Menopause: Conventional and Complementary Medicine Marvel or Myth
by Ann Dunleavy
Introduction: The Holistic view and CAM medicine
Exploring menopause from the holistic perspective using Complementary and Alternative Medicine (CAM) is fundamental to all women who want to take responsibility for their health during this particular part of their lives. However conventional medicine cannot be ignored. According to Kuhn M. A. (1999, “Health is not merely the absence of disease, but a state of balance among body, mind and consciousness – a state of being totally happy with one’s self”. This review will explore the marvel or myth associated with many of the remedies and treatments available as aids in the management of symptoms for women, whose passage through menopause is arduous, stressful, fatiguing and wearisome.
The holistic attitude to health care is defined by Weller B.F. (1999) as “a comprehensive approach to health care that implies body-mind-spirit considerations in all actions and interventions for the patient, while recognizing the concept of the uniqueness of the individual and the influence of external and environmental factors on health”. Western allopathic medicine regards the symptoms as the disease, whereas the holistic therapist is concerned about the underlying processes that have led to the symptoms and with the ultimate goal of restoring balance with the emphasis on building health, not simply fighting disease. The holistic approach treats the whole person. This is the basis for CAM (Complementary and Alternative) medicine.
What does CAM medicine involve?
According to Kuhn M. A. (1999), The Office of Alternative Medicine (OAM) in the USA in 1995, characterized 4 different systems of medicine.
- Allopathic is a system of medicine that embraces all methods of proven value in the treatment of disease. This medical system is dominant.
- Alternative Medicine: Modalities used instead of conventional medicine.
- Complementary Medicine: The use of modalities together to compliment offerings of conventional medicine.
- Integrative Medicine: Used to define a hybrid of complementary and conventional medical treatments:
An assortment of evidence exists that suggests an increase in the use of complementary therapies over recent years. A variety of explanations have been offered to justify this growth, from dissatisfaction with conventional forms of treatment to more general theories of diversification of health care. The increasing popularity of these therapies has prompted many European countries to review their current policies. Many important developments in the self-regulation of the different therapy bodies have given rise to some encouraging initiatives in elevating the standards and expected outcomes within the different modalities of Complementary Health Care. We are the instigators of our own self-care.
Menopause: Cause and Affect
Now let us look at menopause. Menopause is explained by the National Women’s Health Resource Centre as “a natural event that marks the end of fertility and the childbearing years”, as reported in Health Topics A-Z (2008).
Menopause literally means ‘the stopping of menstruation’ and this occurs when the production of the sex hormones oestrogen and progesterone slows down and the ovaries no longer release eggs. Menopause is said to have occurred when a woman has not had a period for 12 months.
For most women, menopause – often referred to as the ‘change of life’, is a gradual transition period spanning 15 to 20 years, unless there is surgical intervention, which causes a sudden rather than a gradual change. The average age for menopause is 51 but some can start in their late 30’s. Commencement before the age of 35 is considered premature, whilst after the age of 55 is considered late and while there is no cause for alarm, medical intervention should be sought.
There is such a variety in the presentation of symptoms and their severity, therefore there is no definite indication that age or experience of symptoms will be the same. Life style, diet, stress, and genetics all play a part in the onset of menopause. It is a well recognised fact that smokers commence menopause at an earlier age because “smoking diminishes the secretion of oestrogen in the ovaries” (Glenville M. 2005).
Surgical menopause occurs following a ‘hysterectomy’, the surgical removal of the womb and/or ovaries. When the ovaries are removed menopause arrives literally overnight as the hormone supply of oestrogen is cut off. Hysterectomy induced menopause, without the removal of the ovaries, occurs at a slower pace, with a decline in ovarian function and hormonal production.
This ‘transient period’ relating to menopause can be divided into three distinct phases, Pre-menopause when periods are still regular but symptoms such as hot flushes appear with mood changes. Peri-menopause occurs as the function of the ovaries declines, periods become irregular and symptoms are more severe. Post-menopause is the final period and beyond, which lasts for the rest of the woman’s life.
Pre-menopause occurs during the late 30’s, when there is a slowing in the functioning of the ovaries. This process accelerates during the 40’s with greater hormone fluctuations of oestrogen affecting ovulation and the production of progesterone in the womb. Menstrual periods may become irregular and sometimes heavy and symptoms such as hot flushes and mood swings become evident. This is when most women seek intervention.
