Rita Ismail, RN, MPH, MTD (HE) (PhD Student) Nancy Fugate Woods, PhD, RN, FAAN (Professor)

1. Herbal Therapies for Symptom Clusters during the Menopausal Transition andEarly Postmenopause: A Systematic Review Rita Ismail, RN, MPH, MTD (HE) (PhD Student) Nancy Fugate Woods, PhD, RN, FAAN (Professor) Ellen Mitchell, PhD (Associate Professor Emeritus) Janet Schnall, MS, AHI (Librarian) 2012 State of the Science Congress on Nursing Science September 14th, 2012, Washington, DC

2. Background • Women in Western countries have more experience menopausal symptoms particularly than in Asia • Complementary and Alternative Medicine (CAM) is an alternative solution due to the negative effects of hormonal therapy • Numerous studies about the effects of herbal therapies on hot flashes and other symptoms have been conducted with inconsistent results • To date no published systematic reviews of effects of herbal therapies on multiple symptoms

3. Purpose To determine the effects of herbal preparations on hot flashes and at least one of other symptoms including sleep, cognitive function, mood, and pain symptoms that women experience during the menopausal transition and early postmenopause.

4. Description of the Studies • 18 studies eligible for review : - 7 black cohosh - 2 black cohosh mixed with other herbs - 9 other herbals (Puerariamirifica, Rheum rhaponticum, herbal medicine, French maritime pine bark, Diascorea alata, and femal) • Study population : Community-based and clinics • Number of participants: 34 – 309 (46.7 – 59.3 years old) • Research designs: RCT, 12 weeks – 12 months • Conducted in 13 countries

5. Measurement • Measurement of Hot Flash • The Greene Climacteric Scale • The Kupperman Menopause Index (KMI) • The Menopause Rating Scale I • Diaries • Measurement of Other Outcomes • The Menopause Rating Scale • The Women’s Health Questionnaire • The Hamilton Anxiety Rating Scale • The Women’s Health Questionnaire • The Beck Anxiety Inventory • The Symptom Rating Test

6. Results….Black Cohosh +: Significant, NS: Not Sig, NR: Not Reported, NM: Not Measured, : p-value not provided

7. Results….Black Cohosh +: Significant, NS: Not Sig, NR: Not Reported, NM: Not Measured, : p-value not provided

8. Results….Black Cohosh +: Significant, NS: Not Sig, NR: Not Reported, NM: Not Measured, : p-value not provided

9. Results…Black Cohosh Mixed with Other Herbs +: Significant, NS: Not Sig, NR: Not Reported, NM: Not Measured, : p-value not provided

10. Results…Other Herbs

11. Results…Other Herbs

12. Results…Other Herbs

13. Results…Other Herbs

14. Results…Other Herbs

15. Summary

16. Conclusion • Herbal therapies may offer promise in management of multiple symptoms, particularly black cohosh mixed with Phyto-female complex or St. John wort; Rheum rhaponticum; and French maritime pine bark • Mostly herbal therapies showed significant effects on sleep and mood symptoms, especially black cohosh, mixed black cohosh, Rheum rhaponticum, and French maritime pine bark • Black cohosh alone showed less significant results on hot flashes and other symptoms • Dose? Duration of study? Number of participants?

17. Limitation & Future Studies • Limitation • Variety of dose, duration, measurement • Small number of studies and participants • Unreported symptoms especially cognitive symptoms • Future Studies - More studies with adequate sample size and longer duration of treatment • Using standardized instruments and provide specific information for each symptom

18. Acknowledgments • Data were collected with support from grants from the National Institute for Nursing Research, NIH, NR01 04141 and NINR, NIH, P50-NR-02323, P30-NR04001 • The Nursing Scholarship Fund, School of Nursing, University of Washington • Donna M. Fraser Endowed Scholarship Fund

19. Thank You