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HONG KONG (Reuters) – Acupuncture may not help relieve hot flushes in women undergoing menopause, a review of past studies involving the practice has shown.

In a paper published in the journal Climacteric, researchers in South Korea and Britain said they trawled though medical literature exploring the efficacy of acupuncture in relieving hot flushes but evidence was scarce.

“Our findings provide no convincing evidence that acupuncture is beneficial for women suffering from menopausal hot flushes,” they wrote.

Many women are concerned about the side effects of hormone replacement therapy (HRT) and opt for alternatives such as acupuncture.

The researchers trawled through 106 papers in total, and narrowed down to six the ones they considered most relevant to the study. The six tested the effects of real acupuncture against the effects of sham acupuncture.

Sham acupuncture would be to penetrate acupuncture points that are not relevant for the treatment of hot flushes.

Only one reported positive effects of acupuncture on the frequency and severity of hot flushes after four weeks of follow-up, while the other five showed no such effects.

Edzard Ernst, a professor at the Complementary Medicine Peninsula Medical School in Britain, recommended that women experiencing menopause return to using HRT.

“We would always recommend that women wanting relief from menopausal symptoms consult their clinician before undertaking any course of treatment,” they wrote.

(Reporting by Tan Ee Lyn; Editing by Bill Tarrant)

© Copyright (c) Reuters

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Acupuncture not helpful for menopausal hot flushes

By Christian Pope, M.D.

February 02, 2012 12:00 AM

I have received several requests to revisit some concerns related to menopause. Over the next few weeks, I would like to address specific topics and many of the individual questions that are being asked.

This week, we will begin with an overview of menopause and ways to address those miserable vasomotor symptoms, or hot flashes.

Next week, I'll specifically address the role of hormone replacement therapy and alternatives in treatment. Given recent findings, specifically regarding the effect of the timing of hormone replacement therapy initiation on cardiovascular risk, it seems appropriate to reassess our concerns in the treatment of menopause in the wake of the recent reanalysis of the Women's Health Initiative (WHI).

Finally, I'll conclude with the concern of loss of sexual desire.

I hope this helps demystify menopause.

A woman in the developed world likely will spend greater than a third of her life beyond menopause, so the symptoms that accompany menopause and the morbidities associated with aging are of increasing importance in women's health. There are many options available to address the quality of life and health concerns of menopausal women.

What is menopause?

Menopause is when a woman stops having her period and her ovaries stop working. This means she can no longer become pregnant.

When does it happen?

The average age of menopause is 52 years, but it can begin any time from age 40 to 58. Menopause can happen over several years. You are menopausal if you haven't had a period for one year.

What can I expect?

Menopause affects every woman differently. Some women have few or no symptoms. Others may have irregular vaginal bleeding (e.g., spotting), hot flashes, and vaginal dryness.

How are the symptoms treated?

Your doctor may have you start taking hormones. This may include estrogen or estrogen combined with another hormone (progesterone). Hormone therapy can help your symptoms. However, it is not for everyone. Taking estrogen for a long time can cause problems like heart disease and cancer. Ask your doctor about the risks and benefits of taking hormones. If you cannot take estrogen, there are other medicines that may help. Your doctor can help you find the right medicine for your symptoms.

Are alternative therapies safe?

Some people think that plant estrogens and herbal supplements are “natural,” which makes them seem safer than hormone therapy. However, there have been very few scientific studies to test this. Talk to your doctor before you use them, because they may interfere with other medicines you are taking.

When should I see my doctor?

You should see your doctor during and after menopause. It is important to get regular tests to check for cancer of the cervix, colon, and breast.

What else should I do after menopause?

You should quit smoking, lower your blood pressure, exercise, and eat a healthy diet. This will help prevent heart disease, which is the leading cause of death in women. Taking enough calcium and vitamin D every day can help prevent osteoporosis, which causes weak bones that can break easily. Your doctor can test the strength of the bones in your spine and hip to see if you have osteoporosis. Regular exercise with strength training and weight-bearing activities like walking and jogging can be especially good for you.

WHAT ARE THE HEALTH CONCERNS?

Major health concerns of menopausal women include vasomotor symptoms (hot flushes), urogenital atrophy (vaginal dryness), urinary incontinence, osteoporosis, cardiovascular disease, cancer, cognition, sleep habits and mood.

