Menopausal Syndrome & Hot Flushes

2021 BMJ Open

The standardised and brief acupuncture treatment produced a fast and clinically relevant reduction in moderate-to-severe menopausal symptoms during the six-week intervention.

Randomised and controlled, with 1:1 allocation to the intervention group or the control group. The assessor and the statistician were blinded.

The acupuncture style was western medical with a standardised approach in the predefined acupuncture points CV-3, CV-4, LR-8, SP-6 and SP-9. The intervention group received one treatment for five consecutive weeks. The control group was offered treatment after 6 weeks.

The acupuncture intervention significantly decreased hot flushes, day-and-night sweats, general sweating, menopausal-specific sleeping problems, emotional symptoms, physical symptoms and skin and hair symptoms compared with the control group at the 6-week follow-up. The pattern of decrease in hot flushes, emotional symptoms, skin and hair symptoms was already apparent 3 weeks into the study. Mild potential adverse effects were reported by four participants, but no severe adverse effects were reported.

The standardised and brief acupuncture treatment produced a fast and clinically relevant reduction in moderate-to-severe menopausal symptoms during the six-week intervention. No severe adverse effects were reported.

Efficacy of a standardised acupuncture approach for women with bothersome menopausal symptoms: a pragmatic randomised study in primary care (the ACOM study) Lund KS, Siersma V, Brodersen J, et al.

2021 Frontiers in Psychiatry

Acupuncture alone or combined with standard care was associated with significant improvements in perimenopausal depression and reductions of other menopausal symptoms.

Our review found that acupuncture was better than standard care alone in reducing HAMD score by 1.4–3.6, which is of clinical significance—acupuncture is better than or at least equivalent to antidepressant in improving perimenopausal women's depression. In addition to the satisfactory short-term effects, the intermediate- and long-term benefits of acupuncture against PMD outlast those of antidepressants. Long-term clinical efficacy is crucial in the management of depressive symptoms, as depression is characterized by a high recurrence rate. Frequent relapse of depression and withdrawal symptoms of antidepressants are also two major reasons for numerous patients reject psychotropic agents and seek help from CAM therapy.

It is interesting to note that acupuncture also improved perimenopausal symptoms (decreased KI scores), better than either antidepressant alone or antidepressant combined with HRT, reflecting different underlying mechanisms of the two interventions (acupuncture vs. pharmacotherapy).

Acupuncture as an Independent or Adjuvant Management to Standard Care for Perimenopausal Depression: A Systematic Review and Meta-Analysis Zhao FY, Fu QQ, Kennedy GA, Conduit R, Zhang WJ, Zheng Z.

2020 Evidence-Based Complementary and Alternative Medicine

The use of acupuncture in the management of perimenopausal depression is safe, effective, and offers long-lasting benefits relative to antidepressants and HRT.

Here, we report a meta-analysis of 16 RCTs that together, comprising 1311 participants. Our analysis of both the effective rate and HAMD score revealed that acupuncture achieved better outcomes in the management of perimenopausal depression-relative antidepressants and HRT. Additionally, follow-up analysis indicates that the benefits of acupuncture against perimenopausal depression last longer those of antidepressants. However, measurements of the levels of estrogenic hormones did not reveal statistically significant differences in those treated by acupuncture relative to pharmacologic antidepressants. Further research is therefore warranted to establish whether the observed acupunctural benefits are associated with changes in the levels of estrogen.

Our meta-analysis suggests that, in the management of perimenopausal depression, acupuncture is relatively safer than pharmacological agents. The main adverse effects following acupuncture include subcutaneous bleeding and pain following the piercing. These side effects can be reduced by choosing different acupoints. Additionally, patients with fear of needles experience needle sickness, which is characterized by anxiety, dizziness, palpitations, and sweating. These side effects are temporary and can be reduced by training acupuncturists to psychologically prepare patients prior to starting the procedure. On the contrary, negative side effects of antidepressants are related to the respective drugs’ mechanisms of action and most cannot be avoidable. It should, however, be noted that the risks associated with acupuncture could not be assessed with confidence as many of the RCTs in our study did not adequately report adverse effects of their interventions.

