Use of Complementary Alternative Medicine and Traditional Chinese Medicine among Women Attending a Menopausal-related Psychosomatic Clinic in Taiwan

某臺灣更年期身心門診求醫婦女使用整體與輔助療法及傳統中醫治療之探討

10.29478/TJP.200903.0006

蕭美君(Mei-Chun Hsiao)；劉嘉逸(Chia-Yih Liu)；林義雄(Yi-Hsiung Lin)；林幼儀(Yonie Lin)；黃子玶(Tzu-Ping Huang)；王素貞(Su-Chen Wang)

更年期 ； 整體與輔助療法 ； 傳統中醫治療 ； 醫院焦慮與憂鬱量表 ； menopause ； complementary alternative medicine ； traditional Chinese medicine ； hospital anxiety depression scale

台灣精神醫學

23卷1期（2009 / 03 / 01）

53 - 61

英文

目的：更年期婦女主因為雌激素濃度的減少及波動，容易出現身心症狀。荷爾蒙治療為主要處理方式，但在東亞接受度較低，且近來對荷爾蒙的可能副作用有更多存疑，整體與輔助療法及傳統中醫治療似乎日益普遍。此研究主要在探討某東亞區之某醫學中心更年期身心門診中，使用整體與輔助療法及傳統中醫治療的比率與型態種類。方法：以橫斷面調查，在某醫學中心更年期身心門診求醫治療之女性。研究對象為Greene更年期量表中出現至少一項中重度加上另一項至少輕度以上症狀者，且其醫院焦慮與憂鬱量表分數大於8分的40-65歲女性。結果：共收案103名，95名個案同意加入研究（反應率92.2%）。其中有90.5%使用過整體與輔助療法，前三名依序為鈣片(43.2%)、大豆異黃酮(38.9%)及綜合維他命(32.6%)；有48.4%個案表示過去6個月中曾使用傳統中醫治療。教育程度較高與過去有荷爾蒙療法使用史者，有較高比例使用整體與輔助療法。結論：具中重度更年期症狀之更年期婦女，有較高比例使用整體與輔助療法。整體與輔助療法或傳統中藥治療，與精神藥物可能產生的的藥物交互作用值得注意。未來大規模研究是必須的，特別是針對一般大眾或健康的更年期婦女，以利比較其差異性。

Background: Menopausal women suffer from physical and mood symptoms mainly due to estrogen level fluctuation. Hormone therapy (HT) has been the mainstream treatment, but East Asian societies have lower acceptance of HT and the benefit of HT has been scrutinized harshly recently. Complementary and alternative therapy (CAM) and traditional Chinese medicine (TCM) are getting more popular. The aims of the study were to investigate the characteristics of CAM and TCM use in a menopause-related psychosomatic clinic in Taiwan. Method: This study was a cross-sectional survey of women who sought treatment at one menopause- related psychosomatic clinic in a large medical center. The studying subjects under study were woman between 40-65 years with at least one moderate to severe climacteric symptom and at least another mild symptom according to the Greene Climacteric Scale. The scores of Hospital Anxiety Depression Scale had to be over 8. Results: One hundred and three women met the inclusion criteria and 95 subjects agreed to join the study (response rate 92.2%). Among the study subjects, 86(90.5%) had used CAM. The three most common CAM used were calcium (43.2%), isoflavone (38.9%), and megavitamins (32.6%). Forty eight (48.4%) of them reported that they had used TCM in the past 6 months. The usage rate of CAM is related to higher years of education and previous use of HT. Conclusion: We found that CAM use among Asian menopausal women is quite common. The role of education about CAM or TCM and their interactions with current medications should be taken into serious consideration. Further larger sample studies are necessary, especially in the general population or healthy menopausal women, to compare the possible differences.

