Menopause Remedy Makers Get Tough

On television, in magazines, even in doctors' mailboxes, bold promotions for "natural" remedies for menopause symptoms are showing up in the wake of bad news about hormone pills.

While scientists research whether products like black cohosh, soy and red clover can live up to the claims, some herbal manufacturers are boosting advertising, sending samples to doctors and setting up exhibits at medical meetings.

The makers of Promensil - a red clover supplement that promoters say can "take the edge off" symptoms like hot flashes - even offered doctors $1,000 to attend an informational session following last month's North American Menopause Society meeting here.

"That was the first time that I've ever seen an herb company try the same tactics that are very common among drug companies - bribing doctors to attend a promotion," said Dr. Adriane Fugh-Berman of George Washington University. She declined the invitation.

The herbal companies "see a golden opportunity in the exodus from estrogen," Fugh-Berman said, after a Women's Health Initiative study showed over the summer that the estrogen-progestin pill many women take could actually be harmful.

Australia-based Novogen, the maker of Promensil, contends that its informational session was not prompted by the study and that the money was just to cover the cost of staying an extra day after the menopause society meeting - not to influence those attending.

Warren Lancaster, Novogen's vice president for North America, said the company has made offers like that before. But now, he said, doctors are "more open to hear that (informational) message now that they're being bombarded with women coming in and saying, `I'm not going to take hormone replacement therapy anymore."'

"That has probably increased our opportunity to talk to those doctors," he said. He said sales of Promensil are up about 15 percent since the WHI study made news in July.

The Women's Health Initiative found an increased risk of breast cancer, strokes and heart attacks among users of estrogen-progestin supplements. Millions of women have taken the pills to relieve menopausal symptoms, including hot flashes and vaginal dryness.
Many doctors say short-term hormonal use may still be warranted for some women.

A review of 29 studies on alternative remedies in last week's Annals of Internal Medicine found that only the herb black cohosh and soy appear to have some benefits. But the article noted that most of the studies were small and not definitive.

Still, producers of alternatives are working to take advantage of the hormone backlash.

"From a company perspective, we see this could potentially double our sales within the next two years," said Dr. Aaron Tabor, whose company, Physicians Laboratories, sells Revival Soy products over the Internet.

Before the WHI study raised questions about hormones, Tabor's company ran ads promoting the general health benefits of soy. Now, Tabor said, more ads "are directed at the menopause issue."

A prominently placed section on the Web site for Remifemin, GlaxoSmithKline's black cohosh supplement, reads: "Newsflash: NIH reports raise serious doubts about the safety of long-term HRT use."

While scientists at Columbia University and elsewhere are studying how black cohosh might work, an industry spokesman said many stores are having a hard time keeping it in stock.

Cartoonist Dee Adams said many readers of her humor-based Web site on menopause, www.minniepauz.com., have reported seeing more ads for herbals. But they are confused because their doctors know so little about them.

"Everybody's just in this big pinch about what to do," Adams said.

Dr. Lauren Streicher of Northwestern Memorial Hospital, who has a busy Chicago ob-gyn practice, said patients who have quit hormones come into the office saying, "I'm totally miserable. What do I do?"

"As a physician, you hate to say to them, `I don't know,"' she said.

Streicher said she is frustrated by the lack of research on hormone alternatives. "I want it to be proven to be beneficial beyond the placebo effect and proven to be safe," she said.

Fugh-Berman, a co-author of the Annals review, said doctors should be wary of the new push, and sees a parallel with the past promotion of hormone supplements. "The advertising ran way ahead of the evidence," and doctors bought into it, she said.

Many prescribed estrogen and progestin to prevent heart disease because of observational studies, but until the WHI study, there was no strong evidence from randomized studies comparing hormones to a placebo - the gold standard of research.

"The lesson that we should learn from the WHI is that we should wait for results of randomized controlled trials," Fugh-Berman said.

By Lindsey Tanner