03

Jan

2008

Can Acupuncture Ease the Symptoms of Menopause?  E-mail
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Body - Acupuncture
Thursday, 03 January 2008 16:04

Dr Cohen is employed at the University of Pittsburgh, Rousseau at the Yale University School of Nursing, and Carey is in private practice as an RN, which gives them an adequate background of knowledge. The intended audience is women in menopause and health care providers for those women, who should inform their patients about the effectiveness of acupuncture for menopausal symptoms. The research involved 17 women. 

The control group received a 20 to 30 minute acupuncture treatment for enhancing the Chi, while the experimental group was treated at specific menopausal related body points. After the treatment with acupuncture for four months a 30 percent decline in the severity of the average monthly hot flushes was observed. Additionally, sleep disturbances decreased significantly in the experimental group. However, both the control and the experimental groups experienced a reduction in mood changes

In a randomized, 2-group clinical study, acupuncture was used for the relief of menopausal hot flushes, sleep disturbances, and mood changes. The experimental acupuncture treatment consisted of specific acupuncture body points related to menopausal symptoms. The comparison acupuncture treatment consisted of a treatment designated as a general tonic specifically designed to benefit the flow of Ch'i (energy). Results from the experimental acupuncture treatment group showed a decrease in mean monthly hot flush severity for site-specific acupuncture, The comparison acupuncture treatment group had no significant change in severity from baseline over the treatment phase. Sleep disturbances in the experimental acupuncture treatment group declined over the study. Mood changes in both the experimental acupuncture treatment group and the comparison acupuncture treatment group showed a significant difference between the baseline and the third month of the study. Acupuncture using menopausal-specific sites holds promise for nonhormonal relief of hot flushes and sleep disturbances. KEY WORDS: acupuncture, controlled needling, hot flushes, menopause, mood changes, sleep disturbances Holist Nurs Pract 2003;17(6):295-299 [PUBLICATION ABSTRACT]

Full Text (2661 words)

Copyright Aspen Publishers, Inc. Nov/Dec 2003

[Headnote]

In a randomized, 2-group clinical study, acupuncture was used for the relief of menopausal hot flushes, sleep disturbances, and mood changes. The experimental acupuncture treatment consisted of specific acupuncture body points related to menopausal symptoms. The comparison acupuncture treatment consisted of a treatment designated as a general tonic specifically designed to benefit the flow of Ch'i (energy). Results from the experimental acupuncture treatment group showed a decrease in mean monthly hot flush severity for site-specific acupuncture, The comparison acupuncture treatment group had no significant change in severity from baseline over the treatment phase. Sleep disturbances in the experimental acupuncture treatment group declined over the study. Mood changes in both the experimental acupuncture treatment group and the comparison acupuncture treatment group showed a significant difference between the baseline and the third month of the study. Acupuncture using menopausal-specific sites holds promise for nonhormonal relief of hot flushes and sleep disturbances. KEY WORDS: acupuncture, controlled needling, hot flushes, menopause, mood changes, sleep disturbances Holist Nurs Pract 2003;17(6):295-299

Menopausal symptoms impact the lives of individual women, their families, their productivity, and their lives within their communities.1-4 While hormone replacement therapy (HRT), now known as hormone therapy (HT), is the most often cited remedy for menopausal symptoms, nonhormonal interventions are preferred by some women and by nearly all women with menopausal symptoms induced or accelerated by breast cancer treatment.5 Previous small-sample studies indicate that nonhormonal treatments are effective in relieving the symptoms associated with menopause.6 Nonhormonal therapies for menopause symptom relief include pharmacologie therapies7,8 (eg, clonidine, veralipride, metaclopramide, sulpride, venlafaxine), herbs (E. Robinson and S.M. Cohen, unpublished data, 1999) (black cohosh, red clover), dietary alterations9-11 (phytoestrogens), paced respirations,12 physical activity,13,14 and acupuncture. Acupuncture holds promise for short-term management (3-5 years) of menopausal symptoms, and this study was conducted to explore the efficacy of acupuncture for menopausal symptom relief.

ACUPUNCTURE

Within Eastern thought, acupuncture is viewed as a holistic approach grounded in Chinese medical philosophy. Acupuncture stimulates the Ch'i (energy) in humans at points along the body meridians that pass through major organs. It effectively opens blocked gates along the meridians to increase energy flow and balance Yin and Yang. This enables the person to achieve optimal health.15,16 Acupuncture specific to menopausal symptoms is designed to correct a condition known as deficient heat. This condition is a deficiency in Yin energy and is characterized by "five palm sweats," night sweats, and a general mental agitation. An earmark in menopause is the deficiency of kidney Yin that results in the deficient heat symptoms. The deficient heat could invade other organs and cause symptoms related to emotional changes.17 Acupuncture points specific to menopausal symptoms balance the kidney Ch'i by subduing kidney Yang, as well as points that nourish the heart and quiet the spirit.

