlled clinical trial. Indian J Res Homeopathy 2019; 13: 219
• 52 Macías-Cortés ED, Llanes-González L, Aguilar-Faisal L, Asbun-Bojalil J. Is metabolic dysregulation associated with antidepressant response in depressed women in climacteric treated with individualized homeopathic medicines or fluoxetine? The HOMDEP-MENOP Study. Homeopathy 2017; 106: 3-10
• 53 Nayak C, Singh V, Singh K. et al. Management of distress during climacteric years by homeopathic therapy. J Altern Complement Med 2011; 17: 1037-1042
• 54 Sharma B. Menopausal flushes: a bane for women. Indian J Res Homeopathy 2008; 2: 37-44
• 55 Thompson EA, Reilly D. The homeopathic approach to the treatment of symptoms of oestrogen withdrawal in breast cancer patients. A prospective observational study. Homeopathy 2003; 92: 131-134
• 56 Jacobs J, Herman P, Heron K, Olsen S, Vaughters L. Homeopathy for menopausal symptoms in breast cancer survivors: a preliminary randomized controlled trial. J Altern Complement Med 2005; 11: 21-27
• 57 Heudel PE, Van Praagh-Doreau I, Duvert B. et al. Does a homeopathic medicine reduce hot flushes induced by adjuvant endocrine therapy in localized breast cancer patients? A multicenter randomized placebo-controlled phase III trial. Support Care Cancer 2019; 27: 1879-1889
• 58 von Hagens C, Schiller P, Godbillon B. et al. Treating menopausal symptoms with a complex remedy or placebo: a randomized controlled trial. Climacteric 2012; 15: 358-367
• 59 Colau JC, Vincent S, Marijnen P, Allaert FA. Efficacy of a non-hormonal treatment, BRN-01, on menopausal hot flashes: a multicenter, randomized, double-blind, placebo-controlled trial. Drugs R D 2012; 12: 107-119
• 60 Desiderio F, Rudnas B, Panzini I. et al. Homeopathy in the treatment of menopausal symptoms in patients with early breast cancer. Ann Oncol 2015; 26: vi25
• 61 Thompson EA, Relton C. Designing clinical trials of homeopathy for menopausal symptoms: a review of the literature. Menopause Int 2009; 15: 31-34
• 62 Relton C, O'Cathain A, Nicholl J. A pilot 'cohort multiple randomised controlled trial' of treatment by a homeopath for women with menopausal hot flushes. Contemp Clin Trials 2012; 33: 853-859
• 63 National Institute for Health and Care Excellence (NICE guideline NG23). Menopause: diagnosis and management. Published date 12 November 2015. Last updated 5 December 2019. www.nice.org.uk/guidance/ng23
• 64 Shifren JL, Gass ML. NAMS Recommendations for Clinical Care of Midlife Women Working Group. The North American Menopause Society recommendations for clinical care of midlife women. Menopause 2014; 21: 1038-1062
• 65 Goldstein S. An efficient tool for the primary care management of menopause. Can Fam Physician 2017; 63: 295-298
• 66 PLOS ONE Editors. Retraction. Individualized Homeopathic Treatment and Fluoxetine for Moderate to Severe Depression in Peri- and Postmenopausal Women (HOMDEP-MENOP Study): A Randomized, Double-Dummy, Double-Blind, Placebo-Controlled Trial. PLoS One 2020; 15: e0232415
• 67 Dean ME, Coulter MK, Fisher P, Jobst KA, Walach H. Reporting data on homeopathic treatments (RedHot): a supplement to CONSORT. J Altern Complement Med 2007; 13: 19-23
• 68 Patsopoulos NA. A pragmatic view on pragmatic trials. Dialogues Clin Neurosci 2011; 13: 217-224
• 69 Fibert P, Peasgood T, Relton C. Rethinking ADHD intervention trials: feasibility testing of two treatments and a methodology. Eur J Pediatr 2019; 178: 983-993
• 70 Lathoud. Materia médica homeopática. Buenos Aires: Editorial Albatros; 1998
• 71 Muniz EG, Noronha MDDN, Saraiva MDGG, Monteiro WM, Oliveira SS. Neutralization of hemostatic disorders induced by Lachesis muta venom using Brazilian antivenoms. Toxicon 2021; 191: 44-47
• 72 Croaker A, King GJ, Pyne JH, Anoopkumar-Dukie S, Liu L. Sanguinaria canadensis: Traditional Medicine, Phytochemical Composition, Biological Activities and Current Uses. Int J Mol Sci 2016; 17: 1414
• 73 Sampath S, Narasimhan A, Chinta R. et al. Effect of homeopathic preparations of Syzygium jambolanum and Cephalandra indica on gastrocnemius muscle of high fat and high fructose-induced type-2 diabetic rats. Homeopathy 2013; 102: 160-171
• 74 Chakraborty D, Samadder A, Dutta S, Khuda-Bukhsh AR. Antihyperglycemic potentials of a threatened plant, Helonias dioica: antioxidative stress responses and the signaling cascade. Exp Biol Med (Maywood) 2012; 237: 64-76
• 75 Korukanti VP, Ponnam HB, Akondi BR. Evaluation of antiobesity activity of Fucus vesiculosus. Indian J Res Homoeopath 2013; 7: 126-132
• 76 Nandi M, Raha D. Dose-dependent effect of Baryta carbonicum and Baryta muriaticum in homoeopathic trituration on experimentally induced high serum lipid concentration in chickens. Br Homeopath J 1990; 79: 224-227
• 77 Bhalerao RD, Manchanda RK, Roja V. Homeopathy in the management of Dyslipidemia: A short review. Indian J Res Homeopathy 2015; 9: 258-266
• 78 Saha S, Koley M, Hossain SI. et al. Individualized homeopathy versus placebo in essential hypertension: A double-blind randomized controlled trial. Indian J Res Homeopathy 2013; 7: 62-71
• 79 Thompson EA, Montgomery A, Douglas D, Reilly D. A pilot, randomized, double-blinded, placebo-controlled trial of individualized homeopathy for symptoms of estrogen withdrawal in breast-cancer survivors. J Altern Complement Med 2005; 11: 13-20
• 80 Relton C, Weatherley-Jones E. Homeopathy service in a National Health Service community menopause clinic: audit of clinical outcomes. J Br Menopause Soc 2005; 11: 72-73