Treating menopause with homeopathy

The number of aging women is rapidly growing worldwide (Wilken-Jensen & Ottesen, 2003). With increasing life span, women spend nowadays one-third of their lifetime under menopause (Moreira et al., 2014). This implies that a change of the medical approach may be necessary as demand for the treatment of menopause-associated symptoms increases (Wilken-Jensen & Ottesen, 2003). Menopausal women belong, for several reasons, to one of the biggest patient groups using alternative and complementary medicine (CAM) (Wilken-Jensen & Ottesen, 2003). A pilot data collection study within the five National Health Service (NHS) Homeopathic Hospitals in the United Kingdom (UK) showed that menopausal symptoms belonged to the most commonly treated complaints (Thompson et al., 2008). The growing number of postmenopausal women and their great interest in using CAM, especially homeopathy, were important motivating factors in the decision to undertake a systematic review on menopause treated with homeopathy. This topic is timely and highly reflective of current need.

Background menopause

Menopause is defined as the time of the final menstrual period, one which is not followed by any further ovary-controlled menstruation for 12 months, and can only be identified retrospectively (De Gruyter, 1994)). Post-menopause follows menopause and lasts approximately 10 years (Groth & Stolzenberg, 1995).
Menopause is characterised by amenorrhoea and not necessarily by any other symptoms (Utian, 1994) and generally occurs between the ages 48 – 51 years (De Gruyter, 1994). Climacteric, also known as peri-menopause, is the time in the life of a woman when changing from a productive phase into an infertile one (Nayak et al., 2011) and this results from the cessation of the cyclical function of the ovaries (De Gruyter, 1994). During this time the ovaries’ reaction to the Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH) that are produced in the pituitary gland diminishes gradually and eventually ceases altogether. The function of FSH is to stimulate the growth of follicles in the ovaries and the follicles produce oestrogen (Kiener, 2000). The result of the decreased reaction to FSH and FH are a smaller number of ovulations, irregularities of the menstrual cycle and a fall of the ovaries’ production of progesterone and oestrogen. At the same time the concentration of FSH and LH in the blood increases since no positive oestrogen feedback from the ovaries is taking place (Kiener, 2000). In addition to this natural menopausal process involving a deficiency of oestrogen, women with breast cancer can also enter into an ‘artificial’ climacteric phase as a result of the treatment they receive for the cancer. Breast cancer is one of the most common cancers worldwide (Rada et al., 2010). Since oestrogen may promote the growth of oestrogen receptor- positive breast cancers, patients are commonly treated with endocrine medicaments having an anti-oestrogen effect such as tamoxifen and aromatase inhibitors (Rada et al., 2010) such as Anastrozole (Jones & Buzdar, 2004). Breast cancer patients may also be treated with chemotherapy which commonly impairs the natural function of the ovaries (Rada et al., 2010). Consequently, reasons for lack of oestrogen in breast cancer patients can be follicle cell death and ovarian ablation induced by chemotherapy, medicaments withdrawing oestrogen or the natural process of menopause itself (Thompson & Reilly, 2003).
After hysterectomy with bilateral oophorectomy, or bilateral oophorectomy alone, in women of child-bearing age menopause starts immediately and is called ‘surgical menopause’ (Northrup, 1995).

Menopause-associated symptoms

The timing of the menopause differs between women and not every woman develops impairing symptoms during menopause (Katz, 1997).  According to Kiener (2000) the primary menopause-related symptoms include the following:

Vasomotor symptoms such as hot flushes and night sweating, experienced by 75 % of menopausal women.

Psychological and emotional symptoms such as fatigue, mood swings, crying, anxiety, irritability, sleeping difficulties, lack of concentration, depression and   nervousness.

In the urogenital region the mucous membrane of the vagina and vulva is getting thinner. This may lead to vaginal dryness and vaginitis which may cause increased urination and dyspareunia. Some women experience incontinence, cystitis and low libido.

Bone mass/density decreases and approximately 25% of postmenopausal women suffer from severe osteoporosis.