The allopathic or Western view of acupuncture is summarized by Andersson and Lundeberg.18 The mechanism they propose is based on the temporal relationship between hot flushes and luteinizing hormone (LH), in all likelihood related to a gonadotropic-releasing hormone (GnRH) pulse. Beta-endorphin inhibits the release of GnRH. Therefore, they postulate that acupuncture could decrease hot flushes by regulating temperature control through increasing beta-endorphin levels and subsequent inhibition of GnRH. Both eastern and western explanations of acupuncture's effects on menopause symptoms target hot flushes.

BACKGROUND

Although acupuncture has been used for centuries for "women's complaints" in traditional Chinese medicine,19 studies in western scientific journals report that the use of acupuncture for menopausal symptoms is sparse. Wyon et al20 investigated acupuncture for reduction in vasomotor responses, improvement in quality of life, and decrease in urinary excretion of neuropeptides. Twenty-four women were randomized to either electroacupuncture at 2 Hz or superficial needle insertion at the same acupuncture points. Results indicated that hot flushes decreased by 50%, quality of life remained constant, and urinary excretion of neuropeptides decreased significantly during treatment. Ping et al21 used acupuncture and auriculotherapy (acupuncture on the ear) to treat climacteric syndrome (hot flushes). They used acupuncture in 1 group and estriol for symptom treatment in the comparison group. Results showed a significant decrease in hot flushes in both groups with a greater reduction in the acupuncture treatment group. Dong et al22 studied the effect of acupuncture on quality of life and reproductive hormone secretion in a small group of menopausal women (n = 9) in a pre-/posttest design. They found that acupuncture significantly improved menopausal vasomotor symptoms and showed no influence on reproductive hormones. Porzio et al23 conducted a single sample pilot study of acupuncture for menopause-related symptoms in women taking tamoxifen. Results included an improvement in anxiety, depression, and somatic and vasomotor symptoms, and no change in libido.

METHODS AND STUDY DESIGN

The specific aim for this study was to explore the efficacy of acupuncture for menopausal symptom management.

This study was a small scale, randomized clinical trial to examine the effect of acupuncture on the menopausal symptoms of hot flushes, sleep disturbances, and mood changes. Participants were recruited by flyers and by advertisements in local newspapers. Following informed consent and baseline measures, eligible participants commenced their acupuncture treatments. Random assignment to either the experimental acupuncture treatment group or a comparison acupuncture treatment group who received an acupuncture treatment for general health, was known only by the acupuncturist who held a priori determined group assignment per participant number in sealed envelopes. Participants and the principal investigator (PI) were blinded to group assignment. Both experimental acupuncture treatment and comparison acupuncture treatment group members were given a 9-week acupuncture treatment protocol (once a week for 3 weeks, then once every other week for a total of 6 treatments) followed by 3 non treatment weeks. The treatments lasted between 20 and 30 minutes. A licensed acupuncturist delivered acupuncture treatments in her private office. Participants recorded menopausal symptom severity (hot flushes, mood changes, and sleep disturbances) once a day at bedtime in the "daily symptom diary."

Experimental acupuncture treatment

The experimental acupuncture treatment consisted of needling specific acupuncture body points related to menopausal symptoms such as hot flushes. The following sites were used for needling: urinary bladder 15; urinary bladder 23; urinary bladder 32; governor vessel 20; heart 7; pericardium 6; spleen 6; liver 3; spleen 9.

Comparison acupuncture treatment

The comparison acupuncture treatment consisted of a treatment designated as a general tonic (shen mein) and other points: liver 4, kidney 7, and ear points (7)-auricular (shin mein)-sympathetic; kidney; liver; and lung points specifically designed to benefit the flow of Ch'i.

Instruments

A daily symptom diary developed for this study was used to gather data on the severity of menopausal symptoms, such as hot flushes, mood changes, and sleep disturbances. Data in menstrual cycle research studies such as menopausal and PMS symptom investigations are usually collected by participants recording in a daily symptom diary.24 Severity of hot flushes, mood changes, and sleep disturbances were rated (0 = absent, 1 = mild, 2 = mod, 3 = severe) daily at baseline, then for 3 consecutive months during treatment, and 1 month after treatment completion.