During the peri-menopause phase, as the function of the ovaries decline, periods can become irregular and there is a wide variety of symptoms which vary in severity from person to person irrespective of life-style.
It is worth mentioning here that not all women suffer during menopause. Indeed, Glenville M. (2005) reports that “some women sail through – the only thing they notice is that their periods have stopped”. While many women experience a variety of symptoms, Health Topics A-Z, offers us a concise set of common changes and affects:
Menopause symptoms include:-
- Hot flashes (sudden warm feeling, usually with blushing)
- Night sweats (hot flashes that occur at night, often disturbing sleep)
- Fatigue (probably from disturbed sleep patterns)
- Mood swings
- Vaginal dryness
- Fluctuations in sexual desire or response.
Because menopause occurs over a span of some years and in conjunction with the ageing process, other symptoms can arise which are attributed to, and add to the discomfort caused by menopause. These include:
- Weight gain
- Ageing skin
- Lack of energy
- Joint pain
- Hair loss and changes in hair quality.
Adding any or all of these symptoms to those experienced during menopause can render the most organised woman unable to cope and send her running for help wherever she can get it. Glenville M. (2005) writes “Volatile hormones have a powerful impact on the way we feel”.
Post-menopause can only be identified retrospectively as the 12 months following the last period and lasts until the end of the woman’s life. This can be a very empowering phase with a “total metamorphosis to a new self……. a time of renewed sense of self and increased vitality and zest” (Kushi G. 2006). It is during this significant stage of a woman’s life that she can grow in confidence and ability, and through personal development can achieve true fulfilment and peace. Given current trends of life expectancy rates “over a third of a woman’s life is spent in the post reproductive years”, states Judelson D.R. and Dell D. L. (1998). Many women change their life style retiring from work to pursue personal interests. They find new ways of relating to friends and partners and consider post-menopause to be the beginning of a new and rewarding life cycle.
Menopause is a unique, natural and personal experience and can be an invigorating transition. Following menopause many women grow in confidence and ability, achieving individual ambitions, personal goals and true fulfilment.
Conventional medicine during menopause
Our understanding of menopause allows us to develop a more positive and realistic approach towards the symptoms being experienced. It is intriguing to find that most women who have neutral or negative feelings before menopause actually become more positive as they experience this transition.
Menopause can be medically determined by a simple blood test, and according to Judelson D. R. and Dell D. L. (1998) “an elevated follicle-stimulating hormone level, measured in a blood test, confirms menopause”.
The conventional approach is the offer of HRT as the front-line treatment. HRT stands for ‘hormone replacement therapy’, which is abbreviated to HT (hormone therapy) or ET (estrogen therapy). Menopausal hormone therapy includes:
Estrogen only medicines, which are most commonly given on a continuous basis in order to maintain blood levels and to prevent the re-occurrence of symptoms;
Progestin only medicines for women who either cannot take HRT or prefer not to, and their use is primarily for the alleviation of vasomotor symptoms;
Combination Estrogen and progestin medicines offer ‘period-free’ HRT management during menopause especially for the older women. It is a confident way of controlling symptoms in the years after their periods have stopped. For this group of women, Abernethy K. (1997) proposes “a continuous combined oestrogen/progestogen regime” for those who want to “avoid the need for a monthly bleed whilst maintaining endometrial safety”.
Furthermore, Judelson D. R. and Dell D. L. (1998) state that
“Although some doctors initiate low-dose HRT during peri-menopause to reduce symptoms and smooth the transition to full HRT, traditionally doctors do not initiate hormone therapy until they are sure a woman has had her last menstrual period”.
HT can be administered in various ways and the decision of choosing any method should reflect the treatment being offered, tablet, patch, gel, implant or vaginal treatment.
Tablets are the most common method for easy compliance as strength can be tailored to individual requirements. Patches (transdermal application) deliver a constant dose over 24 hours and there are two types the reservoir and the matrix patch, which are worn on the buttocks or abdomen. They are extremely suitable for those opposed to oral administration and offer sustained release full dosage hormone potency.
Gel containing the prescribed HT is available in a measured dose from a pressurised canister, to be gently rubbed into the skin on a daily basis to the soft tissue areas of the body. Abernethy K. (1997) observes that “Women should be encouraged to apply the gel over a wide area for maximum absorption”.
