Over-the-counter drugs and health functional foods to alleviate symptoms of menopause have rapidly grown to reach 300 billion won ($276 million) in the local market.

However, taking such drugs is not helpful for postmenopausal women in their 50s, an expert said Thursday. OTC drugs and health functional foods containing phytoestrogen interfere with the efficacy of a menopausal hormone therapy (MHT), he said.

Currently, OTC treatments for menopause include Dongkook Pharmaceutical’s Feramine-Q, Chong Kun Dang’s Cimidona, Green Cross’ Femigreen, Jinyang Pharm’s Gyno-Plus and Gyno-QS, Nelson Korea’s Jinplus, Aju Pharm’s Remifemin, and Cho-A Pharm’s Erost. These treatments are non-hormone therapies, mainly using phytoestrogens such as cimicifuga, isoflavone, and red clover. Among them, Feramine-Q’s annual sales exceed 5 billion won.

Among the health products, more than 80 drugs use Cynanchum wilfordii, which was at the center of the controversy in 2015 over a Korean biotech firm’s use of a fake substance in making health products.

Before the incident, Cynanchum wilfordii-related products sold 100 billion won in 2014.

Cynanchum wilfordii is still popular, however. Targeting postmenopausal women, health products using Cynanchum wilfordii extracts, mixed extracts, pomegranate concentrates, pomegranate extracts, and pagoda tree fruit extracts sold 17.51 billion won last year.

However, academic circles point out that the effectiveness of such health products has not been sufficiently proven. Some of the studies showed a certain level of alleviation in symptoms of menopause, but they lacked consistency, compared to MHT.

Shin Jung-ho, a professor at Korea University Guro Hospital’s obstetrics/gynecology division, says in an interview with Korea Biomedical Review that phytoestrogen lowers the efficacy of menopausal hormone therapy (MHT).

Shin Jung-ho, a professor at Korea University Guro Hospital’s obstetrics/gynecology department, said phytoestrogen erodes the effectiveness of MHT for women who have a menopause before they turn 60. Shin also serves as public relations chief of the Korean Society of Menopause.

In September, the Journal of American Medical Association (JAMA) reported results of the Women’s Health Initiative (WHI), concluding that MHT reduces the mortality rate of women who experience menopause before the age of 60 by 31 percent. The WHI had a 13-year follow-up on a 2002 study, which said that MHT raises the risk of breast cancer. The initiative, supported by the National Institutes of Health, was carried out on 27,347 women aged 50 to 79.

The WHI study concluded that the mortality rate of menopausal women aged 50-59 went down by 31 percent while they had MHT (estrogen and MPA mixed group’s mortality rate down by 33 percent, estrogen single group, down by 29 percent). The women who took estrogen only had their breast cancer risk reduced and their mortality rate from Alzheimer's disease and dementia by 26 percent.

Shin said the latest study proved again women who experience menopause before turning 60 need MHT. Postmenopausal women before the age of 60, who are managing the symptoms with phytoestrogen, should stop the medication and use MHT instead, he said.

“Phytoestrogen has almost no effect on heart, bones, or blood vessels. It only reduces redness on the face a little,” Shin said. “Estrogen is helpful to fight osteoporosis and maintains blood vessels healthy. But taking phytoestrogen does not make bones stronger or blood vessels healthier.”

He went on to say that if MTH and phytoestrogen are taken together, it will reduce MHT’s efficacy. “Because the two compete against each other over estrogen receptor, the efficacies of both treatments fall. It is where a supplementary drug interferes with a main drug’s efficacy,” Shin said.

He said it was regrettable that many people are suffering menopausal symptoms, shown by such large size of the market, but they choose less effective drugs because of inaccurate information.

As for the 2002 study that said MHT raises breast cancer incidence rate, he said, “In 2002, the study contained the content that MHT was helpful for reducing the mortality rate of those aged between 50 and 60. After an 18-year follow-up observation, this was confirmed again. It is an amazing result that the effectiveness in reducing breast cancer incidence is maintained after 10 years of ceasing the estrogen only therapy.”

Shin emphasized that the key message of the study is that women who have a menopause before 60 should not worry about breast cancer and that they should actively get MHT.

“They don’t have to endure symptoms of menopause anymore. If symptoms such as redness in the face and hot flashes are severe, they will get more benefit from MHT,” Shin said.

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