Women's use of complementary and alternative medicine for the treatment of menopause-related symptoms : a health services research study

University of Technology Sydney. Faculty of Health.Background: The use of complementary and alternative medicine (CAM) is increasingly popular and women are key drivers of this trend. To date, there has not been a nationally-representative study that has examined consultations with individual CAM practitioners as well as the self-prescription of CAM products, for a wide range of menopause-related symptoms, amongst women with different menopause status (surgical and natural menopause). Methods: This study utilised two distinct methodologies: a critical review focusing on CAM use and menopause symptoms via a search of the key medicine and health science databases for peer-reviewed articles published in the previous 10 years; and secondary data analysis from the Australian Longitudinal Study on Women’s Health – a cohort study designed to investigate multiple factors affecting women’s health over a 20-year period. Data from two recent surveys from the ‘mid-age’ cohort women were analysed: women aged 56-61 in Survey 5 conducted in 2007 (n=10,638) and women aged 59-64 in Survey 6 carried out in 2010 (n=10,011). A combination of cross-sectional and longitudinal data analyses was employed, involving chi-square tests, multiple logistic regression and Generalised Estimating Equations, to examine associations between the use of various CAM modalities and products and menopause-related symptoms. Results: The two critical reviews found that a considerable level of CAM use was observed among women in menopause and that many menopausal women use CAM concurrently with their conventional medicine. However, communication regarding CAM between menopausal women and healthcare providers seems less than optimal. Additionally, the varied methodological rigor of the existing literature on CAM use in menopause was evident. In the cross-sectional analyses, 39% (n=3,904) of menopausal women consulted a CAM practitioner, 75% (n=7,508) self-prescribed a CAM product, and 95% (n=9,510) consulted a general practitioner. Differences in consultations with CAM practitioners and the use of self-prescribed CAM were observed amongst women with hysterectomy, oophorectomy and natural menopause. Longitudinal analyses suggested the overall CAM use amongst menopausal women declined with time and was lower amongst women with hysterectomy or oophorectomy compared to natural menopausal women. Cross-sectional and longitudinal analyses found that associations between CAM consultations/self-prescription and menopause-related symptoms were inconsistent across women with different menopause status. Conclusions: This thesis presents empirical findings, in menopause care, regarding the use of CAM for menopause-related symptom management. This thesis highlights a need for future research to examine how menopausal women evaluate and make decisions related to the use of specific CAM