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Use of complementary and alternative medicine during the menopause transition: longitudinal results from the Study of Women's Health Across the Nation

Bair, Yali A. PhD1; Gold, Ellen B. PhD2; Zhang, Guili PhD2; Rasor, Niki MA2; Utts, Jessica PhD3; Upchurch, Dawn M. PhD4; Chyu, Laura MA4; Greendale, Gail A. MD5; Sternfeld, Barbara PhD6; Adler, Shelley R. PhD7

doi: 10.1097/gme.0b013e31813429d6

Objective: This study examined whether use of complementary and alternative (CAM) therapies during the menopause transition varied by ethnicity.

Design: The Study of Women's Health Across the Nation is a prospective cohort study following a group of 3,302 women from five racial/ethnic groups at seven clinical sites nationwide. Using longitudinal data encompassing 6 years of follow-up, we examined trends in use of five categories of CAM (nutritional, physical, psychological, herbal, and folk) by menopause status and ethnicity. To account for potential secular trends in CAM use or availability, we also evaluated the trends in CAM use over calendar time.

Results: Approximately 80% of all participants had used some form of CAM at some time during the 6-year study period. White and Japanese women had the highest rates of use (60%), followed by Chinese (46%), African American (40%), and Hispanic (20%) women. Overall use of CAM therapy remained relatively stable over the study period. In general, CAM use did not seem to be strongly associated with change in menopause transition status. Use of CAM among white women did not change with transition status. Among Chinese and African American participants, we observed an increase in CAM use as women transitioned to perimenopause and a decrease in use of CAM with transition to postmenopause. Among Hispanic and Japanese women, we observed a decrease in use of CAM in early perimenopause, followed by an increase as women entered late perimenopause and a decrease as they progressed to postmenopause. Patterns of use for the five individual types of CAM varied. White women had relatively stable use of all CAM therapies through the transition. Japanese women decreased use of nutritional and psychological remedies and increased use of physical remedies as they transitioned into late perimenopause. Among African American women, use of psychological remedies increased as they progressed through menopause.

Conclusions: Although CAM use did vary in some ethnic groups in relation to advancing menopause status, there was no evidence of influence of calendar time on CAM use. Patterns of CAM use during menopause are likely to be driven by personal experience, menopausal health, and access to therapies. Women's personal preferences should be taken into consideration by healthcare providers for medical decision making during menopause and throughout the aging process.

Six years of longitudinal follow-up data from the Study of Women's Health Across the Nation (SWAN) were used to assess the relationship of race/ethnicity, menopausal status, and calendar time to use of five types of complementary and alternative medicine. Although use was stable over time, significantly more white and Japanese women than other ethnic groups reported use, and use was not strongly associated with change in menopausal status, although the latter differed by race/ethnicity and by type of complementary and alternative medicine.

From the 1Planned Parenthood Affiliates of California, Sacramento, CA; 2Division of Epidemiology, Department of Public Health Sciences, and 3Department of Statistics, University of California, Davis; 4School of Public Health, 5Division of Geriatrics, University of California, Los Angeles; 6Division of Research, Kaiser Permanente Oakland, CA; and 7Osher Center for Integrative Medicine, University of California, San Francisco, CA.

Received January 27, 2006; revised and accepted June 4, 2007.

Funding/support: The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health, Department of Health and Human Services, through the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Women's Health (grants NR004061; AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, AG012495). Supplemental funding from The National Center on Complementary and Alternative Medicine is also gratefully acknowledged.

Financial disclosure: None reported.

Address correspondence to: Ellen B. Gold, PhD, Department of Public Health Sciences, One Shields Avenue, TB-168, University of California, Davis, Davis, CA 95616-8638.

©2008The North American Menopause Society