What is women's health?

Overview

Although men and women share a majority of health issues, there are many
conditions that are specific to women. Women’s health issues are those that are
unique to the female anatomy and those that are found primarily in women. Men and
women may share similar health issues, but these issues can affect women and men
in different ways. Although pain relief is the most common reason for its use,
complementary and alternative medicine (CAM) is used throughout the spectrum of
women’s health.

Many women use CAM as a form of medical treatment. According to a 2008
Centers for
Disease Control and Prevention (CDC) health study, 42 percent
of women surveyed had used some form of CAM. (Men were more likely to adhere to
conventional medical practices.) This figure represents an increase in women’s CAM
use, compared with a similar survey in 2002, which showed that more women were
beginning to use CAM. Financial concerns, mistrust of the health care system,
toxicity of conventional medicines, and limited access to health care are some of
the reasons why women turn to CAM. Women who are thirty to sixty-nine years of age
and those with a higher level of education are more likely to use CAM.

An increasing number of studies have examined the efficacy of CAM in women’s
health. Rigorous scientific-based studies began in earnest in the early 1990s,
coinciding with the establishment of the U.S. government’s Office of Alternative
Medicine, now called the National Center for Complementary and Alternative
Medicine (NCCAM). This center serves as the principal
government agency for analyzing medical practices that are outside the scope of
conventional medicine. NCCAM also scrutinizes and funds evidence-based research on
CAM.

Just as NCCAM examines the efficacy of CAM treatments, it also reviews their
safety. Many herbal medicines used in combination or used with conventional
medications may have adverse side effects. Women who participate in exercise-based
treatments may sustain injuries if they are not physically healthy enough or if
supervision is improper.

Genitourinary Infections

Genitourinary infections involve the bladder, kidneys, vagina, cervix, and,
rarely, uterus. Women experience infections of the bladder and kidneys far more
often than do men. The close proximity, in females, of the entrance to the urinary
tract (urethra) to the anus makes the risk of urinary infections higher for women
than for men. Because urinary tract infections are so common,
many women look for inexpensive and convenient treatment options.

Cranberry juice and cranberry-based products have been used
by women for decades to treat urinary tract infections (UTIs). There have been no
comprehensive, randomized-controlled trials on the use of cranberry juice for
UTIs, so there is no scientific evidence to suggest that it is effective. Clinical
trials do suggest, however, that cranberry juice may prevent infection in women
with recurrent UTIs. A large study sponsored by NCCAM examining the use of
cranberry juice for the treatment and prevention of UTIs is currently
underway.

Lactobacillus is a probiotic
used in the treatment of UTIs, vulvovaginal candidiasis (vaginal yeast infection),
and bacterial
vaginosis. Probiotics are live microorganisms that are
thought to inhibit the growth of unwanted infectious microorganisms. Available
clinical data demonstrate that orally and intravaginally administered
lactobacillus appears to be effective in treating bacterial vaginosis. The data
were inconclusive, however, regarding the effectiveness of lactobacillus
probiotics for UTIs and vulvovaginal candidiasis.

Menopause and Osteoporosis

The cessation of ovarian function and, thus, of regular menses is referred to as
menopause. Hormonal changes that occur during menopause can
cause bothersome effects. Many women experience hot flashes, vaginal dryness,
insomnia, and mood disturbances. Because bone density relies in part on
estrogen secreted by the ovaries, there is a risk of bone
thinning or osteoporosis after menopause. In 2002, the use of
hormone
replacement therapy drugs containing estrogen dramatically
decreased following the announcement of possible health risks. Because of this,
many women have turned to alternative medicine to relieve the effects of
menopause.

Herbal medicines and nutritional supplements. Black cohosh,
evening primrose, soy, gong guai root, ginsing, kava, and DHEA
(dehydroepiandrosterone) are products used to treat hot flashes, vaginal dryness,
and other symptoms of menopause. The most widely studied and used product is
black
cohosh. Lacking, however, is scientific evidence supporting
the effectiveness of these products in treating menopause.

