30 November, 2015: 

Climacteric symptoms including hot flushes, night sweats, pain during sexual intercourse, hair loss, forgetfulness, depression and sleeping disturbances are common complaints among breast cancer patients. Some of them are receiving anti-hormonal treatment and others develop ovarian failure as a consequence of cancer treatment. Among these patients, many therapies for alleviating such symptoms have been tested but the results are conflicting. Recently, Münstedt and colleagues have published an study assessing the role of bee pollen and honey in relieving menopausal symptoms in patients receiving tamoxifen and aromatase inhibitors/inactivators [1]. The authors compared a pollen honey mixture with pure honey (placebo) in a prospective, randomized, cross-over trial. Of the 46 patients recruited; 68.3% reported an improvement in their symptoms while taking honey, compared with 70.9% (22/31) who reported an improvement with pollen (the difference was non-significant). This study provided evidence that honey and bee pollen may improve menopausal symptoms in breast cancer patients on anti-hormonal treatment.

Comment

This study highlights that both honey and the pollen–honey mixture improved menopausal complaints in breast cancer patients. Honey was found to be very effective in patients receiving aromatase inhibitors; nevertheless, an increase in estradiol levels was detected among these subjects and this may raise some concerns regarding the safety of honey in such patients. Previous studies have suggested the possible role of bee products for symptoms in menopausal women [2,3]; however, this study is the first suggesting that the pollen–honey mixture improves menopausal symptoms even in breast cancer patients undergoing anti-hormonal treatment. Anecdotally, certain patients also reported additional favorable effects, including reduced hair loss, improvement in bowel movement and normalized blood pressure.

It is noteworthy that honey, which was intended to be used as a placebo, produced similar effects as pollen and they both exceeded the extent of a placebo effect in this setting, which is believed to be ~25% [4].

This effect of honey may be related to the observed increase in the serum levels of estradiol with honey treatment. This finding is of clinical relevance since honey is perceived as a healthy food. Therefore, it is important to advise breast cancer patients on aromatase inhibitors/inactivators about the risk of honey consumption.

Another finding from this study is that the presence of ovaries may play a role in treatment success. Although the difference was not statistically significant due to the small number of patients with oophorectomy in this study, patients who had not undergone oophorectomy benefited more from honey or pollen treatment (present vs. absent ovaries, 73.1 vs. 33.3%, respectively). Recently it has been demonstrated that the addition of bee pollen to the diet reduces the release of insulin-like growth factor-1, progesterone and estradiol from the ovaries [5]. The unusual taste of bee pollen may limit its potential users. Another problem is that there have been no chemical analyses of honey and pollen. However, it is well known that honey and, particularly, pollen, contain flavonoids.

In conclusion, this study provides evidence that honey and bee pollen improve menopausal symptoms in breast cancer patients, opening a novel strategy for alleviating climacteric complaints in such difficult patients.

Camil Castelo-Branco
Ob Gyn Senior Consultant, Hospital Clínic Barcelona, and Full Professor, University of Barcelona

References

1. Münstedt K, Voss B, Kullmer U, Schneider U, Hübner J.Bee pollen and honey for the alleviation of hot flushes and other menopausal symptoms in breast cancer patients. Mol Clin Oncol 2015;3:869-74 
2. Winther K, Rein E, Hedman C. Femal, a herbal remedy made from pollen extracts, reduces hot flushes and improves quality of life in menopausal women: A randomized, placebo-controlled, parallel study. Climacteric 2005;8:162-70 
   http://www.ncbi.nlm.nih.gov/pubmed/16096172 
3. Georgiev DB, Metka M, Huber JC, Goudev AR, Manassiev N. Effects of an herbal medication containing bee products on menopausal symptoms and cardiovascular risk markers: Results of a pilot open-uncontrolled trial. Med Gen Med 2004;6:46 
   http://www.ncbi.nlm.nih.gov/pubmed/15775873 
4. Sloan JA, Loprinzi CL, Novotny PJ, et al. Methodologic lessons learned from hot flash studies. J Clin Oncol 2001;19:4280-90 
   http://www.ncbi.nlm.nih.gov/pubmed/11731510 
5. Kolesarova A, Bakova Z, Capcarova M, et al. Consumption of bee pollen affects rat ovarian functions. J Anim Physiol Anim Nutr (Berl) 2013;97:1059-65 
   http://www.ncbi.nlm.nih.gov/pubmed/23137268