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Tracy W. Gaudet
The spectrum of complementary and alternative approaches is broad and includes methods worthy of integration into our current practice, and ineffective or fraudulent practices that should be avoided.
A complete history should include the patient’s use of complementary and alternative medicine (CAM), particularly botanicals and supplements, as these can have actions ranging from estrogenic to anticoagulant.
The U.S. Food and Drug Administration does not currently regulate botanicals and supplements, so extra steps must be taken to ensure the quality of such products.
The management of many women’s health issues can be enhanced by the integration of selected CAM approaches.
Perceived congruency of values around life and health with CAM providers was predictive of use of these approaches; dissatisfaction with conventional medicine is not a predictor of use of CAM.
Acupuncture is of benefit in a variety of conditions, including pain, nausea and vomiting of pregnancy, and secondary to chemotherapy.
Mind–body approaches such as stress reduction, visualization, and hypnosis are gaining evidence as valuable adjuncts in a spectrum of women’s health concerns, from surgery to fertility.
The use of complementary and alternative medicine (CAM) for health maintenance and disease management is on a steady rise in the United States, and for nearly 15 years, the number of visits to alternative care providers exceeded the number of visits to primary care providers. Although evidence exists to support many of these approaches, some approaches are used in the absence of any documented benefit and can be potentially dangerous and fraudulent (1). The primary users are women, who are frequently making decisions regarding treatment options without the advice of their physicians. Obstetrician–gynecologists are in an excellent position to help guide patients in their treatment choices, counseling them about potentially dangerous alternative treatments and supporting their use of potentially beneficial ones. The most significant challenge is the lack of training that most obstetrician–gynecologists have in this area; thus, this chapter reviews the domains of CAM as they apply to the practice of gynecology.
Table 13.1 The Five Domains of Complementary and Alternative Medicine
Adapted from National Institutes of Health. National Center for Complementary and Alternative
Medicine. What is complementary and alternative medicine? Available online at: http://nccam.nih.gov/
The concept of complementary and alternative medicine is by definition a relative one. In a landmark publication, CAM was defined as “medical interventions not taught widely at
U.S. medical schools or generally available at U.S. hospitals” (2). As practices or therapies move in or out of the mainstream in this country, the definition of CAM will change. The spectrum of therapies, practitioners, and products that fall into this category are extremely broad and include everything from botanical medicine to “crystal gazing.” The five domains of CAM are listed in Table 13.1.