Soy isoflavones and green tea are widely used in the
treatment and prevention of osteoporosis. Soy isoflavones are derived from
plant-based soy products and possess estrogen-like activities. Also called
phytoestrogens, soy isoflavones are in wide use in many
over-the-counter preparations that promote bone health. The American
Journal of Clinical Nutrition published a large study of isoflavones
in March, 2010, and concluded that soy isoflavones did not prevent osteoporosis.
Conversely, a large amount of scientific evidence suggests that green tea provides
some protection against osteoporosis. Although the antioxidant properties of green
tea may be at work, the exact mechanism of action is not known.

Exercise-based therapies.
Tai
Chi and qigong are traditional Chinese forms of
exercise incorporating discrete low-impact movements, breathing, and meditation.
In 2010, several large, well-designed studies showed that Tai Chi and presumably
qigong were beneficial in preserving bone density in postmenopausal women. In a
2008 randomized clinical trial published in the journal
Menopause, yoga reduced hot flashes by 30 percent. There have
been, however, no double-blind studies. The more aggressive forms of yoga, such as
ashtanga, vinyasa, and Iyenger, which incorporate weight-bearing activities, can
be effective in preventing bone loss.

Pregnancy and Infertility

Many women seek to relieve discomfort during pregnancy and labor without conventional medications and invasive procedures. The prohibitive cost of conventional infertility treatment makes CAM an attractive option.

A Cochrane review of clinical studies using CAM in labor demonstrated that
acupuncture and hypnosis were effective methods of pain
relief. There was no evidence that massage, acupressure, or aromatherapy used to
relieve pain during labor had any benefit. Vitamin C and E supplements have been
touted to reduce the risk of high blood pressure during pregnancy. A large study
sponsored by the National Institutes of Health, however, did not support this
claim.

Yoga and acupuncture practitioners and advocates assert that
these two CAM methods can enhance fertility. Promising scientific evidence exists
that acupuncture in conjunction with in vitro fertilization can increase rates of
pregnancy. Furthermore, numerous studies have demonstrated that yoga improves sex
performance anxiety and female sexual desire, which can indirectly enhance
fertility. Chasteberry has been used for more than two thousand years
by women to treat various gynecological disorders, such as infertility; clinical
evidence supporting this claim is lacking, however.

Hyperemesis gravidarum is severe, persistent nausea and vomiting that occurs in
early and mid-pregnancy. There are alternative treatments that are used to treat
this condition. The most commonly used treatments are acupuncture,
acupressure, ginger products, and vitamin B6. A
Cochrane review of twenty-seven randomized controlled trials examined these
treatments, but the effectiveness of these modalities could not be determined
because the studies were conducted in a way that introduced bias. More
well-designed studies are needed.

Cancers of the Female Reproductive System

The diagnosis of cancer may bring emotional and physical disruptions to a woman’s daily life. Many women also have doubts about conventional treatment decisions. It is not uncommon for women to turn to CAM to meet their emotional and physical needs. The use of CAM in women with breast, ovarian, and uterine cancer encompasses prevention, cure, and treatments to minimize the side effects of conventional therapies.

Herbal medicines and nutritional supplements.
Antioxidants such as vitamin C, vitamin E,
coenzyme Q10, and green tea are thought to prevent cancers of the
breast, ovaries, and uterus. Also, soy isoflavones and garlic are
thought to prevent these types of cancers. Between the years 2002 and 2009,
numerous large clinical trials examined the use of antioxidants, soy products, and
garlic in the prevention of cancers in women. These studies provided no sufficient
evidence to support the claim that most of these products are protective against
cancers.

Studies examining garlic use for ovarian cancer prevention, however, are more
promising. Although the National Cancer Institute does not
recommend using garlic for cancer prevention, it does recognize that garlic may
contain anticancer properties and that more studies are needed to determine this.
There are no high-quality studies available that support the use of herbal
medicines or nutritional products as a cancer cure.

