To link to full-text access for this article, visit this link: http://dx.doi.org/10.1067/mob.2001.116524 Byline: Margery L.S. Gass, Maida B. Taylor Keywords: Hormone replacement therapy; menopause; raloxifene; black cohosh; St John's wort; alternative therapy; botanicals; soy protein; isoflavones Abstract: Today, 42% of Americans use alternative nonprescription therapies to treat medical conditions; 46% of nonprescription alternative use for principal medical conditions is done without consulting either a medical doctor or a nonphysician practitioner of alternative therapy. Many nontraditional alternatives are used to treat the hot flashes and somatic complaints of menopause, for which options such as hormone replacement therapy and other prescription and over-the-counter drugs are also available. To date, no one agent treats all menopausal symptoms as effectively as estrogen. Selective estrogen-receptor modulators can help prevent osteoporosis but do not relieve menopausal symptoms. However, some women are unwilling or unable to take hormone replacement therapy, and some decide to discontinue therapy. Evidence supporting the use of some nonprescription alternatives for conditions related to menopause is limited. Patients need to be aware of the potential for drug interactions when these alternative therapies are used concomitantly with prescription drugs. The current evidence to support use of hormone replacement therapy, selective estrogen-receptor modulators, and nontraditional alternatives is reviewed here. (Am J Obstet Gynecol 2001;185:S47-56.) Author Affiliation: Cincinnati, Ohio, and San Francisco, California From the Department of Obstetrics and Gynecology, University Menopause and Osteoporosis Center, University of Cincinnati College of Medicine,.sup.a and the Department of Reproductive Sciences, Obstetrics and Gynecology, University of California at San Francisco..sup.b Article Note: (footnote) [star] Reprint requests: Margery Gass, MD, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH 45267.