Obstet Gynecol Clin North Am. 2002 Sep; 29(3): 555-73.

Alternative medicine and the perimenopause an evidence-based review.

Taylor M.

Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco 94127, USA. [email protected]

Alternative medicine is no longer mystical, mythical, or remote. At last 50% of the adult population has tried some sort of alternative therapy. As the population ages, and chronic illness becomes more prevalent, the use of alternatives is likely to continue to increase. CAM often targets chronic disorders that are often poorly addressed by conventional care. such as headache, arthritis. insomnia, fatigue, and so forth. Managed care, indirectly by imposing barriers to access and directly by offering riders that cover CAM services, are pushing patients away from more expensive conventional therapies. In conditions like the perimenopause, where the symptoms may wax and wane unpredictably, quality research is needed to demonstrate the efficacy of interventions. In the not so distant past, CAM practices have been given a pass, permitted to lay claim to historical uses as proof of efficacy. This exemption from the rules has been revoked. Major journals have issued a call for a new, more evenhanded approach. The editors of the prestigious New England Journal of Medicine asserted that [36]: There cannot be two kinds of medicine--conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is 'Eastern' or 'Western', is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant expect for historical purposes and cultural interest. Gynecologists and others who care for women need to be aware of the evidence supporting or refuting the claims made for both conventional and alternative medicine. Any therapy that provides effective and safe mitigation of the tumultuous and distressing endocrine events associated with the perimenopausal transition should be offered and used. An expanded array of therapeutic options may increase the likelihood of successful treatment and promote enhanced satisfaction and well-being for women. Such improvements can help to cement long-term relationships between providers and patients, for health and well-being now and in the future.