G Model MAT-6233; No. of Pages 3
ARTICLE IN PRESS Maturitas xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
Short Communication
Complementary/alternative and conventional medicine use amongst menopausal women: Results from the Australian Longitudinal Study on Women’s Health Wenbo Peng, Jon Adams, Louise Hickman, David W. Sibbritt ∗ Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
a r t i c l e
i n f o
Article history: Received 23 April 2014 Received in revised form 5 August 2014 Accepted 6 August 2014 Available online xxx Keywords: Menopause Complementary and alternative medicine Hormone replacement therapy Surgical menopause Oophorectomy Hysterectomy
a b s t r a c t Large population-based studies of complementary and alternative medicine (CAM) and conventional medicine use amongst menopausal women are lacking. This study helps address this gap by analysing data from a nationally representative sample of 10 011 Australian women aged 59–64 years. Overall, 39% of menopausal women consulted CAM practitioners, 75% used self-prescribed CAM, 95% consulted general practitioners (GP) and 50% consulted specialists during the previous year, and 12% were current hormone replacement therapy (HRT) users. Our findings suggest that CAM is a significant healthcare option utilized by women to treat menopausal symptoms, and so requires attention from GPs and specialists. © 2014 Elsevier Ireland Ltd. All rights reserved.
1. Introduction
2. Methods
All women’s transition to menopause naturally or surgically is due to the loss of ovarian hormones [1]. Surgical menopause – hysterectomy and/or oophorectomy – results in an abrupt or rapid drop in hormone levels, accompanied by the occurrence of menopausal symptoms, while natural menopause is characterized by a slow decrease in ovarian functions until menstrual cycles cease [1]. Hormone replacement therapy (HRT) has long been documented as the first-line conventional treatment for women experiencing menopausal symptoms, despite a number of known side effects [2]. Meanwhile, complementary and alternative medicine (CAM) constitutes a popular treatment option for menopausal women [3]. No large population-based research to date has focused upon CAM and conventional medicine use amongst menopausal women, including consultation with practitioners and use of therapies. In response, this paper reports on both CAM and conventional medicine use by a nationally representative sample of women with surgical or natural menopause from the Australian Longitudinal Study on Women’s Health (ALSWH).
This study is a secondary data analysis of the middle-age cohort of ALSWH. The ALSWH was designed to investigate multiple factors affecting women’s health over a 20-year period. The women were randomly selected from the national Medicare database containing the names and addresses of all Australian citizens and permanent residents in 1996. A paper-based questionnaire was sent by mail to these women. Data for the research reported here were obtained from a survey conducted in 2010, involving 10 011 women aged 59–64 years. The main variables of analysis were women’s menopausal status and CAM and conventional medicine use. Menopausal status was determined from the answers to questions about menstrual pattern and gynaecological surgeries. Women were categorized into three groups: hysterectomy; oophorectomy; and natural menopause. The women were asked about their consultations with a range of CAM practitioners (including massage therapists, naturopaths/herbalists, chiropractors/osteopaths and acupuncturists), their use of a range of self-prescribed CAM (including vitamins/minerals, yoga/meditation, herbal medicines, aromatherapy oils and Chinese medicine), their consultations with general practitioners (GP) and specialists, and their current use of HRT for the management of menopausal symptoms. Pearson’s chi-square tests were employed to compare the variables of CAM and conventional medicine use to the categorical
∗ Corresponding author at: Faculty of Health, University of Technology Sydney, Level 7, Building 10, 235–253 Jones Street, Sydney, NSW 2007, Australia. Tel.: +61 2 9514 4172; fax: +61 2 9514 4835. E-mail address: [email protected] (D.W. Sibbritt). http://dx.doi.org/10.1016/j.maturitas.2014.08.002 0378-5122/© 2014 Elsevier Ireland Ltd. All rights reserved.
Please cite this article in press as: Peng W, et al. Complementary/alternative and conventional medicine use amongst menopausal women: Results from the Australian Longitudinal Study on Women’s Health. Maturitas (2014), http://dx.doi.org/10.1016/j.maturitas.2014.08.002
G Model
ARTICLE IN PRESS
MAT-6233; No. of Pages 3
W. Peng et al. / Maturitas xxx (2014) xxx–xxx
2
menopausal status variable. Statistical significance was set at p < 0.05. To correct for multiple comparisons, a modified Bonferroni test was used. All analyses were conducted using the statistical software package STATA 12.
