Alternative treatments for menopausal symptoms. Qualitative study of women's experiences.

OBJECTIVE: To describe women's experiences with alternative treatments for symptoms attributed to menopause. DESIGN: Descriptive qualitative study. SETTING: Personal interviews and focus groups were conducted in private rooms at the Toronto Hospital; telephone interviews were conducted at mutually convenient times. PARTICIPANTS: Thirteen perimenopausal women with a mean age of 52.6 +/- 2.6 years who were experiencing symptoms attributed to menopause and were using alternative therapies participated in the study. METHOD: Women using alternative therapies for menopausal symptoms were recruited via posted notices and were screened over the telephone. Data were collected during semistructured personal interviews, telephone interviews, and a focus group. All interviews were audiotaped, transcribed, and mailed to participants for verification. Recruitment continued until theme saturation was reached. MAIN FINDINGS: Because of their "natural" origin, the women perceived alternative treatments to be safe and considered them somewhat effective. Factors influencing use of alternative therapies included personal control over health, confidence in advice from nonphysicians, perceived pressure from physicians to use hormone replacement therapy, and physicians' disinterest and frequently negative attitudes toward alternatives. CONCLUSION: Personal control was a central issue. Helping women during their menopausal years feel they have some control over their health, including their informed choice of treatments, might help them to trust their physicians more and to feel more confident in their ultimate treatment decisions, which might include improvements in health behaviour.

Alternative treatments for menopausal symptoms. Systematic review of scientific and lay literature.

OBJECTIVE: To review the scientific literature on common alternative remedies for treatment of symptoms attributed to menopause and to contrast this with available lay literature. QUALITY OF EVIDENCE: Scientific articles were identified by searching MEDLINE, CINAHL, and HEALTH databases from 1966 to mid-1997 for English-language articles. More than 200 references were reviewed; 85 were selected for citation based on specific reference to alternative medicine for symptoms commonly attributed to menopause (e.g., hot flashes), to the effects of changing estrogen levels (e.g., irregular menses, vaginal dryness), and to reported side effects of the treatments. MAIN FINDINGS: The scientific literature was categorized under the headings nutritional supplements, herbal remedies, homeopathic remedies, and physical approaches. Some scientific evidence of the safety and efficacy of alternative treatments during menopause was uncovered, with the strongest evidence emerging in favour of phytoestrogens, which occur in high concentrations as isoflavones in soy products. CONCLUSIONS: In available controlled studies, the strongest data support phytoestrogens for their role in diminishing menopausal symptoms related to estrogen deficiency and for possible protective effects on bones and the cardiovascular system. Randomized controlled trials, standardization of dosage, and accurate safety and efficacy labeling are required to ensure proper use of alternative remedies.

Flaxseed and its mammalian lignan precursor cause a lengthening or cessation of estrous cycling in rats.

Flaxseed and its mammalian lignan precursor secoisolariciresinol diglycoside (SDG) have been shown to be mammary cancer-protective in rats. Thus, the antiestrogenic effects of flaxseed and SDG were compared with tamoxifen, an antiestrogen, by monitoring rat estrous cycling. Four-week supplementation of a high-fat diet with flaxseed (2.5, 5, or 10%) or SDG (0.75, 1.5 or 3.0 mg/day) produced a dose-related cessation or lengthening (by 18-39%) of estrous cycles in up to 66% of rats. With tamoxifen (1 mg/kg body weight/day), 83% of the animals had irregular cycles or were in persistent diestrus. Flaxseed and SDG were antiestrogenic without gross tissue toxicity.

Dose-dependent production of mammalian lignans in rats and in vitro from the purified precursor secoisolariciresinol diglycoside in flaxseed.

