Menopause
337 Case Studies
149 Member Stories
39 Research

Acupuncture for menopausal symptoms may offer a viable alternative for women who can't or don't want to use hormone treatment to alleviate hot flashes, sleep difficulties or mood swings, according to a research study at the University of Copenhagen. This is welcome news for women as hormonal therapy for menopausal symptoms have fallen out of favor and other medical treatments are only somewhat effective.

What is menopause?

Menopause is the time in a woman’s life that marks the end of your menstrual cycles. It's diagnosed after you have gone twelve months without a menstrual period. Menopause can occur at any time in your 40s or 50s, but the average age is 51 in the US. Menopause is a natural biological process. Nevertheless, the physical symptoms, such as hot flashes, and psychological symptoms of menopause may interrupt your sleep, decrease your energy, or affect psychological wellbeing. There are lots of effective treatments available, from natural therapies to hormone treatment.

The North American Menopause Society (NAMS) published the recommendations in July 2008 for menopausal hormonal therapy (HT) in postmenopausal women to increase the benefit-risk ratio in the treatment of postmenopausal symptoms. Osteoporosis was the concerned area for the treatment.[1]


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Hormone Replacement Therapy (HRT) Concerns

When a woman enters menopause, her levels of estrogen drop, and annoying symptoms start. Hormone replacement therapy (HRT) can suppress symptoms by boosting the estrogen levels while also providing protection against cardiovascular disease and osteoporosis (bone weakening). There are two types of hormone treatments: hormone replacement therapy (HRT) and estrogen replacement therapy (ERT). HRT is the administration of progesterone and estrogen; ERT is the administration of estrogen alone. Only women who have had a hysterectomy (removal of the uterus) can take estrogen alone, because taking this “unopposed" estrogen may cause esophageal cancer. The combination of estrogen and progesterone in HRT eliminates the possibility of uterine cancer.

Pros once disagreed on whether HRT increases or reduces the chance of developing breast cancer. A Harvard study concluded that short-term use of hormones carried little risk, while HRT employed for at least five years among women 55 and over appeared to increase the risk of breast cancer. In 2002, the Women's Health Initiative (WHI) quieted a lot of the debate, especially concerning long-term use of HRT. The use of combined estrogen and progestin therapy was ceased in the big test when invasive breast cancer hazard hit a threshold among participants.

 The dangers of HRT were determined to outweigh the advantages. The use of combined HRT also higher risk of coronary heart disease, stroke, and even dementia. Besides the findings of the WHI about the dangers of HRT, side effects of therapy include bloating, breakthrough bleeding, headaches, vaginal discharge, fluid retention, swollen breasts, or nausea. A 2001 study reported that HRT might worsen asthma in postmenopausal women who had asthma before menopause. Some side effects may be lessened or prevented by altering the HRT regimen.

See: Hot Flashes & High Appetite with Bisoma Acupuncture & Sasang Diet

Estrogen for Menopause

Estrogen, the main component of hormonal therapy, plays a vital role in almost every tissue of the body. The role of estrogen studied in the breast, breast cancer, and female reproductive system has led to its establishment as a therapeutic agent. The studies revealed the use of selective estrogen receptor modulators (SERMs) in the treatment of postmenopausal symptoms, especially osteoporosis. SERMs are the ER ligands that show partial or full agonistic activity there. The pharmacological actions of SERMs let FDA approves bazedoxifene and lasofoxifene (third-generation SERMs) for the treatment of postmenopausal osteoporosis.2

See: Ayurvedic Home Remedies For Menopause Symptoms

Cognitive function studies after menopause

Studies conducted on the evaluation of estrogen effects in the cognitive function of healthy older women after attaining menopause yielded noticeable results. The method involved the administration of standardized tests of memory, learning, and abstract reasoning on 727 women. The results indicated the women on estrogen replacement after menopause improved significantly in their cognitive functioning. Moreover, the effect of estrogen was independent of age, education, and APOE genotype.3

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Acupcunture treatment for menopause symptoms

Menopausal hormonal therapy in long terms causes intolerable side effects such as chronic cardiovascular disorders, e.g., stroke & thromboembolism, and cancer, e.g., ovarian & breast cancer. Therefore, female targets for non-pharmacologic treatments promising for minimal side effects. Acupuncture is a practical approach to the management of vasomotor symptoms. The studies have evaluated the effects of acupuncture on the frequency & severity of hot flashes, postmenopausal symptoms, and quality of life in females postmenopause. The action of acupuncture on frequency & severity of hot flashes persisted for three months. The possible mechanism suggested behind this is the reduction in the concentration of β- endorphin in the hypothalamus. The condition arises because of the decreased concentrations of estrogen. The reduced levels of endorphins result in the drop of thermoregulation centers, which mediate the release of CGRP. CGRP is responsible for vasomotor symptoms. Hence, through the regulation of endorphins, the effects on vasomotor symptoms can also be managed.4

