Botanical Dietary Supplement Use in Peri- and Postmenopausal Women

Mahady GB, Parrot J, Lee C, et al.

Taking average life span into account, the vast majority of women will reach menopause. Additionally, between 55% and 75% will experience symptoms typically associated with menopause. Hormone replacement therapy (HRT) will be recommended as first-line therapy for many; however, a significant number will refuse or discontinue HRT and turn to botanical dietary supplements (BDS) because of perceived risks of HRT. Objective To determine the use of BDS in women between the ages of 40 and 60 years, including information about commonly used BDS, the reasons for use, information resources used, whether BDS were used concomitantly with prescription or OTC products, if physicians were apprised of their use, and the overall perception of safety and efficacy of BDS. Methods Five hundred female outpatients at University of Illinois at Chicago (UIC) clinics were interviewed by healthcare practitioners. The botanical/drug history questionnaire used by the interviewing practitioner was based on a modification of an American Dietetics Association and American Pharmaceutical Association working group report on dietary supplements in combination with a clinical drug history questionnaire used by UIC clinics. Respondents were 46.8% African-American, 39.6% Caucasian, 11.7% Hispanic, and 1.5% Asian, with a mean age of 50.34 years. Results BDS were used by 79% of respondents (n = 395), of which 36.5% used BDS daily. Of the positive respondents, 51.7% used one or two BDS, whereas 48.4% used three or more. Usage ranged from 1 to 11 botanicals (mean = 2.86). Commonly used botanicals included soy (42%), green tea (34.68%), chamomile (20.76%), gingko (20.51%), ginseng (17.97%), echinacea (15.44%), and St. John's wort (7.34%). Black cohosh, garlic, red clover, kava, valerian, evening primrose, and ephedra were used by less than 15% of respondents. A two-tailed t test comparison of means determined that participants were more likely to use BDS to treat than to prevent disease. Concomitant use of BDS with prescription and OTC medications was analyzed with cross-tabulation calculations, relative risk assessments, and chi-square tests, and the study authors reported that respondents taking BDS were more likely to also take prescription and OTC medications. Efficacy ratings were high for BDS, and 68% claimed to have no side effects. Only 3% of respondents obtained BDS information from healthcare professionals, and 70% of respondents were not informing their physicians of BDS use. Conclusion A high percentage of study participants were using multiple BDS. Healthcare providers need to discuss BDS use with their patients and to become familiar with the large amounts of available data on the safety and efficacy of BDS. Concomitant BDS use with prescription and OTC medications was commonplace, often without a physician's knowledge. Risk of adverse effects could be high, particularly with women taking prescription medications in conjunction with St. John's wort, kava, valerian, and ephedra. Consumer education about the possible benefits and risks associated with BDS use is urgently needed. Menopause 2003 Jan-Feb;10(1):65-72. Return to Top