Are plant-based therapies effective in managing menopausal symptoms?
Data of publication of the systematic review: June 2016
Design
Systematic review of 62 randomized controlled trials (RCTs).
Participants
A total of 6653 women (median age range: 52.0 to 53.5 years) in perimenopausal, menopausal or post-menopausal stage.
Intervention
52 studies used biologically based therapies (36 on phytoestrogens, 16 on others) and 10 studies used Chinese medicinal herbs and other herbs. Intervention duration ranged from 4 weeks to 2 years.
Comparator
Comparison: Plant-based therapies versus placebo, casein, lactose, wheat or soy drink.
Major Outcomes
Outcome 1: Number of hot flashes in 24 hours;
Outcome 2: Number of night sweats in 24 hours;
Outcome 3: Vaginal dryness score measured by a 4-point scale of severity. Higher scores indicated more severe vaginal dryness.
Settings
The reviewers did not state whether the study was conducted in in-patient or out-patient settings.
Comparison    Plant-based therapies versus placebo, casein, lactose, wheat or soy drink
Main Results
Compared to placebo, casein, lactose, wheat or soy drink, plant-based therapies significantly reduced the number of hot flashes in 24 hours (pooled mean difference (MD): -1.31, 95% CI: -2.02 to -0.61) and reduced vaginal dryness (pooled MD: -0.31, 95% CI: -0.51 to -0.10) among perimenopausal, menopausal or post-menopausal women. The effect of plant-based therapies, compared to placebo, casein, lactose, wheat or soy drink, is not significant in reducing the number of night sweats in 24 hours (pooled MD: -2.14, 95% CI: -5.57 to 1.29).
Comparison: Plant-based therapies versus placebo, casein, lactose, wheat or soy drink among perimenopausal, menopausal or post-menopausal women
Outcomes No. of studies (Total no. of participants) Mean score / No. of participants Heterogeneity test ( I2) Pooled MD (95% CI) Overall quality of evidence*
Intervention Comparator
1 18 (1990) Not reported/998 Not reported/992 94% -1.31 ( -2.02 to -0.61) Very High
2 2 (169) Not reported/80 Not reported/89 99% -2.14 (-5.57 to 1.29) High
3 3 (238) Not reported/137 Not reported/101 48% -0.31 (-0.51 to -0.10) Very High
Keys: MD: mean difference; CI: confidence interval.
Comparison    Plant-based therapies versus placebo, casein, lactose, wheat or soy drink
Main Results
Compared to placebo, casein, lactose, wheat or soy drink, plant-based therapies significantly reduced the number of hot flashes in 24 hours (pooled mean difference (MD): -1.31, 95% CI: -2.02 to -0.61) and reduced vaginal dryness (pooled MD: -0.31, 95% CI: -0.51 to -0.10) among perimenopausal, menopausal or post-menopausal women. The effect of plant-based therapies, compared to placebo, casein, lactose, wheat or soy drink, is not significant in reducing the number of night sweats in 24 hours (pooled MD: -2.14, 95% CI: -5.57 to 1.29).
Comparison: Plant-based therapies versus placebo, casein, lactose, wheat or soy drink among perimenopausal, menopausal or post-menopausal women
Outcomes 1 2 3
No. of studies (Total no. of participants) 18 (1990) 2 (169) 3 (238)
Mean score / No. of participants Intervention Not reported/998 Not reported/80 Not reported/137
Comparator Not reported/992 Not reported/89 Not reported/101
Pooled MD (95% CI) -1.31 ( -2.02 to -0.61) -2.14 (-5.57 to 1.29) -0.31 (-0.51 to -0.10)
Overall quality of evidence* Very High High Very High
Keys: MD: mean difference; CI: confidence interval.
Conclusion
Benefits
Plant-based therapies had shown significant effect in reducing the number of hot flashes in 24 hours and improving the symptom of vaginal dryness among perimenopausal, menopausal or post-menopausal women. For both Outcome 1 and 3, the overall quality of evidence is very high. Further research is most unlikely to have an important impact on our confidence in this estimate of effect. For Outcome 2, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect.
Harms
Concerns for the safety of chemicals in plants were raised without reporting specific cases in detail.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/27327802
The synopsis is based on the following article:
Franco OH, Chowdhury R, Troup J, Voortman T, Kunutsor S, Kavousi M, et al. Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 21;315(23):2554-63.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.