Various other symptoms such as dizziness, palpitations, paraesthesia, tachycardia, diarrhoea, constipation, arthralgia and weight gain may arise.

After the menopause women suffer more often from cardiovascular diseases such as apoplexy. Further typical menopause-associated symptoms include menstrual disturbances such as irregular and/or heavy bleeding (Katz, 1997). Penny, Razlog, Deroukakis, and Johnston (2009) complete this symptom list with loss of elasticity in the skin, mild hirsutism, myalgia, cold extremities and formication.
Nencioni et al. (1999) found, in their cross-sectional analysis of 9309 women, that from pre- to post-menopause significant increases in total cholesterol, low density lipoprotein (LDL) and triglycerides take place. Increased lipid levels have been linked with a higher risk of cardiovascular disease (Rousseau, 2001).
Breast-cancer patients being treated with anti-oestrogens such as tamoxifen and Anastrozole are known to develop more intense menopausal symptoms such as hot flushes and sweat due to oestrogen deficiency (Jones & Buzdar, 2004). However Gupta et al. (2006) conducted a cross-sectional survey in Solihull Hospital in the West Midlands, UK, from December 2003 – May 2004, to identify symptoms due to oestrogen deficiency in women who had been treated for breast cancer within the last 5 years. They found no association between tamoxifen use and the intensity of hot flushes, sweats, heart complaints or sleeping difficulties. However, an important finding from this survey was that women taking antidepressant treatment developed menopausal symptoms, including hot flushes and sweats, more often and more severely.
Subsequently, the issue of whether women who are receiving breast cancer treatment suffer from more intense vasomotor symptoms than those women who undergo a natural menopause remains a matter of debate. It is, however, clear that they suffer from menopausal symptoms like sudden heat in the face, neck and chest and that hot flushes are typical (Rada at al., 2010).

Hormone therapy

In the 1960s the treatment of all menopausal symptoms with oestrogen was considered as effective and imperative (Wilson & Wilson, 1963). Also, in the following years, hormone therapy (HT) was regarded as beneficial in the treatment of menopausal symptoms, improving quality of life, preventing osteoporosis and cardiovascular disease (Speroff et al., 1999). More recently Bordet, Colas, Marijnen, Masson, and Trichard (2008) describe how in this day and age, hot flushes are the main reason for menopausal women to take HT.
On the other hand, in the middle 1970s, oestrogen was found to increase the risk of endometrial cancer (Smith, Prentice, Thompson, & Herrmann, 1975). For this reason, from 1976 onwards, oestrogen was administered in combination with progesterone to protect against endometrial cancer (Rousseau, 2001). Later it was discovered that HT with oestrogen alone, or oestrogen combined with progesterone, given to menopausal women in their 50s and 60s, increased breast density and the risk of developing breast cancer. Furthermore, the combined use of HT raised the risk of breast cancer to a higher degree than oestrogen as single medication (Dixon, 2003).
Women also reported other, less severe, side-effects from HT like breast enlargement and tenderness (Thompson & Relton, 2009) and Wilken-Jensen and Ottesen (2003) described the adverse effects of increased risk of venous thromboembolism and vaginal bleeding.
Because of the link between breast cancer and oestrogen, as well as oestrogen with added progesterone, breast cancer survivors are advised not to take HT to avoid recurrences of the cancer (Rousseau, 2001). Moreover, due to the potential for side effects, the use of HT is not recommended for all women and remains a controversial topic. Katz (1997) describes how half of studied women being prescribed HT discontinued within 6 months. Many women decide against HT for fear of cancer, undesirable side effects and also, for some, the opinion that menopause is a natural process (Wilken-Jensen & Ottesen, 2003). In a survey conducted between July 1993 and June 1995, Reynolds, Obermeyer, Walker, and Guilbert (2002), found that one of the main reasons for stopping HT under post-menopause was the fear of weight gain.
The contra-indication of HT in breast cancer survivors, and the various potential side-effects of HT, are plausible reasons for women to seek alternative treatment modalities when suffering from menopause-related ailments.

