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HRT alternatives: examining successful products in Europe that could have a place in the U.S. market. (Eurotrends).

From time to time it is valuable to compare international markets to see which success stories have not already surfaced in the U.S. One of those success stories is black cohosh, a well researched herbal product for menopausal symptoms. A leading black cohosh product called Remifemin[R] has experienced constant growth over the last five decades in Germany, Europe and internationally. In Germany, the group of natural menopause products, predominantly black cohosh, has taken over 20% market share of all menopausal products, including HRT synthetic hormones. In Hungary a small but very active phytomedicines company, Phytotec Hungaria Bt., has already reached position two in the drug market directly behind the leading estrogen drug, only two years after introduction. These success stories go around Europe in parallel developments. The most successful marketing strategy with such a group of products is working with the physicians and the strong science of the product to convince them first that there is a real pro ven alternative to standard hormone replacement therapy, which has recently come under more pressure scientifically.

Causing deeper interest in alternative menopause products was the publication of the HERS study, which involved 2800 women studied over a period of three years. The study showed higher overall mortality, significantly higher rates of bile duct surgery and urinary incontinence in the HRT group compared to the control. Black cohosh in the U.S. was already growing at a rate of 109% per year, but the publicity of this negative trial increased growth by an additional 46% in the week immediately following the publication of the negative HRT study.

Other natural menopause remedies such as red clover and soy isoflavones are also on the rise. The whole segment may well become a leading natural products segment. The willingness of women to try a natural alternative to alleviate menopausal symptoms was recently surveyed by the U.K. Women's Nutritional Advisory Service (WNAS), who asked 500 women with an average age of 49.8 years about their views on HRT, other drugs and natural alternatives. The results were striking. The survey found that 89% of responders would try a natural alternative to alleviate menopausal symptoms, in contrast to just 32%, who would favor taking an HRT product and 50% who would take other medication from their doctor. The most common reasons for women not taking HRT was concern for potential dangers, such as increased risk of breast cancer, thrombosis and heart disease.

A major advantage of black cohosh is that it has no estrogenic effect and possible risks regarding cancer cell growth could be excluded due to another mechanism of action. The activity has been scientifically elucidated and is described as SERM = Specific Estrogen Receptor Modulator, an activity which acts via the same receptor but without the negative effects of estrogen.

What can we learn from the success of natural menopause treatments? In general, the European markets for herbal medicines are much more stable than in the U.S., and the main reason for that is they have the support, or at least acceptance, of the medical community. This support is mainly missing in the U.S. at the moment, e.g. the negative PR about St. John's Wort, which hit the U.S. market a lot harder than the leading European markets like Germany. For physicians it is normal that a product which is effective like St. John's Wort may have side effects and interactions. They also know that side effects and interactions are usually much less severe in herbal products than with synthetic drugs. However, support is missing and must become a major task for the industry's future and acceptance by the medical community in the U.S.

Joerg Gruenwald, Ph.D., is president of Phytopharm Consulting, Institute for Phytopharmaceuticals, a consulting company for herbal medicines and dietary supplements, specialized in international alliances, product and partner findings for new product development and regulatory advice worldwide. He is also the author of the PDR for Herbal Medicines. Dr. Gruenwald can be reached at Waldseeweg 6, D-13467 Berlin, Germany; 49-30 4000 8100, Fax.: 49-30-4000-8400; E-mail:; Website:
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Title Annotation:hormone replacement therapy; alternatives to treatment of menopause
Author:Gruenwald, Joerg
Publication:Nutraceuticals World
Article Type:Brief Article
Geographic Code:1USA
Date:Sep 1, 2002
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