Vasomotor symptoms (VSM) commonly known as hot flushes (or “flashes) and night sweats, are the primary reason women seek help around the time of menopause. These symptoms are often disruptive to daily activities as well as to sleep. In fact, VSM affects nearly 80 percent of women and typically begins before menopause. Although most women will experience hot flushes for six months to two years average duration, frequency and severity of symptoms improves with time.

Both race and ethnicity affects the likelihood of VSM. For examples, compared with white women, Japanese and Chinese women are less likely and African-American women are more likely to report VSM. Other factors associated with hot flushes include a high body mass index, smoking, and being less physically active. Additionally, hot flushes are more likely in surgically menopausal women (have had ovaries removed) than in naturally menopausal women.

The physiology behind hot flushes is incompletely understood. They are usually due to the result of estrogen withdrawal, rather than low estrogen levels. In symptomatic postmenopausal women, hot flushes are likely triggered by small increases in core body temperature acting within a narrow zone. Exactly how estrogen and alternative therapies play a role in modulating these events in unknown.

What are the treatment options?

Estrogen therapy taken either orally or through the skin is the most effective treatment for hot flushes and is the only therapy currently approved by the U.S. Food and Drug Administration (FDA) for this indication. In one of most evidence-based databases, the Cochrane Database, estrogen therapy was found to be highly effective in alleviating hot flushes and night sweats. Hot flush frequency was reduced by 75 percent and severity decreased as well.

With greater awareness of estrogen risk profile, many low-dose estrogen products have been developed and approved for symptoms relief. Studies have shown that such lower doses are actually equally effective in alleviating symptoms as the former higher dose formulation, with fewer risks. Side effects of estrogen include breast pain, vaginal bleeding and increased risks of blood clots and stroke, although this risk is rare and will be covered in a later discussion on this topic.

There are both oral as well as transdermal (patches, sprays) forms of estrogen that are taken either daily, or applied weekly and get absorbed into the circulation to increase the body's natural estrogen level. Many women find the transdermal route more convenient and actually more effective. Such therapies include Climara, Evamist, and Vivelle-Dot which are changed either weekly or twice weekly.

Oral contraceptives are an alternative form of estrogen therapy for the treatment of VMS in healthy, nonsmoking, perimenopausal women. Contraception and good control of the irregular menstrual patterns that are so commonplace with the menopause transition are additional benefits.

Although estrogen therapy may be contraindicated in some women due to uncontrolled hypertension, obesity, or smoking, progesterone therapy alone has been found effective for VSM and has resulted in a 75-percent reduction in VSM.

For women who are not candidates for estrogen therapy or prefer alternatives, other options are certainly available. Simple lifestyle changes can be beneficial in all women such as wearing light, layered clothing, keeping the thermostat low, using portable fans at the desk and bedside. Weight loss is always encouraged, since it too has been shown to reduce the frequency and severity of hot flushes.

The use of acupuncture has gained popularity and has been shown to reduce VSM in several studies. Phytoestrogens, plant-derived substances with estrogenic properties, decrease hot flush severity and frequency. Black cohosh (a supplement) is another popular alternative treatment, but its efficacy similar to that of placebo. Vitamin E (800 internnational units/day) is often recommended as well.

Additionally, several drugs used for other indicationsm such as antidepressants, have shown promise for the treatment of VSM. Some of these are Paxil, Effexor, Gabapentin, and a newer drug, Pristiq have been used with great success in the treatment of VSM.

Women who are bothered primarily at night by night sweats and sleep disruption may also benefit from a trial of sleep medication. Use each evening is never recommended for long periods of time, yet used intermittently can surely improve sleep habits.

When deciding between the available interventions for vasomotor symptoms, the safest option should be encouraged first, and each should be individualized. Patient preference, symptoms severity, side effects, and the presence of other conditions, such as depression, will influence treatment choices. Hot flushes is the most common reason women seek medical attention around the time of menopause “¦ you're not alone.

Where can I get more information?

American Congress of Obstetrics and Gynecology website: http://www.acog.org

National Institutes of Health website: http://www.nih.gov/about/contact.htm

North American Menopause Society website: http://www.menopause.org

Dr. Christian S. Pope specializes in obstetrics and gynecology. He has offices in New Bedford and Mattapoisett and practices at St. Luke's Hospital, the New Bedford site of Southcoast Hospitals Group. He can be reached at 508-999-6245.

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