3. Results The study sample consisted of 10011 women, with 23% of women having had a hysterectomy, 11% of women having had an oophorectomy, and 66% of women considered to be in natural menopausal. Overall, 39% of menopausal women consulted a CAM practitioner, 75% used at least one self-prescribed CAM, 95% consulted a GP and 50% consulted a specialist in the previous 12 months, and 12% of menopausal women were taking HRT at the time of questionnaire completion. In addition, if massage therapists, chiropractors/osteopaths, and vitamins/minerals were excluded from the analysis, 12% of the menopausal women studied consulted a CAM practitioner, and 41% of the menopausal women studied used at least one self-prescribed CAM. No statistically significant associations were found between consultation with CAM practitioners and menopausal status (Table 1). Natural menopausal women reported using selfprescribed yoga/meditation more than surgical menopausal women (p < 0.001). Conversely, surgical menopause women were more likely to consult with a GP and a specialist compared to natural menopause women (p < 0.001). Surgical menopausal women were more likely to use HRT than natural menopausal women (p < 0.001),
with the highest rate seen in women with oophorectomy, followed by women with hysterectomy and natural menopausal women. 4. Discussion Our study findings show a high prevalence of CAM use amongst menopausal women in Australia in contrast to findings from US research [3]. However, the variation of research design (e.g. target population and definition of CAM) as well as menopausal status (e.g. inclusion of pre- or peri-menopausal women) may account for this difference in reported CAM use prevalence across the two studies. Our analysis shows that only the use of self-prescribed yoga/meditation was significantly associated with menopausal status, which is not consistent with results from the Study of Women’s Health across the Nation [3]. Nevertheless, this finding is not too surprising given women with surgical menopause experience more intense and severe symptoms than natural menopausal women [4], and yoga/meditation is specifically recommended as an alternative to HRT for menopausal women with mild symptoms [2]. In the present study, the prevalence of HRT use differs by menopausal status. This could be a result of menopausal women’s perception about HRT, where the severity of symptoms and history of hysterectomy/oophorectomy play important roles in the decision-making process on HRT use [4]. Our study shows that a large number of menopausal women use self-prescribed CAM and consult GPs concurrently. An explanation for this finding could be the high level of support from
Table 1 Comparison of menopausal women against use of complementary/alternative and conventional medicine, 2010. Menopausal status (%)
CAM practitioners Massage therapists Naturopaths/herbalists Chiropractors/osteopaths Acupuncturists Any CAM practitioner CAM therapies Vitamins/minerals b,c
Yoga/meditation
Herbal medicines Aromatherapy oils Chinese medicines Any CAM therapy Conventional practitioners GPsb,c
Specialistsa,b,c
HRT a,b,c a b c
p-value
Oophorectomy, n = 1141
Hysterectomy, n = 2260
Natural menopause, n = 6610
Total, n = 10 011
No Yes No Yes No Yes No Yes No Yes
74.4 25.6 92.4 7.6 80.9 19.1 94.6 5.4 61.4 38.6
74.5 25.5 91.8 8.2 81.4 18.6 95.0 5.0 60.4 39.6
74.9 25.1 90.7 9.3 81.7 18.3 94.0 6.0 60.8 39.2
74.7 25.3 91.2 8.8 81.5 18.5 94.3 5.7 60.8 39.2
0.886
No Yes No Yes No Yes No Yes No Yes No Yes
33.0 67.0 85.0 15.0 74.6 25.4 85.5 14.5 96.5 3.5 27.2 72.8
30.9 69.1 84.7 15.3 73.0 27.0 84.7 15.3 97.0 3.0 24.8 75.2
31.0 69.0 81.3 18.7 73.0 27.0 85.2 14.8 96.0 4.0 25.0 75.0
31.2 68.8 82.5 17.5 73.2 26.8 85.1 14.9 96.3 3.7 25.2 74.8
0.365
No 1–2 times 3+ times No 1–2 times 3+ times
3.3 23.0 73.7 42.4 30.1 27.5
4.2 24.0 71.8 45.7 33.9 20.4
5.4 35.2 59.4 52.8 32.7 14.5
4.9 31.3 63.8 50.0 32.7 17.3
ARTICLE IN PRESS Maturitas xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
Short Communication
Complementary/alternative and conventional medicine use amongst menopausal women: Results from the Australian Longitudinal Study on Women’s Health Wenbo Peng, Jon Adams, Louise Hickman, David W. Sibbritt ∗ Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
a r t i c l e
i n f o
Article history: Received 23 April 2014 Received in revised form 5 August 2014 Accepted 6 August 2014 Available online xxx Keywords: Menopause Complementary and alternative medicine Hormone replacement therapy Surgical menopause Oophorectomy Hysterectomy
a b s t r a c t Large population-based studies of complementary and alternative medicine (CAM) and conventional medicine use amongst menopausal women are lacking. This study helps address this gap by analysing data from a nationally representative sample of 10 011 Australian women aged 59–64 years. Overall, 39% of menopausal women consulted CAM practitioners, 75% used self-prescribed CAM, 95% consulted general practitioners (GP) and 50% consulted specialists during the previous year, and 12% were current hormone replacement therapy (HRT) users. Our findings suggest that CAM is a significant healthcare option utilized by women to treat menopausal symptoms, and so requires attention from GPs and specialists. © 2014 Elsevier Ireland Ltd. All rights reserved.
