Complementary medicine and therapies are thriving in Australia thanks to their appeal in supplementing conventional care and addressing a wider scope of healthcare needs. But in an industry that is largely self-regulated, how do you navigate their use when it comes to the health of your women patients? What are the important considerations to keep in mind? We speak to two experts to find out.
According to a 2020 report by IbisWorld, the largest industry information publisher in the world, the alternative health industry in Australia, which includes complementary medicine and therapies, is expected to grow to $3.8 billion over the next five years.
The driver, according to the report, will be consumers who are becoming more proactive about their health and wellbeing, and who are more likely to purchase additional treatments outside conventional medicine.
The report observes that complementary medicine and therapies (CM&T) are often used to improve the consumer’s holistic wellbeing and quality of life, rather than treat or cure a particular condition.
These developments carry implications for health professionals, many of whom are already incorporating aspects of integrative medicine, including prescribing or recommending complementary medicines, into their practice.
Previous surveys of GPs in Australia found that many had identified an urgent need for high-quality complementary medicine information resources to be provided to assist their knowledge, and to support their consultations with patients.
Indeed, natural therapies was identified in the ‘top 5’ of topics for health professional skills development in a recent survey by Jean Hailes on health professionals’ learning needs.
The terms ‘natural therapy’, ‘complementary therapy’, ‘complementary medicine’, ‘alternative medicine’ and ‘complementary and alternative medicine’ (CAM) are often used interchangeably.
However, the preferred term in Australia is complementary medicine and therapies. The National Health and Medical Research Council defines complementary medicine as “a wide range of healthcare medicines, therapies...and other products that are not generally considered within the domain of conventional medicine.”
Types of complementary medicine include naturopathy, traditional Chinese medicine and acupuncture, herbal medicine, homeopathy, nutrition and remedial massage.
The first comprehensive examination of complementary medicine use by people in Australia suggested that two thirds of the population use some form of complementary medicine and therapies. Users were more likely to be women, have a chronic disease diagnosis, no private health insurance, and a higher education level.
What was compelling about this cross-sectional survey was the suggestion that people with chronic conditions might not be having their healthcare needs met by conventional services and treatment and were looking to complementary medicine to supplement conventional care and address their unmet needs. Given their likelihood to use a variety of healthcare approaches, this could be risky for them.
The survey’s authors said this underlined the need for medical providers to actively inquire about their patients’ CM use, and to provide a meaningful response to them regarding safety and comparative efficacy.
Dr Susan Arentz, Adjunct Research Fellow at NICM Health Research Institute, the country’s leader in integrative and complementary medicine research and policy, believes that people now want to be more involved in their healthcare. “They are looking for more than just a mechanistic approach to treating disease,” she explains.
They want to be optimally well, to have high levels of wellbeing, to have personal agency, and they want to be empowered. And definitely women have those desires."Dr Susan Arentz, Adjunct Research Fellow, NICM Health Research Institute
“They want to be engaged in decision-making around their own health and that sits well within an evidence-based practice model of healthcare, which not only emphasises being informed by the best available evidence but takes into account people’s preferences and values and practitioner’s expertise and experience.
“It’s accessible, it gives them an opportunity to take control and to exercise their own choices.”
Dr Arentz says that women prefer to use a ‘natural’ medicine compared to a pharmaceutical option with side effects, and that has been well-established in the literature. The herb St John’s wort (Hypericum perforatum), for example, can be used for mild depression. Systemic reviews, she says, speak to its efficacy and lack of side effects.
There are also some women’s health conditions that are associated with high uptake of CM&T.
More than 70% of women with polycystic ovary syndrome (PCOS) in Australia use natural and complementary therapies to improve one or more aspect of their health. The natural remedies most often used include supplements, such as vitamins, minerals and fish oil, and herbal medicine in the forms of teas, tablets or liquid.
Data from the 2012 Australian Longitudinal Study of Women’s Health (ALSWH) cross-sectional survey of 7427 women aged 34-39 years revealed that women with endometriosis were more likely to consult with a massage therapist, acupuncturist and/or naturopath/herbalist compared to women without the disease.
Consultations with a naturopath/herbalist were also significantly higher for women with irregular or heavy periods. Women who had severe period pain were also more likely to consult with an acupuncturist and/or naturopath/herbalist. Similarly, women with premenstrual syndrome (PMS) were more likely to consult with a massage therapist, acupuncturist, naturopath/herbalist and ‘other alternative health practitioner’.
In a 2017 research paper, women who identified as attempting to conceive were more likely to consult with an acupuncturist or a naturopath/herbalist.
Given that some complementary medicines are widely available in pharmacies, supermarkets and online stores, and carry a perception that they are ‘safe’ because they are ‘natural’, many people tend to self-prescribe. But this can be fraught.
Jean Hailes naturopath Sandra Villella points to Australian research that shows that phytoestrogens, Evening Primrose Oil, and ginseng as three of the most common self-prescribed compounds for treating menopausal hot flushes.
“I wouldn’t prescribe any of those as first-line treatments,” she says. “We know that phytoestrogens, commonly found in soy and also in linseeds, legumes and grains, are safe in a diet. But highly-processed soy foods or soy supplements may not behave in the same way.
“Furthermore, only a third of the population has the specific bacteria in the gut that converts the phytoestrogen in soy to a more potent form, and therefore [only this section of the population is] likely to see benefit.
In the ‘80s, people self-prescribed and health practitioners prescribed Evening Primrose Oil for everything, but research now suggests it’s no better than a placebo for hot flushes."Sandra Villella, Jean Hailes naturopath
Ms Villella says there is evidence that Korean ginseng may improve sexual function and arousal in menopausal women. “But there have been reports of vaginal bleeding in postmenopausal women who took Panax ginseng.”
Vitex or Chaste tree (Vitex agnus-castus) a herb native to the Mediterranean region, is often used by women for the treatment of PMS. Ms Villella warns that it should not be self-prescribed as it is herb with very “real” actions, and it needs to be prescribed with both an understanding of the specific targeted actions and the condition the woman is presenting with.
“There are some interesting [examples] – and I mean interesting in not a good way – in how some women inappropriately self-prescribe this herb,” she says.
Ms Villella says that while PMS is its primary indication, naturopaths may prescribe it in collaboration with a medical specialist for women with diminished ovarian activity. A collaborative approach is essential as there have been cases of ovarian hyperstimulation when taken inappropriately.
Like many professionals in her field, Ms Villella says she always takes a thorough medical history from her patients and the medications they might be taking before prescribing anything new. This reduces the possibility of adverse interactions.
Dr Arentz believes that health professionals must respect their patients’ desire to be involved in their own health choices.
“It would help if they developed an understanding of why people are using them and if they stayed open-minded about their risks and benefits... MIMS provides information about complementary medicines.”
She believes it is also helpful for health professionals to remember that 30% of pharmaceuticals have been developed from herbal medicines.
It is worth noting that many CM, especially herbal medicines, are prescribed based on hundreds of years of traditional use. The World Health Organization (WHO) states that this long-term traditional use should not be ignored. WHO supports the appropriate use of herbal medicines and encourages the use of remedies that are proven to be safe and effective. They promote further appropriate scientific studies into herbal medicines and other CM&T.
Jean Hailes recently presented a health professional webinar on the use of complementary medicine and therapies in women’s health, featuring Ms Villella and Dr Arentz.