A review of
previous studies about how women manage menopause symptoms has found
that they frequently use alternative treatments but often do not inform
their doctors about them.
The study, accepted and published online by the journal Maturitas,
is written by University of Delaware student Dunia Tonob and faculty
member Melissa Melby, associate professor of anthropology.
Tonob, a senior majoring in anthropology, is the first author on the
paper, an accomplishment that Melby calls “remarkable” for an
In the collaboration with Melby, Tonob conducted a literature review —
collecting, assessing and synthesizing previously published information
on the subject of menopause and what is called CAM, or complementary
and alternative medicine. It had been about seven years since such a
wide-ranging review was undertaken, said Melby, who specializes in the
biological and medical aspects of anthropology.
“We wanted to step back and take a broader view of how physicians can
relate to their patients who may or may not be using CAM,” Tonob said.
She and Melby looked at three types of health approaches that are
considered complementary or alternative: natural products, such as
herbal or soy remedies; mind-body practices, including yoga and
meditation; and traditional Chinese and Japanese (Kampo) medicine.
“Menopausal women use alternative medicine at very high rates,” Melby
said, often because they don’t feel that biomedical treatments have
been helpful or that such treatments are too aggressive. In turn, she
said, doctors often seem dismissive of CAM and can be quick to label any
benefits a woman experiences as a placebo effect.
The study she and Tonob conducted seeks to raise awareness among
healthcare providers about the use of CAM and open lines of
communication with their patients.
“Biomedical practitioners who make an effort to learn about CAM and
ask patients about their CAM use or interest may dramatically improve
the patient-provider relationship and rapport,” they write in a summary
of their paper. “By working with women to integrate their CAM-related
health-seeking behaviors and treatments, providers may also boost the
efficacy of their own biomedical treatments.”
The collaboration came about when Tonob, who plans to become a
doctor, approached Melby about ways to raise her writing skills to a
higher academic level. She excelled at writing assignments for her
courses but wanted to get experience in the kinds of scientific writing
that is done for professional publications.
Melby, who has conducted research in Japan and on alternative remedies used in menopause, was considering a request from Maturitas
for a literature review on the subject. Tonob, who was writing a senior
thesis about how people use alternative medicine, had also spent time
shadowing doctors in China as a Plastino Scholar last year.
Tonob’s interests and abilities made her a great fit for the Maturitas project, Melby said.
“Writing for publication is a very different process than writing for
class,” said Tonob, recalling the numerous revisions and rewrites she
and Melby did in preparing the paper for submission. “I’m very happy
that I got this experience in writing for a wider audience than a class
Tonob plans to attend medical school, but she’s first taking time to
earn a master’s degree in medical anthropology at Oxford University,
which she will attend in the fall.
Providing direct care to patients remains her career goal, she said,
“but I also fell in love with the field” of medical anthropology.
Maturitas is an international, multidisciplinary,
peer-reviewed scientific journal of post-reproductive health in both
genders, ranging from basic science to health and social care. It is the
official journal of the European Menopause and Andropause Society and
is also affiliated with the Australasian Menopause Society.
The article by Tonob and Melby is available here.
Article by Ann Manser; photo by Kathy F. Atkinson