 

Background homeopathy

The medical system of homeopathy was founded by Samuel Hahnemann (1755-1843), a German medical doctor, and, the name he awarded this system, ‘homeopathy’ is derived from the Greek expressions ‘homoios’ and ‘pathos’ which translate as similar and suffering. Suffering similarly captures the fundamental principle of homeopathy, that likes can be treated with likes. Hahnemann was not the first to speak of this idea, the notion of similars had previously also been described by Hippocrates and Paracelsus. However, it was Hahnemann who introduced the use of similars as an essential part of a medical science (Ullman, 2014). There are three primary principles that underpin the practise of homeopathy and set it apart from other forms of medicine. According to Ullman (1997) the principle of similars means that a substance that can provoke symptoms in a healthy person can be used (in small doses) to cure the same symptoms in an ill patient. The second principle of homeopathy that remedies are prescribed for patterns of symptoms (totality) and not simply for isolated symptoms. As a result a homeopath administers remedies that are individually adapted for the overall condition of a sick person. This means that two persons with the same diagnosis may be given different homeopathic remedies since prescriptions are based upon the entire symptom picture and not the medical diagnosis. The third homeopathic principle is that of potentisation; homeopathic remedies are made from substances that are consecutively diluted and potentised by succussion. Through this process the original substance diminishes gradually and the more a homeopathic remedy is diluted and succussed, the more potent it becomes (Ullman, 1997). The paradox of potentisation has generated much scepticism and debate about homeopathy (Cooper & Relton, 2010). On the other hand homeopathic remedies are not known to produce harmful side-effects, since they contain extremely low levels of the material substance (Katz, 1997). During consultations homeopaths focus on the patient’s individual symptoms to prescribe a similar remedy. Women seeking help for menopause-related symptoms will be prescribed a homeopathic remedy adapted to their personal complaints, perhaps fitting, since each woman experiences menopause differently (Katz, 1997). The absence of side-effects and the individualised medication are attractive notions and hence it is not difficult to understand why some menopausal women seek homeopathic help. In a recent retrospective survey of 563 menopausal women with vasomotor symptoms in the USA, who had stopped HT, nearly half were using CAM and homeopathy was among the most frequently used (Kupferer, Dormire, & Becker, 2009).

Reference list:

Bordet, M. F., Colas, A., Marijnen, P., Masson, J.L., & Trichard, M. (2008). Treating hot flushes in menopausal women with homeopathic treatment: Results of an observational study. Homeopathy, 97(1), 10-15.

Cooper, K. L., & Relton, C. (2010). Homeopathy for insomnia: A systematic review of research evidence. Sleep Medicine Reviews, 14(5), 329-337.

De Gruyter, W. (1994). Pschyrembel: Klinisches Wörterbuch (257th ed.). Berlin, Germany: Wörterbuch-Redaktion.

Dixon, J. M. (2003). Hormone replacement therapy and the breast. Surgical Oncology, 12(4), 251-263.

Groth, S., & Stolzenberg, R. (1995). Wechseljahre: Eine Broschuere zur Selbsthilfe (5th ed.). Berlin, Germany: Oktoberdruck.

Gupta, P., Sturdee, D. W., Palin, S. L., Majumder, K., Fear, R., Marshall, T., & Paterson, I. (2006). Menopausal symptoms in women treated for breast cancer: The prevalence and severity of symptoms and their perceived effects on quality of life. Climacteric, 9(1), 49-58.

Jones, K. L., & Buzdar, A. U. (2004). A review of adjuvant hormonal therapy in breast cancer. Endocrine-Related Cancer, 11(3), 391-406.

Katz, T. (1997). Homeopathic treatment during the menopause. Complementary Therapies in Nursing & Midwifery, 3(2), 46-50.

Kiener, C. (2000). Das MSD Manual (6th ed.). Muenchen/Jena, Germany: Urban & Fischer.

Kupferer, E. M., Dormire, S. L., & Becker, H. (2009). Complementary and alternative medicine use for vasomotor symptoms among women who have discontinued hormone therapy. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 38(1), 50-59.