Effectiveness and Safety of Acupuncture for Perimenopausal Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Xiao, X., Zhang, J., Jin, Y., Wang, Y., & Zhang, Q.

2018 The Journal of Alternative and Complementary Medicine

Evidence supports the use of acupuncture for menopause symptoms as an adjunctive or stand-alone treatment for reducing vasomotor symptoms and improving health-related quality of life outcomes.

Evidence from RCTs supports the use of acupuncture as an adjunctive or stand-alone treatment for reducing VMSs and improving HRQOL outcomes, with the caveat that observed clinical benefit associated with acupuncture may be due, in part, or in whole to nonspecific effects. The safety of acupuncture in the treatment of VMSs has not been rigorously examined, but there is no clear signal for a significant potential for harm.

Management of Menopause Symptoms with Acupuncture: An Umbrella Systematic Review and Meta-Analysis Befus D, Coeytaux RR, Goldstein KM, McDuffie JR, Shepherd-Banigan M, Goode AP, Kosinski A, Van Noord MG, Adam SS, Masilamani V, Nagi A, Williams JW Jr.

2017 PLOS One

Acupuncture is non-inferior to hormone therapy or other applied relaxation therapies in alleviating the symptoms of menopause for its safety, non-invasive and especially considering the side effect of hormone therapy.

This meta-analysis of women with breast cancer confirms that acupuncture had no significant effect on the severity of hot flush, but did significantly alleviate the symptoms of menopause. We conclude that acupuncture is non-inferior to hormone therapy or other applied relaxation therapies in alleviating the symptoms of menopause for its safety, non-invasive and especially considering the side effect of hormone therapy. Recent studies show that use of acupuncture does not correlate with increased levels of plasma estradiol. Considering the safety and lack of serious adverse effects associated with acupuncture, in contrast to hormone therapy, acupuncture should be considered for treating hot flush and menopause syndrome in women with breast cancer.

Effect of acupuncture on hot flush and menopause symptoms in breast cancer- A systematic review and meta-analysis Chien TJ, Hsu CH, Liu CY, Fang CJ.

2017 Complementary Medicine Research

Both the total score and the subgroup analysis strongly indicated that acupuncture can alleviate menopause-related symptoms.

Six studies were included. Our analysis found that acupuncture can reduce the MRS score in menopausal women by the end of the treating period (2-3 months, on average) and even in the follow-up period (1-3 months), not only in the total score but also in each subscale score. But the grade of evidence is very low.

Both the total score and the subgroup analysis strongly indicated that acupuncture can alleviate menopause-related symptoms. However, the evidence is not very strong. Thus, further studies about the efficiency of acupuncture on menopausal symptoms based on well-designed trials are needed.

Acupuncture May Improve Quality of Life in Menopausal Women: A Meta-Analysis of Randomized Controlled Trials Li W, Luo Y, Fu W, Lei R.

2016 Obstetrics & Gynecology

Acupuncture is associated with a significant reduction in sleep disturbances in women experiencing menopause-related sleep disturbances.

We identified 31 randomized controlled trials with 34 effect sizes involving a total of 2,433 participants. Acupuncture is associated with a significant reduction in the likelihood of sleep disturbances, a significant increase in the secretion of serum estradiol, and reduction in the secretion of serum follicle-stimulating hormone and luteinizing hormone. Studies with a large effect size of acupuncture-associated changes in serum estradiol had a significantly lower odds of sleep disturbances than did those with a small-to-moderate effect sizes.

Acupuncture is associated with a significant reduction in sleep disturbances in women experiencing menopause-related sleep disturbances. Our findings suggest that acupuncture should be adopted as part of a multimodal approach for improving sleep disturbances in perimenopausal and postmenopausal women.

Acupuncture to Reduce Sleep Disturbances in Perimenopausal and Postmenopausal Women Chiu HY, Hsieh YJ, Tsai PS.

2016 Obstetrics & Gynecology

Acupuncture is associated with a significant reduction in sleep disturbances in women experiencing menopause-related sleep disturbances.

We identified 31 randomized controlled trials with 34 effect sizes involving a total of 2,433 participants. Acupuncture is associated with a significant reduction in the likelihood of sleep disturbances, a significant increase in the secretion of serum estradiol, and reduction in the secretion of serum follicle-stimulating hormone and luteinizing hormone. Studies with a large effect size of acupuncture-associated changes in serum estradiol had a significantly lower odds of sleep disturbances than did those with a small-to-moderate effect sizes.