1. Archer JS(1999).NAMS/Solvay, Resident Essay Award: Relationship between estrogen, serotonin, and depression.Menopause,6,71-78.
2. Baber RJ,Templeman C,Morton T,Kelly GE,West L(1999).Randomized placebo-controlled trial of an isoflavone supplement and menopausal symptoms in women.Climacteric,2,85-92.
3. Barton DL,Loprinzi CL,Quella SK(1998).Prospective evaluation of vitamin E for hot flashes in breast cancer survivors.J Clin Oncol,16,495-500.
4. Bensoussan A,Talley NJ,Hing M,Menzies R,Guo A,Ngu M(1998).Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial.JAMA,280,1585-1589.
5. Blatt MG,Wiesbader H,Kupperman HS(1953).Vitamin E and climacteric syndrome.Arch Intern Med,91,791-796.
6. Collaborative Group on Hormonal Factors in Breast Cancer(1997).Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer.Lancet,350,1047-1059.
7. Davis SR,Briganti EM,Chen RQ,Dalais FS,Bailey M,Burger HG(2001).The effects of Chinese medicinal herbs on postmenopausal vasomotor symptoms of Australian women. Randomized controlled trial.Med J Aust,174,68-71.
8. Eisenberg DM,Davis RB,Ettner SL(1998).Trends in alternative medicine in the United States, 1990-1997: results of a follow-up national survey.JAMA,80,1569-575.
9. Eisenberg DM,Kessler RC,Foster C,Norlock FE,Calkins DR,Delbanco TL(1993).Unconventional medicine in the United States: Prevalence, costs, and patterns of use.N Engl J Med,328,246-252.
10. GollschewskI S,Anderson D,Skerman H,Lyons-Wall P(2004).The use of complementary and alternative medications by menopausal women in South East Queensland.Women's Health Issues,14,165-171.
11. Gonzalez Tones M,Domingo C(2002).Treatment of menopause with acupuncture.Rev Enferm,25,8-11.
12. Greene JC(1998).Constructing a standard climacteric scale.Maturitas,29,25-31.
13. Han KK,Soares JM,Haidar MA,de Lima GK,Baracat EC(2002).Benefits of soy isoflavone therapeutic regimen on menopausal symptoms.Obstet Gynecol,99,389-394.
14. Hirata JD,Swiersa LM,Zell B,Small R,Ettinger B(1997).Does dong quai have estrogenic effects in post- menopausal women? Double-blind, placebo-controlled trial.Fertil Steril,68,981-986.
15. Hulley S,Grady D,Bush T(1998).Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/Progestin Replacement Study (HERS) Research Group.JAMA,280,605-613.
16. Huntley AL,Ernst E(2004).Soy for the treatment of perimenopausal symptoms: a systematic review.Maturitas,47,1-9.
17. Jacobson JS,Troxel AB,Evans J(2001).Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer.J Clin Oncol,19,2739-2745.
18. Kam IW,Dennehy CE,Tsourounis C(2002).Dietary supplement use among menopausal women attending a San Francisco health conference.Menopause,9,72-78.
19. Kang HJ,Ansbacher R,Hammoud MM(2002).Use of alternative and complementary medicine in menopause.Int J Gynaecol Obstet,79,195-207.
20. Keenan NL,Mark S,Fugh-Berman A,Browne D,KaczmarczYK J,Hunter C(2003).Severity of menopausal symptoms and use of both conventional and complementary/alternative therapies.Menopause,10,507-515.
21. Knight DC,Howes JB,Eden JA(1999).The effect of Promensil, an isoflavone extract, on menopausal symptoms.Climacteric,2,79-84.
22. Kronenberg F,Fugh-Berman A(2002).Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials.Ann Intern Med,137,805-813.
23. Maclennan AH,Wilson OH,Taylor AW(1996).Prevalence and cost of alternative medicine in Australia.Lancet,347,569-573.
24. Mantyranta T,Hemminki E,Kangas I,Topo P,Uutela A(1997).Alternative drug use for the climacteric in Finland.Maturitas,27,5-11.
25. Mckenna DJ,Jones K,Hughes K(2001).Efficacy, safety, and use of ginkgo biloba in clinical and preclinical applications.Altern Ther Health Med,7,70-86.
26. Porzio G,Trapasso T,Martelli S(2002).Acupuncture in the treatment of menopause-related symptoms in women taking tamoxifen.Tumori,88,128-130.
27. Rossouw JE,Anderson GL,Prentice RL(2002).Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Writing Group for the Women's Health Initiative Investigators.JAMA,288,321-333.
28. Scambia G,Mango D,Signorile PG(2000).Clinical effects of a standardized soy extract in postmenopausal women: a pilot study.Menopause,7,105-111.
29. Tice JA,Ettinger B,Ensrud K,Wallace R,Blackwell T,Cummings SR(2003).Phytoestrogen supplements for the treatment of hot flashes: the Isoflavone Clover Extract (ICE) Study: a randomized controlled trial.JAMA,290,207-214.
30. van de Weijer PH,Barentsen R(2002).Isoflavones from red clover (Promensil) significantly reduce menopausal hot flush symptoms compared with placebo.Maturitas,42,187-193.
31. Wiklund IK,Mattsson LA,Lindgren R,Limoni C,Swedish Alternative Medicine Group(1999).Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial.Int J Clin Pharmacol Res,19,89-99.
32. Wuttke W,Seidlova-Wuttke D,Gorkow C(2003).The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers.Maturitas,44,67-77.
33. Xu H,Lawson D,Kras A,Ryan D(2005).The use of preventive strategies for bone loss.Am J Chin Med,33,299-306.
34. Zhang CZ,Wang SX,Zhang Y,Chen JP,Liang XM(2005).In vitro estrogenic activities of Chinese medicinal plants traditionally used for the management of menopausal symptoms.J Ethnopharmacol,98,295-300.
35. Zigmond AS,Snaith RP(1983).The hospital anxiety and depression scale.Acta Psychiatr Scand,67,361-370.