Compounded and complementary therapies for menopause

Compounded and complementary medicines are generally not recommended because they have not been shown to be safe and effective.

Compounded ‘bio-identical’ hormone therapy (containing a variety of estrogens, progestogens and often other hormones) has been promoted as safer and more effective than systemic menopausal therapy. However, these claims are not supported by evidence, and there is evidence of harms. In addition, compounded formulations are not subject to the same regulations as registered pharmaceutical products, and the strength and purity can be inconsistent. Government regulatory bodies and medical societies recommend against their use. Bio-identical hormones should not be confused with ‘body-identical’ hormones (transdermal estradiol and micronised progesterone), which are synthetic pharmaceutical-grade hormones that are identical to natural hormones. Patient information sheets on bio-identical hormone therapy are available from the Australasian Menopause Society website.

Placebo-controlled clinical studies of complementary medicines or supplements to treat menopausal hot flushes found:

• inconsistent evidence of efficacy for
  • vitamin E supplements (although safe to use)
  • soy extracts (and safety in breast cancer has not been established)
• no evidence of efficacy for
  • red clover isoflavones
  • black cohosh (and Australian product information warns that cases of liver toxicity have been reported)
  • magnesium supplements
  • omega 3 supplements
  • homeopathy
  • other herbal/botanicals including evening primrose oil, dong quai, ginseng.