Acupuncture is associated with a significant reduction in sleep disturbances in women experiencing menopause-related sleep disturbances. Our findings suggest that acupuncture should be adopted as part of a multimodal approach for improving sleep disturbances in perimenopausal and postmenopausal women.

Acupuncture to Reduce Sleep Disturbances in Perimenopausal and Postmenopausal Women: A Systematic Review and Meta-analysis Chiu, Hsiao-Yean RN, PhD; Hsieh, Yu-Jung RN, MSN; Tsai, Pei-Shan RN

2015 Evidence-Based Complementary and Alternative Medicine

Acupuncture can be safely applied as an alternative, adjuvant treatment in clinical practice to treat sleep disorders in postmenopausal women.

In general, these studies presented improvements in sleep-related variables. Despite the overall positive effects, acupuncture still cannot be stated as a reliable treatment for sleep-related complaints, not due to inefficacy, but rather limited evidence. Nevertheless, results are promising and new comprehensive and controlled studies in the field are encouraged.

Regardless of the still limited evidence about the effects of acupuncture for postmenopausal sleep disorders, none of the selected articles described side or deleterious effects. Thus, acupuncture can be safely applied in clinical practice for this population as an alternative treatment, but not as primary or single conduct.

Acupuncture to Treat Sleep Disorders in Postmenopausal Women: A Systematic Review Bezerra AG, Pires GN, Andersen ML, Tufik S, Hachul H.

2015 Menopause

Acupuncture improves hot flash frequency and severity, menopause-related symptoms, and quality of life (in the vasomotor domain) in women experiencing natural menopause.

Of 104 relevant studies, 12 studies with 869 participants met the inclusion criteria and were included in this study. We found that acupuncture significantly reduced the frequency and severity of hot flashes. Acupuncture significantly decreased the psychological, somatic, and urogenital subscale scores on the Menopause Rating Scale. Acupuncture improved the vasomotor subscale score on the Menopause-Specific Quality of Life questionnaire. Long-term effects (up to 3 mo) on hot flash frequency and severity were found.

This meta-analysis confirms that acupuncture improves hot flash frequency and severity, menopause-related symptoms, and quality of life (in the vasomotor domain) in women experiencing natural menopause.

Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials Chiu HY, Pan CH, Shyu YK, Han BC, Tsai PS.

2013 Cochrane Database of Systematic Reviews

When acupuncture was compared with no treatment, there appeared to be a benefit from acupuncture, but acupuncture appeared to be less effective than hormone therapy.

We found insufficient evidence to determine whether acupuncture is an effective treatment for controlling vasomotor menopausal symptoms. When we compared acupuncture with sham acupuncture, there was no evidence of any significant difference in their effect on menopausal vasomotor symptoms. When we compared acupuncture with no treatment there appeared to be a benefit from acupuncture, but acupuncture appeared to be less effective than hormone therapy (HT). These findings should be treated with great caution as the evidence was of low or very low quality and the studies comparing acupuncture versus no treatment or HT were not controlled with sham acupuncture or placebo HT. Data on adverse effects were lacking.

Acupuncture for menopausal hot flushes Dodin S, Blanchet C, Marc I, Ernst E, Wu T, Vaillancourt C, et al.

2013 European Journal of Integrative Medicine

The evidence suggested that traditional acupuncture can improve hot flashes in menopausal women and could be a potential treatment for menopausal women.

Eleven RCTs were included in this systematic review, and nine were included in the meta-analysis. Traditional acupuncture (TA) showed statistically significant improvement relative to sham acupuncture (SA) in HF severity without heterogeneity. However, HF frequency and quality of life (QOL) did not differ between TA and SA. Nevertheless, TA showed significant improvement of HF frequency and severity, and QOL when compared to the control (wait list or no treatment).

Traditional acupuncture for menopausal hot flashes: A systematic review and meta-analysis of randomized controlled trials Dodin S, Blanchet C, Marc I, Ernst E, Wu T, Vaillancourt C, Paquette J, Maunsell E.