Queen Charlotte's & Chelsea and Chelsea & Westminster Hospitals and Honorary Senior Lecturer, Imperial College London, London, UK.
Climacteric. 2011 Dec;14 Suppl 2:2-7. doi: 10.3109/13697137.2011.626367.
An integrated approach can be employed when counselling women about menopausal management options, where lifestyle, complementary therapies and hormone replacement therapy (HRT) are discussed. Women might opt to use an alternative approach to HRT for a variety of reasons, e.g. fear of side-effects and risks or contraindications to HRT. There are many choices of dietary and herbal approaches for menopausal symptoms, which essentially divide into food supplements and herbal medicines. The choice can often be overwhelming and confusing for the woman. Of concern, the evidence for efficacy and safety of some of these complementary therapies can be extremely limited or non-existent. In order to enable women to make a fully informed choice, it is important that, when a recommendation is made regarding a specific complementary therapy, it should focus on preparations for which a significant dataset exists for efficacy and safety and in which there is ongoing research and development. One of the most extensively studied food supplements has been the phytoestrogenic preparation containing red clover isoflavones. There have been six randomized trials thus far studying the impact on vasomotor symptoms, three of which have shown a significant benefit compared to placebo. There are also data from small randomized and observational trials showing positive outcomes for surrogate markers of osteoporosis and cardiovascular disease. A recent study using validated depression scales has shown that women using red clover isoflavones may also derive psychological benefits. Safety data are reassuring for the endometrium and breast, although further studies would be welcome, particularly in women with significant medical risks.
在为女性提供更年期管理方案咨询时，可以采用综合方法，讨论生活方式、补充疗法和激素替代疗法（HRT）。女性可能出于多种原因选择替代 HRT 的方法，例如担心副作用和风险，或 HRT 的禁忌症。有许多针对更年期症状的饮食和草药方法可供选择，这些方法基本上可以分为膳食补充剂和草药药物。对于女性来说，选择往往会让人感到不知所措和困惑。值得关注的是，这些补充疗法中的一些在疗效和安全性方面的证据可能非常有限或不存在。为了使女性能够做出完全知情的选择，当建议使用特定的补充疗法时，重要的是应该专注于那些在疗效和安全性方面有大量数据的制剂，并且这些制剂还在进行研究和开发。研究最广泛的食品补充剂之一是含有红三叶草异黄酮的植物雌激素制剂。迄今为止，已经进行了六项随机试验来研究其对血管舒缩症状的影响，其中三项与安慰剂相比显示出显著益处。也有小型随机和观察性试验的数据表明，替代骨质疏松症和心血管疾病的标志物有积极的结果。最近一项使用经过验证的抑郁量表的研究表明，使用红三叶草异黄酮的女性也可能获得心理益处。安全性数据对于子宫内膜和乳房来说是令人放心的，尽管还需要进一步的研究，特别是对于有重大医疗风险的女性。