Implants, as the name implies, are small pellets which are inserted under the skin through a small incision and the HT is slowly released over a period of months which can last even up to a year or two. “The higher the implant dose the longer it will remain effective”, explains Abernethy K. (1997). This is an ideal practice for the busy woman of today’s world whereby she can forget about menopause until symptoms start to re-occur.
Vaginal treatments include creams, pessary, tablets and slow release rings which “exert a direct beneficial effect on atrophic vaginitis without systemic effects” prompts Abernethy K. (1997). Older women may prefer this type of treatment for relief of vaginal symptoms as opposed to systemic HT.
According to Hope S., Rees M. and Brockie J. (1999), “A preparation of vaginal progesterone 4% gel can be used during the last 12 days of the cycle in a woman with an intact uterus as an adjunct to oestrogen for HRT. There is also a progesterone pessary that can be used vaginally or rectally”.
The absence of the hormone oestrogen (oestrogen) also affects the centres in the brain that control the positive state of mind and sense of well-being, affecting feelings of control and tranquillity. For this reason many women experience menopausal mood changes resembling a roller-coaster ride. Dr. Miriam Stoppard (1998), a leading healthcare expert in the UK, asserts that “feelings such as tension, anxiety, depression, listlessness, irritability and mood swings can occur at any age, but rarely occur together, or as frequently, as they do during menopause”. As these feelings can arise with little or no provocation with mood swings from wild elation, at one end of the scale, to deep despondency at the other, including anxiety or panic, it is no wonder that many women foresee a bleak future with loss of self-esteem inevitably resulting in depression.
HRT is prescribed to alleviate the oestrogen deficiency Which cause menopausal symptoms, “nonhormonal therapies are aimed at alleviating individual symptoms” (Abernethy K. 1997).
Clonidine is now offered as a nonhormonal treatment to reduce the intensity of hot flushes and is taken twice weekly.
Antidepressants can be prescribed for mood swings which are so severe that they may give rise to depression. It is worth noting that some women may be clinically depressed as well as menopausal.
Tranquillizers may be given in times of extreme stress but only on a short term basis.
Vaginal lubricants such as ‘KY Jelly’ or ‘Senselle’ are available to aid with vaginal symptoms making intercourse less painful and improving vaginal blood flow.
Some women wish to avoid all therapeutic drugs not just HRT and seek medical advice for confirmation of menopausal symptoms only, but it is important for all women to know of (1)the variety of medications on offer to help alleviate unwanted menopausal symptoms, (2) support groups and (3)counselling services available
CAM medicine and its efficacy
Safety within this framework implies that the benefits outweigh the risks of said treatment or therapy, i.e. it does no harm when used under defined conditions and as intended.
Effectiveness is the presumption that the therapy or treatment, when applied under typical conditions by the average practitioner for the typical subject, will bring some benefit.
All health consumers should question the background, qualifications and competence of any potential health care practitioner whether conventional, complementary or alternate, enquiring about all aspects of treatment, service delivery, quality and quantity of treatment sessions, expectations and costs.
For all menopausal women the goal is a relief of discomfort during these transitional years and to achieve optimal health which will last into the later years of her life.
They all share a core belief that:
- Illness occurs if the body is out of balance.
- The body can heal itself and maintain a healthy state if given the right conditions.
- The whole person should be treated, not just the disease or the symptoms.
- The gentlest therapies must be tried first before harsher ones.
- There is no quick fix, since healing and balance take time.
- Natural products are preferable to synthetic ones, as noted in Complementary therapies (2008).
“The alternative medical approach focuses on strengthening the female body by encouraging it to balance, regulate, and normalise itself during the transition to menopause”, as reported in the Alternative, Natural and Integrative Approaches for the Treatment of Menopause. It goes on to say that a shift in emphasis from HRT to natural ways of encouraging the body to balance and heal itself, focussing on dietary, nutritional and lifestyle changes supplemented by therapies such as acupuncture, herbs, and homeopathic remedies, have shown to be effective.
The National Centre for Complementary and Alternative Medicine (NCCAM) and the menopause Guide (2007) divides CAM therapies into three main categories;
1. Naturopathy and homeopathy.
2. Manipulative and Body-based Therapies.
3. Mind-body therapies.
(a) Naturopathy – herbal supplements, homeopathy and eating certain foods that are thought to prevent disease or heal. At times of stress such as menopause, the digestive system becomes less efficient so any supplements taken orally need to be readily absorbed.
