Many women are looking for alternative ways to manage hot flashes, sleep problems and other symptoms of menopause.

The most effective treatment is hormone replacement therapy, but that carries possible health risks that many women are not willing to take. Hormones have been tied to increased risks of blood clots, heart attack, stroke and breast cancer.

So researchers are studying alternatives -- generally with mixed results.

In the new study, Iranian researchers found that massage -- either with aromatherapy oils or without -- was better than doing nothing for 90 women with menopause symptoms.

"I don't think that's surprising," said Dr. Hilda Y. Hutcherson, a clinical professor of obstetrics and gynecology at Columbia University Medical Center in New York.

Considering some of the symptoms the study measured -- like irritability, depressed mood and sleep problems -- it makes sense that a couple of massages per week could make some women feel better, said Hutcherson, who was not involved in the study.

And the added aromatherapy, she said, might work better based on what research suggests about certain scents.

One of the oils used in this study, for example, was lavender.

"Lavender has been shown in studies to help people feel more relaxed," Hutcherson said.

Still, the study had a number of limitations.

"I think the biggest limitation is the small number of people involved," Hutcherson said.

Another is the fact that the researchers measured all menopause symptoms as a group, giving each woman an overall score.

That means it's not clear whether massage, with or without aromatherapy, helps with only certain symptoms. Would it be useful to women whose primary complaint is hot flashes, or vaginal dryness, or insomnia?

"This study doesn't tell us," Hutcherson said.

The findings, reported in the journal Menopause, are based on 90 women who came to a "menopausal clinic" in a Tehran women's hospital.

Fatemeh Darsareh and colleagues at Tehran University of Medical Sciences randomly assigned the women to one of three groups: one that received aromatherapy massage twice a week for four weeks; one that received massage sessions with unscented oils; and a "control" group given no immediate treatment.

The aromatherapy oils included lavender, rose, rosemary, almond and evening primrose.

The women completed a standard menopause symptom-rating scale before and after the four-week treatment period.

In the end, women in the aromatherapy group reported the biggest decline in symptoms. They fell from an average score of about 22 (on a scale of 0 to 44), to a 13 after treatment.

Women who got massage with plain oil dipped from an average score of 22 to 19, and those in the control group held steady at 22.

Another issue with the study, though, is that no one -- the women or the researchers -- was "blinded" as to which treatment each woman was receiving.

Blinding means that no one involved in the study knows who is receiving the "real" treatment -- and it's considered important in maintaining a study's objectivity.

But in this case, it's not possible to keep a woman from knowing if she's getting a regular massage or one with aromatherapy.

"There are a lot of limitations to the study," Hutcherson said. "However, I think it contains information that may be interesting to women" looking for non-hormonal options.

Some other treatments under study for relief of menopause symptoms include antidepressants like paroxetine (Paxil), fluoxetine (Prozac), venlafaxine (Effexor) and escitalopram (Lexapro) -- and the evidence is mixed so far.

As for non-drug treatments, there are several herbs or other "natural" products marketed for easing menopause symptoms -- like black cohosh, soy, red clover and dong quai. But there is little evidence that they work, according to the North American Menopause Society.

Hutcherson said some research supports exercise or acupuncture, and those are the two main alternative options she discusses with her patients.

If women are interested in aromatherapy massage, they could give it a try, according to Hutcherson.

But there are still plenty of questions -- including how many sessions an individual might need to get lasting relief. And of course, there's the cost, which may not be covered by insurance.

The cost of massage therapy varies widely based on where a woman lives, the length of each session (in this study, they were 30 minutes) and who is performing the massage. But a typical range would be $60 to $75 for an hour.

Many women, though, need no pricey treatment for menopause symptoms.

Besides exercise, other simple steps that may help and are unlikely to hurt include avoiding hot and spicy foods, turning down the thermostat (for women with moderate hot flashes) and learning relaxation techniques such as gentle yoga or meditation.

SOURCE: bit.ly/JXRmbT Menopause, online April 30, 2012.

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