1. Introduction
2. Methods
All women’s transition to menopause naturally or surgically is due to the loss of ovarian hormones [1]. Surgical menopause – hysterectomy and/or oophorectomy – results in an abrupt or rapid drop in hormone levels, accompanied by the occurrence of menopausal symptoms, while natural menopause is characterized by a slow decrease in ovarian functions until menstrual cycles cease [1]. Hormone replacement therapy (HRT) has long been documented as the first-line conventional treatment for women experiencing menopausal symptoms, despite a number of known side effects [2]. Meanwhile, complementary and alternative medicine (CAM) constitutes a popular treatment option for menopausal women [3]. No large population-based research to date has focused upon CAM and conventional medicine use amongst menopausal women, including consultation with practitioners and use of therapies. In response, this paper reports on both CAM and conventional medicine use by a nationally representative sample of women with surgical or natural menopause from the Australian Longitudinal Study on Women’s Health (ALSWH).
This study is a secondary data analysis of the middle-age cohort of ALSWH. The ALSWH was designed to investigate multiple factors affecting women’s health over a 20-year period. The women were randomly selected from the national Medicare database containing the names and addresses of all Australian citizens and permanent residents in 1996. A paper-based questionnaire was sent by mail to these women. Data for the research reported here were obtained from a survey conducted in 2010, involving 10 011 women aged 59–64 years. The main variables of analysis were women’s menopausal status and CAM and conventional medicine use. Menopausal status was determined from the answers to questions about menstrual pattern and gynaecological surgeries. Women were categorized into three groups: hysterectomy; oophorectomy; and natural menopause. The women were asked about their consultations with a range of CAM practitioners (including massage therapists, naturopaths/herbalists, chiropractors/osteopaths and acupuncturists), their use of a range of self-prescribed CAM (including vitamins/minerals, yoga/meditation, herbal medicines, aromatherapy oils and Chinese medicine), their consultations with general practitioners (GP) and specialists, and their current use of HRT for the management of menopausal symptoms. Pearson’s chi-square tests were employed to compare the variables of CAM and conventional medicine use to the categorical
∗ Corresponding author at: Faculty of Health, University of Technology Sydney, Level 7, Building 10, 235–253 Jones Street, Sydney, NSW 2007, Australia. Tel.: +61 2 9514 4172; fax: +61 2 9514 4835. E-mail address: [email protected] (D.W. Sibbritt). http://dx.doi.org/10.1016/j.maturitas.2014.08.002 0378-5122/© 2014 Elsevier Ireland Ltd. All rights reserved.
Please cite this article in press as: Peng W, et al. Complementary/alternative and conventional medicine use amongst menopausal women: Results from the Australian Longitudinal Study on Women’s Health. Maturitas (2014), http://dx.doi.org/10.1016/j.maturitas.2014.08.002
G Model
ARTICLE IN PRESS
MAT-6233; No. of Pages 3
W. Peng et al. / Maturitas xxx (2014) xxx–xxx
2
menopausal status variable. Statistical significance was set at p < 0.05. To correct for multiple comparisons, a modified Bonferroni test was used. All analyses were conducted using the statistical software package STATA 12.