Moreira, A. C., Silva, A. M., Santos, M. S., & Sardao, V. A. (2014). Phytooestrogens as alternative hormone replacement therapy in menopause: What is real, what is unknown. The Journal of Steroid Biochemistry and Molecular Biology, 143(9), 61-71.

Nayak, C., Singh, V., Singh, K., Singh, H., Gupta, J., Lamba, C. D.,…Luxmi, K.S. (2011). Management of distress during the climacteric years by homeopathic therapy. The Journal of Alternative and Complementary Medicine, 17(11), 1037-1042.

Nencioni, T., Ciammella, M., Bonaccorsi, G., Morano, D., Viglino, S., Grassini, E.,…Petronio, P. (1999). The effect of menopause on blood lipid and lipoprotein levels. Artherosclerosis, 147(1), 147-153.

Northrup, C. (1995). Frauenkoerper Frauenweisheit(2nd ed.). Muenchen, Germany: Zabert Sandmann.

Penny, B. L., Razlog, R., Deroukakis, M., & Johnston, G. (2009). A comparative study of Klimakt-Heel and Femolene Ultra in the management of typical climacteric symptoms. Health SA Gesondheid, 14(1), 144-148.

Rada, G., Capurro, D., & Pantoja, T. (2010). Non-hormonal interventions for hot flushes in women with a history of breast cancer (Review). The Cochrane Library, ?(9), 1-65. doi:10.1002/14651858.CDOO4923.pub2

Reynolds, R. F., Obermeyer, C. M., Walker, A. M., & Guilbert, D. (2002). The role of treatment intentions and concerns about side effects in women’s decision to discontinue postmenopausal hormone therapy. Maturitas, 43(3), 183-194.

Rousseau, M. E. (2001). Evidence-based practice in women’s health: Hormone therapy for women at menopause. Journal of Midwifery & Women’s Health, 46(3), 167-180.

Smith, D. C., Prentice, R., Thompson, D. J., & Herrmann, W. L. (1975). Association of exogenous estrogen and endometrial carcinoma. The New England Journal of Medicine, 293(23), 1164 – 1167.

Thompson, E. A., & Reilly, D. (2003). The homeopathic approach to the treatment of symptoms of oestrogen withdrawal in breast cancer patients: A prospective observational study. Homeopathy, 92(3), 131-134.
Thompson, E. A., Barron, S. J., Mathie, R. T., Baitson, E. S., Berkovitz, S. R., Fisher, P.,…Roniger, H. (2008). Towards standard setting for patient-reported outcomes in the NHS homeopathic hospitals. Homeopathy, 97(3), 114-121.

Thompson, E. A., & Relton, C. (2009). Designing clinical trials of homeopathy for menopausal symptoms: A review of the literature. Menopause International, 15(1), 31-34.

Ullman, D. (1997). Homoeopathie fuer Kinder: Erkrankungen bei Kindern naturgemaess behandeln (11th ed.). Muenchen, Germany: Scherz.

Ullman, D. (2014). Homeopathic educational services: A condensed history of homeopathy. Retrieved from https://www.homeopathic.com/Articles/Introduction_to_Homeopathy/A_Condensed_History_of_Homeopathy.html

Utian, W.H. (1994). Ovarian function, therapy-orientated definition of menopause and climacteric. Experimental Gerontology, 29(3-4), 245-251.

Wilken-Jensen, C., & Ottesen, B. (2003). The aging woman: The role of medical therapy. International Journal of Gynecology and Obstetrics, 82(3), 381-391.

Wilson, R. A., & Wilson, T. A. (1963). The fate of the non-treated postmenopausal woman: A plea for the maintenance of adequate oestrogen from puberty to the grave. Journal of the American Geriatric Society, 34(11), 1-12.

Abbreviations:

CAM – Complementary and Alternative Medicine
FSH – Follicle Stimulating Hormone
HT – Hormone Therapy
LDL – Low Density Lipoprotein
LH – Luteinising Hormone
UK – United Kingdom