Supplements of interest are Vitamins A, B complex, C, D, and K to prevent pre-mature ageing of the skin, emotional distress and fatigue, maintaining bone density and for stabilising brain and liver function.
Minerals include Calcium and Phosphorus, Magnesium, Zinc, Boron and Folic Acid for a healthy heart, bones and normal muscle contraction, cell growth and brain function. For the body to remain healthy it needs vitamins and minerals which are interdependent for optimum efficiency. Herbal medicines can be used by the body to balance hormones and Glenville M (2005) indicates that “up to 70% of drugs in use today have their origin in plants”. Of interest to menopausal women are Black Cohosh and Wild Yam, a form of natural hormone therapy, Dong Quai, Gotu Kola for the treatment of hot flushes, vaginal dryness and low sex drive, and St John’s Worth for fatigue and depression. Chamomile, Fennel, Kava Kava and Valerian relieve anxiety, insomnia and palpitations. The homeopath selects a constitutional remedy based on the totality of the client’s symptoms and her physical, mental and emotional state. This strengthens the body’s vital defences and restores a healthy balance and sense of well being
(b) Manipulative and Body-based Therapies – involves manipulation of body structures, such as bones, joints and soft tissues, as well as the circulatory and lymph systems. These include chiropractic and osteopathic manipulation, acupuncture/acupressure, kinesiology and massage, and reflexology to help distressed muscles and joints to function smoothly and in harmony.
“Chiropractic proved long ago that spinal imbalance and dysfunction can interfere with normal nerve function, which, in turn causes misfunction in organs and glands”, states Valentine T. and C. (1985). The Dorn method – a gentle relation of osteopathy and chiropractic, is a holistic, effective, safe and non-manipulative treatment to correct misalignments in the spine and joints and a true self-help method, which uses motion to divert the muscle tension and in this process it realigns the bones.
Acupressure/Acupuncture involves the applying of pressure either by finger or needle to specific points on the body tapping into the body’s energy systems to relieve symptoms or illness elsewhere in the body. These pressure point or ‘tseubo’ are the gateways to the body’s energy channels called meridians and by applying various degrees of pressure to specific points, the energy called chi that flows through these meridians can be regulated to speed up or slow down as needed, relieving stress and painful conditions. Acupressure is an impressive first aid treatment for menopausal symptoms.
Kinesiologists believe that each muscle is connected with a specific part of the body and if a muscle is not functioning correctly this will cause a complication or blocked pattern of energy in the related part of the body. Also blocked energy can lead to weakness in the corresponding organ and will register in the muscle that relates to that organ. Health is maintained by ensuring proper muscles function and kinesiologists deal with each client holistically making sure that the triad of health – the chemical, mental and structural components are as an equilateral composite of a triangle.
The relaxation and healing power of massage has been well documented over the past 5,000 years offering physiological and psychological benefits to the receiver. Massage is the art of rhythmically applying pressure with contrasting stroking and alternating pulling or kneading movements, is commonly used to induce relaxation and serenity by easing strain and tension, and promotes circulation and good muscle tone.
Reflexology involves applying gentle but firm pressure to areas of the hands or feet to relieve symptoms or discomforts in areas of the body connected by the meridian energy system.
(c) Mind-body therapies are a form of energy medicine, a rich healing tradition that has developed in various forms and at various times around the world, embraces meditation, reiki, hypnosis and counselling. Energy is the blueprint or invisible foundation for health in the body. All beings are made-up of energy pathways and centres that interplay with our cells, organs, moods and thoughts. Complementary therapies (2008) also refer to the Alexander technique and aromatherapy. Hypnosis and counselling intervention, notable for their therapeutic contributions in dealing with crisis, helps the client to gain insight into motives, needs, buried emotions and concerns that might be affecting health on all levels, also fall into this category. When energy healing is introduced it alters the body’s neurochemistry, which in turn affects the mind, mood and behaviour of that individual, which makes it an excellent first aid for self treatment during menopause.
The Alexander technique is not taught to alleviate specific symptoms but to address the source and practitioners believe that by restoring harmony to the whole person specific problems often disappear.