The mammalian lignans enterodiol (ED) and enterolactone (EL) produced from colonic bacterial action on dietary precursors have exhibited anticarcinogenic effects in vitro. The major lignan precursor in flaxseed (a rich source) has been identified as secoisolariciresinol diglycoside (SDG). The purpose of this study was to first isolate SDG and determine whether 1) SDG accounted for all the lignan production from flaxseed; 2) this production was dose-related; and 3) a relationship between in vitro production and in vivo urinary excretion existed. Extraction of flaxseed with dioxane:ethanol (1:1, v/v) followed by chromatographic separations yielded the purified SDG. Rats were fed a high fat diet without/with 2.5, 5 or 10 g/100g ground flaxseed or 1.1, 2.2 or 4.4 micromol SDG/d (equivalent to levels in the respective flaxseed diets) for 4 wk. In vitro lignan production was assessed by fermenting flaxseed or SDG for 24 h with human fecal inoculum. Urinary lignan excretion increased linearly with doses from 0-5% flaxseed and 0-2.2 micromol SDG/d followed by a plateau, indicating a threshold response. When all doses were considered, a curvilinear relationship was observed. A similar trend was seen in vitro for SDG, resulting in a high correlation between in vitro production and in vivo excretion of lignans (r = 0.990, P < 0.02). Thus in vivo response can be predicted with confidence based on in vitro results. Theoretical urinary ED + EL from the SDG present in flaxseed correlated with the actual excretion in flaxseed-fed animals (r = 0.655, P < 0.005). However, urinary ED + EL of SDG-fed rats was only 20% of levels of flaxseed-fed rats, indicating the presence of other precursors or incomplete conversion of SDG to ED and EL.

Flaxseed and its lignan and oil components reduce mammary tumor growth at a late stage of carcinogenesis.

Flaxseed, a rich source of mammalian lignan precursor secoisolariciresinol-diglycoside (S.D.) and alpha-linolenic acid (ALA), has been shown to be protective at the early promotion stage of carcinogenesis. The objective of this study was to determine whether supplementation with flaxseed, its lignan or oil fractions, beginning 13 weeks after carcinogen administration, would reduce the size of established mammary tumors (present at the start of treatment) and appearance of new tumors in rats. Dietary groups consisted of the basal diet (BD, 20% corn oil) alone or supplemented with a gavage of 2200 nmol/day S.D. [S.D., equal to level in 5% flaxseed (F)], 1.82% flaxseed oil (OIL, equal to level in 5% F) or 2.5% or 5% flaxseed (2.5% F and 5% F, respectively). After 7 weeks of treatment, established tumor volume was over 50% smaller in all treatment groups (OIL, 2.5% F, 5% F, P < 0.04; S.D., P < 0.08) while there was no change in the BD group. New tumor number and volume were lowest in the S.D. (P < 0.02) and 2.5% F (P < 0.07) groups. The combined established and new tumor volumes were smaller for the S.D., 2.5% F and 5% F groups (P < 0.02) compared to the OIL and BD groups. The high negative correlation (r = -0.997, P < 0.001) between established tumor volume and urinary mammalian lignan excretion in the BD, S.D., 2.5% F and 5% F groups indicates that the reduction in tumor size is due in part to the lignans derived from the S.D. in flaxseed. However, there was no relationship between new or total tumor development and urinary lignan levels. The effect of flaxseed oil may be related to its high ALA content. In conclusion, the S.D. in flaxseed appears to be beneficial throughout the promotional phase of carcinogenesis whereas the oil component is more effective at the stage when tumors have already been established.

Antitumorigenic effect of a mammalian lignan precursor from flaxseed.

Secoisolariciresinol diglycoside (SD), a mammalian lignan precursor found in high-fiber foods, was isolated from flaxseed and tested for effects on mammary tumorigenesis in rats fed a high-fat (20%) diet. Ingestion of purified SD at 1.5 mg/day for 20 weeks starting 1 week after treatment with the carcinogen dimethylbenzanthracene resulted in a 37% reduction (p < 0.05) in the number of tumors per tumor-bearing rat and a 46% reduction (p < 0.05) in the number of tumors per tumor-bearing rat and a 46% reduction (p < 0.05) in the number of tumors per number of rats in each group. Urinary mammalian lignan excretion significantly increased (p < 0.0001) with SD treatment, indicating the conversion of SD to mammalian lignans. No enlargement or gross abnormalities of the major organs were observed in the SD-treated rats. This study showed, for the first time, that SD has an antitumor effect when provided at the early promotion stage of tumorigenesis and may contribute to the health benefits of high-fiber foods.