3. Results The study sample consisted of 10011 women, with 23% of women having had a hysterectomy, 11% of women having had an oophorectomy, and 66% of women considered to be in natural menopausal. Overall, 39% of menopausal women consulted a CAM practitioner, 75% used at least one self-prescribed CAM, 95% consulted a GP and 50% consulted a specialist in the previous 12 months, and 12% of menopausal women were taking HRT at the time of questionnaire completion. In addition, if massage therapists, chiropractors/osteopaths, and vitamins/minerals were excluded from the analysis, 12% of the menopausal women studied consulted a CAM practitioner, and 41% of the menopausal women studied used at least one self-prescribed CAM. No statistically significant associations were found between consultation with CAM practitioners and menopausal status (Table 1). Natural menopausal women reported using selfprescribed yoga/meditation more than surgical menopausal women (p < 0.001). Conversely, surgical menopause women were more likely to consult with a GP and a specialist compared to natural menopause women (p < 0.001). Surgical menopausal women were more likely to use HRT than natural menopausal women (p < 0.001),
with the highest rate seen in women with oophorectomy, followed by women with hysterectomy and natural menopausal women. 4. Discussion Our study findings show a high prevalence of CAM use amongst menopausal women in Australia in contrast to findings from US research [3]. However, the variation of research design (e.g. target population and definition of CAM) as well as menopausal status (e.g. inclusion of pre- or peri-menopausal women) may account for this difference in reported CAM use prevalence across the two studies. Our analysis shows that only the use of self-prescribed yoga/meditation was significantly associated with menopausal status, which is not consistent with results from the Study of Women’s Health across the Nation [3]. Nevertheless, this finding is not too surprising given women with surgical menopause experience more intense and severe symptoms than natural menopausal women [4], and yoga/meditation is specifically recommended as an alternative to HRT for menopausal women with mild symptoms [2]. In the present study, the prevalence of HRT use differs by menopausal status. This could be a result of menopausal women’s perception about HRT, where the severity of symptoms and history of hysterectomy/oophorectomy play important roles in the decision-making process on HRT use [4]. Our study shows that a large number of menopausal women use self-prescribed CAM and consult GPs concurrently. An explanation for this finding could be the high level of support from
Table 1 Comparison of menopausal women against use of complementary/alternative and conventional medicine, 2010. Menopausal status (%)
CAM practitioners Massage therapists Naturopaths/herbalists Chiropractors/osteopaths Acupuncturists Any CAM practitioner CAM therapies Vitamins/minerals b,c
Yoga/meditation
Herbal medicines Aromatherapy oils Chinese medicines Any CAM therapy Conventional practitioners GPsb,c
Specialistsa,b,c
HRT a,b,c a b c
p-value
Oophorectomy, n = 1141
Hysterectomy, n = 2260
Natural menopause, n = 6610
Total, n = 10 011
No Yes No Yes No Yes No Yes No Yes
74.4 25.6 92.4 7.6 80.9 19.1 94.6 5.4 61.4 38.6
74.5 25.5 91.8 8.2 81.4 18.6 95.0 5.0 60.4 39.6
74.9 25.1 90.7 9.3 81.7 18.3 94.0 6.0 60.8 39.2
74.7 25.3 91.2 8.8 81.5 18.5 94.3 5.7 60.8 39.2
0.886
No Yes No Yes No Yes No Yes No Yes No Yes
33.0 67.0 85.0 15.0 74.6 25.4 85.5 14.5 96.5 3.5 27.2 72.8
30.9 69.1 84.7 15.3 73.0 27.0 84.7 15.3 97.0 3.0 24.8 75.2
31.0 69.0 81.3 18.7 73.0 27.0 85.2 14.8 96.0 4.0 25.0 75.0
31.2 68.8 82.5 17.5 73.2 26.8 85.1 14.9 96.3 3.7 25.2 74.8
0.365
No 1–2 times 3+ times No 1–2 times 3+ times
3.3 23.0 73.7 42.4 30.1 27.5
4.2 24.0 71.8 45.7 33.9 20.4
5.4 35.2 59.4 52.8 32.7 14.5
4.9 31.3 63.8 50.0 32.7 17.3