Aromatherapy involves the use of essential oils, which are the life force of aromatic flowers, herbs, plants, trees or spices for therapeutic purposes, which enter the body by inhalation and through the skin during massage. Once inhaled, Sullivan K. (2004) maintains that aromatic signals are sent to the limbic system of the brain, where they exert a direct effect on the mind and emotions and can be very effective for menopausal complaints, insomnia and depression. Examples of interest are Bergamot, Chamomile, Geranium and Lavender for emotional upset and stress related insomnia. Jasmine and Patchouli are used for physical ageing and frigidity, and while Fennel appears to have a balancing affect on emotions Melissa calms palpitations and rapid breathing.
Hypnosis and Counselling can be very effective as a form of psychotherapy since emotional problems can affect overall health.
The practitioner helps the client to gain insight into motives and needs, buried emotions and concerns that might be affecting health on all levels. There is now a merging of traditional Eastern philosophies and western care. Changes that alters the body’s neurochemistry, will in turn affect the mind, mood and behaviour of that individual. For some, menopause is a gateway to enlightenment and for others it is hard and tiring work, but by using an holistic system of medicine, that embraces a wide range of alternative therapies, women can empower themselves to pass through menopause with more vigour and energy than they ever had before.
Exploring the optimum approach
About half of the women today who start synthetic hormone replacement give it up because of the side effects. Few women know and truly understand all the alternatives approaches for treating menopausal symptoms but more women nowadays are seeking information on natural remedies because of the well-publicised adverse side-effects of conventional medicine. They seek essential education and understanding about their options. Women who are hormonally vulnerable will no longer allow their problems to be dismissed as trivial, and in reply, many of those involved in modern medicine have widened their scope to include a more holistic approach to health care.
Because complementary therapies are often based on traditional knowledge, there is less scientific evidence available about their safety and effectiveness. However the increasing utilization of these therapies has begun to fuel scientific research, and many have been found to be safe and effective. They may also be less invasive and more cost-effective than conventional medical treatments.
Hormone therapy is considered to be a generally safe way to manage menopausal symptoms, but it may not be right for every woman. Menopause and Alternative Therapy (2007) quotes a report in the August issue of JAMA (Journal of the American Medical Association) 2007 confirming the benefits of HRT to prevent bone fracture and probably colorectal cancer but found that the effects on dementia were uncertain. Harmful effects included an increased risk of blood clots and stroke and an increase in breast cancer with 5 or more years of use.
HRT in the form of oestrogen alone or combined with progestin is taken by millions of women to reduce acute symptoms of menopause and many physicians have prescribed it to prevent chronic conditions such as heart disease.
Oestrogen with or without progestin (a synthetically produced hormone) has been the main treatment within conventional medicine for menopausal symptoms. Natural progesterone seems to have been totally overlooked by medical science in favour of synthetic progesterone called progestins, but there is a big difference in the way both affect the body. Synthetic progestins lack the intrinsic physiological benefits of progesterone and disrupt many fundamental processes in the body while natural progesterone plays a part in the development of healthy nerve cells and brain, and thyroid function.
Hypnosis is a valuable tool for menopausal women, as according to Tavares M. (2003) “it involves interaction between mind and body, using the mind to affect therapeutic change, and can be instrumental in engendering coping strategies, helping people to connect with their inner being and activate innate healing forces”.
Successful treatment during menopause seems to be more about modifying life-style, maintaining a healthy weight, learning relaxation techniques and adapting good nutritional choices including herbs and supplements like calcium for healthy bones and a wide range of Vitamins. It is well to note that alternative therapies and complementary medicines while they are readily available without prescription may still have side effects or interact with other medication, or they may not be the most effective at that particular time. Advice should always be sought from a qualified professional before embarking on the alternate or complementary route, and it is proposed that the GP should always be informed of any such treatment undertaken.
A randomised survey of 100 midlife women within my local area [see Appendix 1] was carried out to record the age groups, type of menopausal symptoms experienced and the use of conventional or alternate/complementary medicine within this context.
Results [see Appendix 2] show the largest percentage of women questioned were 40-60 age group and indicate that a large number of women are more in favour of using complementary and alternative medicine for treatment of symptoms during menopause, with younger women wanting a more integrated approach between GP and CAM medicine.
Most women only develop interest in menopause as symptoms arise and in the past it seems to be the severity of these symptoms that drove women to investigate alternative treatments. There are many models of service to menopausal women but the consensus is that it is advisable to start small, safe and simple, with therapeutic intervention offered for target outcomes. All care should be specifically directed to the individual’s interrelated systems for balance and harmony.