Sample

A convenience sample of 18 women (experimental acupuncture treatment group, 8; comparison acupuncture treatment group, 9) was recruited in a New England state to participate in a study of menopausal symptom management. One participant dropped out after the baseline symptom recording, leaving 17 who completed the study. Eligibility criteria for study participation included self-identification of menopausal hot flushes. Women who had concurrent treatment of menopausal symptoms with hormonal supplementation, other pharmacologie therapies, herbal remedies, or acupuncture (including acupressure) were excluded from the study. Participants were required to have ceased previous treatment of menopausal symptoms with hormones, other medications, herbs, or acupuncture at least 3 months prior to enrollment in the study to allow for a sufficient cleansing period.

Data collection and analysis

Data were collected in the acupuncturist's private office. Participants were introduced to the study, written informed consent was obtained, and baseline demographic data were surveyed. The acupuncturist performed the randomization and set up the appointments for acupuncture treatments. Study participants recorded menopausal symptoms in the daily symptom diary and returned the diaries at each acupuncture appointment or in the case of the last diary, sent it by mail. Four months of daily symptom recordings were entered into the data set. One comparison acupuncture treatment group participant's last month of data were lost in the mail and were not entered into the last month's data analysis. Only after all data were received did the PI or the participants know their group membership.

Sample demographic data were profiled using descriptive statistics and measures of central tendency. For all statistical tests, significance was determined as p < or = .05. Symptom severity data were aggregated by calculating a monthly mean for each symptom. Serial t-tests with confidence intervals were conducted to determine statistical significance for variables of interest across aggregated monthly measurement points. No attempt was made to statistically compare the experimental acupuncture treatment group to the comparison acupuncture treatment group because of the small sample size. Rather, intragroup comparisons were made across measurement points.

RESULTS

The convenience sample included 16 Caucasian women and 1 Hispanic woman. Mean age was 47.3 years, with a range of 43 to 53 years. All had menopausal hot flushes and were within 3 years of the onset of perimenopausal symptoms. Eleven of the 17 women had ceased having menstrual cycles within the past 2 years and the remaining 6 women had not had a period in 3 to 4 months.

Results from the experimental acupuncture treatment group showed a decrease in mean monthly hot flush severity (30%) for site-specific acupuncture (Fig 1). Hot flush severity declined from baseline to month 2 (p = .05), baseline to month 3 (p = .005), and baseline to posttreatment month 4 (p = .019). The comparison acupuncture treatment group had no change in severity from baseline over the treatment phase (Fig 2). Hot flushes in the comparison acupuncture treatment group did decline from baseline to the posttreatment month. Sleep disturbances in the experimental acupuncture treatment group declined over the study (Fig 1) and reached a statistically significant difference (.05) from baseline in posttreatment month. Again, there was no statistically significant decline in sleep disturbances in the comparison acupuncture treatment group during treatment. However, there was a significant difference in sleep disturbances in the comparison acupuncture treatment group between baseline and posttreatment. Mood changes decreased both in the experimental acupuncture treatment and comparison acupuncture treatment groups. The experimental acupuncture treatment group showed a significant difference between the baseline and the posttreatment month of the study (.05) and approached significance in the comparison acupuncture treatment group (.056).

DISCUSSION

In this study, acupuncture using menopausal symptom specific sites significantly reduced the severity of hot flushes during treatment and the month following treatment. Both sleep disturbances and mood changes decreased in severity over the treatment phase of the study. Differences in severity declined from the baseline month, approaching statistical significance in the second treatment month (month 3) and achieving significance in the posttreatment month. Our current findings compare favorably with previous small sample studies using acupuncture for menopausal-symptoms reduction.20

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FIGURE 1. Hot flash severity.

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FIGURE 2. Sleep disturbances.

Future studies with larger samples are needed to better understand the effects of acupuncture on menopausal symptoms.

CLINICAL IMPLICATIONS

We've seen an increase in the use of complementary and alternative treatments for menopausal symptoms in recent years. The numbers of women seeking alternatives is expected to increase following publication of the Women's Health Initiative data that reported increased risk of breast cancer and cardiovascular events in women using combined HT.25 To assist these women, effectiveness data on alternatives is essential.

This study contributes to the growing body of knowledge related to the effectiveness of acupuncture for menopausal symptom management. Acupuncture appears to hold real promise as a way for women to manage their symptoms without the concerns raised by the use of HT. For nurses in holistic practice, acupuncture may be recommended as a safe and effective therapy for reducing menopausal hot flushes as well as contributing to the reduction in sleep disruptions. In turn, by reducing hot flushes and improving sleep, overall quality of life for women suffering from menopausal symptoms may be improved.

[Reference]

REFERENCES

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2. Knobf MT, Lenox R, Donlick M, Miano T, Sexton D, Fox J. A prospective quality of life study of women treated with adjuvant therapy for breast cancer. In: Proceedings of Fourth National Conference on Cancer Nursing Research. Atlanta, Ga: American Cancer Society; 1997: 54.