Physical and mind/body interventions. Meditation, yoga, and
hypnosis are often used in conjunction with conventional medicine in the treatment
of breast, ovarian, and uterine cancer. Clinical trials have demonstrated that all
three modalities are effective in reducing anxiety, pain, and insomnia during
cancer treatment, although scientists continue to debate the exact mechanisms of
action. Acupuncture may help with nausea during chemotherapy, but more
high-quality studies are needed to confirm its efficacy. Art therapy
combines the creative process with traditional therapy to allow for the expression
of thoughts and feelings. A study of women who had breast cancer showed an
improvement of mood disorders when art therapy was applied.

Menstrual Disorders

Menstrual cramps and premenstrual syndrome (PMS) may be a
monthly source of physical and emotional distress to premenopausal women. About 35
percent of women experience painful menses on a regular basis. Although a majority
of women experience some degree of abdominal bloating, anxiety, irritability, and
breast tenderness during the premenstrual period, about 2 percent of women have
severe disrupting symptoms. Although these symptoms are typically treated with
medications and dietary and lifestyle changes, many women find these modalities
intolerable or ineffective and so turn to CAM.

Omega-3, rose hip tea, vitamin B1 (thiamine), magnesium, vitamin
B6, vitamin E, chasteberry, evening primrose, and calcium are used
in the treatment of menstrual cramps and PMS. No clinical trials have provided
strong evidence supporting the efficacy of most of these products.
Calcium supplementation, however, showed promising evidence
as a treatment for PMS. A Cochrane database review found promising evidence
supporting the use of a Chinese herbal medicine called jingqianping granules for
menstrual cramps and PMS; however, more well-designed clinical trials are needed
to confirm this. There is clinical evidence as well that chasteberry is effective
in treating the symptoms of PMS and breast pain associated with menses; however,
more studies are needed. In a 2009 review, acupuncture appeared to be a promising
treatment for PMS. In another, similar review study, transcutaneous electrical
nerve stimulation and massage therapy were found to be ineffective in treating
menstrual cramps.

Endometriosis, a condition in which cells of the uterus grow
in other parts of the body, can cause pelvic pain and severe menstrual cramps.
Traditional Chinese herbs are used in the treatment of this disorder. The limited
reviews that found traditional Chinese herbs helpful were not high-quality
randomized-control trials. Therefore, more study is needed to confirm the efficacy
of this treatment.

Conclusions

Despite extensive use of CAM by women, there remains a lack of high-quality scientific evidence to support the effectiveness of most CAM modalities. Rigorous, well-designed clinical trials to determine the effectiveness of CAM therapies for women have become popular only in the twenty-first century. Major studies sponsored by NCCAM are being conducted for a variety of treatment modalities.

Women should not replace traditional medicine for serious medical disorders, such as cancer, with CAM. Women using CAM as a complementary therapy should be aware of the efficacy and safety profile of the treatment before use.

Bibliography

Barnes, P. M., B. Bloom, and R. L. Nahin. “Complementary and Alternative Medicine Use Among Adults and Children: 2007 United States.” National Health Statistics Reports 12 (December 10, 2008): 1-23. Gives results of the second nationwide health survey in the United States and explains why prayer was excluded from the survey’s definitions of CAM modalities.

Carlson, L. E. “Mind-Body Interventions in Oncology.” Current Treatment Options in Oncology 9, nos. 2/3 (2008): 127-134. Looks at the use of mind/body therapies in the treatment of cancer.

National Center for Complementary and Alternative Medicine. http://www.nccam.nih.gov. The lead U.S.-government agency on CAM. An invaluable resource.

Zoorob, J. R. “CAM and Women’s Health: Selected Topics.” Primary Care 37, no. 2 (2010): 367-387. Looks at CAM use in women from the perspective of primary care medicine.