Empowerment seems to be the most popular term in relation to menopause at present and women need to embrace a constructive approach to their treatment.
Adapting Sir John Whitmore’s GROW model as an effective tool in life coaching to achieve goals, women should approach menopause in a theoretical manner, regularly reviewing and updating their information, their current symptoms and severity. Only the woman experiencing the symptoms can evaluate her needs and relevant treatment.
G = Goals: What does she want?
R = Reality: What is happening now?
O =Options: What could she do?
W =Will: What will she do?
G. – Women want current relevant information on all aspects of care during menopause, the advantages and dis-advantages of each treatment, how to easily access what is readily available, and what the treatment can hope to achieve.
R. – They need to know what is happening to their bodies, physically, mentally and emotionally due to hormone imbalance.
O. – They must be ready and willing to access any and all information, no matter what the source, and discuss all treatments with their relevant health care professional.
W. – They must take matters regarding their treatment into their own hands and not expect others to fully know or realize the most relevant treatment for them at any given time. They must take responsibility for their own health.
Conclusion: Obtaining true potential and fulfilment
While there are still many physical and emotional implications for women who are diagnosed menopausal, it is no longer the debilitating event that our predecessors feared. Knowledge is all empowering, giving the modern woman the necessary facts to make informed decisions about her health.
No longer do we have to choose between conventional medicine and the CAM therapies. A combination of both forms of care, with patient centeredness at the heart of service development, is now viewed as an integral part of caring. As long as women are sensible and inform both the doctor and complementary therapist of all drugs, treatments and remedies being used, all can work together in a collaborative and co-operative manner recognising and respecting the role and contribution of colleagues within conventional medicine and complementary health-care. Effective communication enables women to make informed decisions and includes finding out about the individual’s needs and priorities. Sufficient information should be provided in a way that the client can understand and question, including an explanation of any risks involved. Women must adopt an individual approach to ascertain their needs and responsibilities in relation to their well-being for example the GROW model.
The only obstacle to modern woman obtaining her true potential and fulfilment is her own thoughts and limiting beliefs. The wide variety of ongoing studies (mentioned earlier) into CAM medicine can dispel any myth regarding their utilization within the field of women’s health.
Surely combined conventional and complementary medicine during menopause with its variety, effectiveness and mostly its patient centeredness and holistic approach to care, is the marvel of the modern approach. When used in conjunction, they allow the menopausal woman to facilitate her goal of optimal health and self awareness by empowering her with a strong understanding of the principles of wellness and not just the absence or control of symptoms.
For the menopausal woman any therapeutic intervention purposely directed to the individual’s interrelated systems for balance and harmony and being issue specific to menopausal symptoms, can but achieve positive target outcomes for that person.
Results of Random Local Survey of Midlife Woman
Survey Results of 100 questionnaires distributed locally:
Objective: Survey to document age, life stage, symptoms experienced and treatment sought.
Design and Location: Questionnaire with tick-box system handed out to women’s groups in my local area.
Subjects: Women aged 30-40, 40-50, 50-60 and over 60.
Measures: To explore different areas of treatments GP visits, CAM treatments, integrated system of care or none.
Results: 18 questionnaires not returned – considered void
The largest age group were 50-60 and the smallest group were the over 60’s, with 11 between 30-40 and 29 aged 40-50 – chart 1.
Of those that experienced symptoms, either peri-menopausal or post-menopausal, chart 2 shows that 43% of those surveyed are using or have used some form of CAM therapies, 25% managed symptoms themselves seeking no outside intervention (either their symptoms were not very severe or they experienced little or no symptoms). GP visits for conventional treatment accounted for 19%, while 13% used both conventional and complementary medicine to support them.
Conclusion: A quarter of those questioned 25% did not seek any intervention for menopausal symptoms and these were typically the older age group. Those 13% that experienced both conventional and complementary care moved between both as symptom severity changed. The 19% that attended GP only agreed that they lacked sufficient knowledge of the complementary health care available in this area. While the majority of women surveyed 43% used some variety of complementary therapy, there was no definite trend within the choice of therapy used, some getting satisfaction with herbs and vitamins while others experienced one or more of the manual therapies, mind/body therapies, energy medicine, aromatherapy or Bach/Bush flower remedies. It was predominantly the younger women that indicated they would prefer a more integrated approach between conventional and CAM medicine.
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