3. Knobf MT, Lenox R, Fox J. A prospective study of symptom distress in women treated with adjuvant therapy for breast cancer. Oncol Nurs Forum. 1997;24:301.

4. Carpenter JS, Andrykowski MA. Hot flushes in postmenopausal women treated for breast cancer. ONF Congr Proc. 1998;25:310.

5. Bachman G. Nonhormonal alternatives for the management of early menopause in younger women with breast cancer. J Nat Cancer Inst Monogr. 1994;16:161-167.

6. Soltes BA. Therapeutic options for menopause in cancer survivors. Oncol Nurs Updates. 1997;4:1-12.

7. Loprinzi C, Pisansky T, Fonseca R, et al. Pilot evaluation of venlafaxine hydrochloride for the therapy of hot flushes in cancer survivors. J Clin Oncol. 1998;16:2377-2381.

8. Freedman RR, Woodward S, Sabharwal S. [alpha]^sub 2^-Adrenergic mechanism in menopausal hot flushes. Obstet Gynecol 1990;76:573-578.

9. Murkies AL, Lombard C, Strauss BJG, Wilcox G, Burger HG, Morton MS. Dietary flour supplementation decreases postmenopausal hot flushes: effect of soy and wheat. Maturitas. 1995;21:189-195.

10. Brzezinski A, Adlercreutz H, Shaoul R, et al. Short-term effects of phytoestrogen-rich diet on postmenopausal women. Menopause 1997;4:89-94.

11. Dennerstein L, Dudley E, Burger H. Wellbeing and the menopausal transition. J Psychosom Obstet Gynecol. 1997;18:95-101.

12. Freedman RR, Woodward S. Behavioral treatment of menopausal hot flushes: evaluation by ambulatory monitoring. Am J Obstet Gynecol. 1992;167:436-439.

13. Guthrie J, Smith A, Dennerstein L, Morse C. Physical activity and the menopause experience: a cross-sectional study. Maturitas. 1995:20:71-80.

14. Hammar M, Berg G, Lindgren R. Does physical exercise influence the frequency of postmenopausal hot flushes? Acta Obstet Gynecol Scand. 1990;69:409-412.

15. NIH. Consensus development statement on acupuncture. NIH Consens Statement [Online] November 3-5 1997 [1997, 11, 15]; 15(5):1-20.

16. Firebrace P, Hill S. Acupuncture. New Canaan, Conn: Keats; 1994. 17. Williams T. The Complete Illustrated Guide to Chinese Medicine. Boston, Mass: Element; 1996.

18. Andersson S, Lundeberg T. Acupuncture-from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypotheses. 1995;45:271-281.

19. Johns R. The Art of Acupuncture Techniques. Berkeley, Calif: North Atlantic Books; 1996.

20. Wyon Y, Lindgren R, Lundeberg T, Hammar M. Effects of acupuncture on climacteric symptoms, quality of life, and urinary excretion of neuropeptides among postmenopausal women. Menopause. 1995;2: 3-12.

21. Ping J, Ren-hai M, Zhong-xiang W. Body acupuncture plus ear pressing in the treatment of menopausal syndrome. Int J Clin Acupunct. 1999;9(4):471-473.

22. Dong H, Ludicke F, Comte I, Campana A, Graff P, Bischof P. An exploratory pilot study of acupuncture on the quality of life and reproductive hormone secretion in menopausal women. J Altern Complement Med. 2001;7(6):651-658.

23. Porzio G, Trabasso T, MArtelli S, et al. Acupuncture in the treatment of menopause-related symptoms in women taking tamoxifen. Tumori. 2002;88:128-130.

24. Shaver J, Woods N. Concordance of perimenopausal symptoms across two cycles. Res Nurs Health. 1985;8:313-319.

25. Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy post-menopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002;288:321-333.

[Author Affiliation]

Susan M. Cohen, DSN, C-FNP * Mary Ellen Rousseau, MS, CNM * Bonnie L. Carey, OMD, LAc, RN

[Author Affiliation]

From the University of Pittsburgh, Pittsburgh, Pa (Dr Cohen); and the Yale University School of Nursing, New Haven, Conn (Ms Rousseau). Ms Bonnie is in private practice, in Salem, Conn.

This study was supported by a Yale University School of Nursing Intramural Grant.

Corresponding author: Susan M. Cohen, DSN, C-FNP, University of Pittsburgh, 440 Victoria Bldg, 3500 Victoria St, Pittsburgh, PA 15261 (e-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).

 

 

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