Acupuncture therapy reduces the serum follicle-stimulating hormone and luteinizing hormone levels, which leads to an increase in serum estradiol levels. This mentioned mechanism of action is the possible theory behind the effects of acupuncture on menopausal symptoms. The same argument applies to the improvement in psychological traits and therefore treats the disturbed sleep cycle, mood swings, and sexual incapabilities. But several other studies contraindicated these stated hypotheses; hence, a more detailed survey on acupuncture therapy is a must. Till then, acupuncture should be used as an adjunct therapy to the menstrual hormonal treatment.[4]

See: Menopause Relief with Ayurvedic Herbs

Acupuncture Points for Hot Flashes in Menopause

The set of acupuncture points used in a randomized controlled trial for the treatment of hot flashes in breast cancer patients is mentioned in the following table:[5]

 

 

Acupuncture Point

Meridian

Location

DU 14

du mai

At the base of the neck, in the shallow point below the spinous process of the 7th cervical vertebra (C7)

GB 20

gallbladder

In the depression present between the margins of sternomastoid and trapezius muscles

BL 13

bladder

At the lower border of the spinous process of the 3rd thoracic vertebra (T3)

PC 7

pericardium

In between of the tendons of palmaris longus and flexor carpi radialis

H 6

heart

In the tendon of flexor carpi ulnaris

K7

kidney

At the lower leg, in the shallow region between the medial malleolus and anterior border of the Achilles tendon

St 36

stomach

At below the knee, one finger width lateral to the anterior crest of the tibia

SP 6

spleen

At the medial malleolus of the lower leg, in shallow near the medial crest of the tibia

Ear shen men

-

At the lower side of superior antihelical crus facing the fossa

Ear sympathetic point

-

On the inferior antihelical crus

 


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Acupuncture for Estrogen Deficiency

The imbalance in estrogen levels causes several disorders. Irregular menstruation is the most prominent among them. The pathological conditions observed due to deficiency of estrogen in premenopausal women are endometriosis, breast cancer, colorectal cancer, prostate cancer, cardiovascular disorders, obesity, etc. Acupuncture is one of the therapeutic options for the treatment of estrogen deficiency. The following points describe the therapeutic effects of acupuncture on estrogen- and ER-associated diseases:5

Han’s acupoint stimulator treatment improves the pregnancy rates in females with decreased ovarian reserves during in-vitro fertilization and embryo transfer cycles. The therapy works by increasing the antral follicle count & anti-Mullerian hormone levels and diminishing the estradiol level, FSH & FSH/luteinizing hormone ratio.

Polycystic ovary syndrome, the most prominent cause of anovulation in reproductive women, can be treated with electroacupuncture. The therapy works by partially reversing the nerve growth factor abundance in the ovaries.

Osteoporosis treated with warm needle moxibustion showed better therapeutic effects than that oral administration of caltrate and vitamin D2.

Climacteric syndrome, associated with an increase in body weight, showed significant improvement with acupuncture therapy

Acupuncture, according to scientific research, is responsible for growth in ovarian granular cell layer P450 aromatase. P450 is an enzyme that plays a prominent role in the synthesis of estrogen. The increased integration of estrogen leads to the improved endometrial receptivity at the time of implantation.[5]


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Research in acupuncture for menopause symptoms

A new 2019 Danish research indicates that acupuncture may bring relief for many women.[6]

Acupuncture for menopausal symptoms is a sensible alternative for women who can't or don't want to use hormone treatment to alleviate hot flashes, sleep difficulties, or mood swings, according to a research study at the University of Copenhagen.

The Danish study clearly shows that menopausal symptoms may also be successfully treated with acupuncture, according to researchers led by Dr. Lund. This is welcome news for women as hormonal therapy for menopausal symptoms has fallen from favor and other medical treatments are somewhat effective.

In the analysis, Lund's team tracked outcomes for 70 menopausal women in Denmark who underwent five weeks of standardized Western medical acupuncture or no acupuncture.

The acupuncture was performed by family physicians in nine unique clinics and who was trained in acupuncture and was doing it for an average of 14 years. Each session lasted 15 minutes.

Compared to women who did not undergo the needling process, those who did had significant reductions in hot flashes, the study found. Acupuncture recipients also said they had less intense and less frequent daytime and night sweats, overall perspiration, sleep issues, psychological and physical symptoms, and hair and skin issues.

In general, 80 percent of those women who underwent acupuncture stated they believed the treatment had helped reduce their menopause symptoms.

The research team emphasized that the brief length of this study implies that a placebo effect could not be ruled out in the acupuncture treatment group. They also stressed that this acupuncture intervention is most relevant to women who undergo moderate-to-severe menopausal symptoms.


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Summary

Different approaches of acupuncture at pre-defined acupoints are widely used to treat menopausal symptoms and the diseases which have the estrogen deficiency as their leading cause of occurrence. Treatment of postmenopausal osteoporosis, frequency& severity of hot flashes, vasomotor symptoms, anovulation leading to decreased pregnancy rate during in-vitro fertilization, climacteric syndrome, polycystic ovary syndrome, estrogen synthesis by an increase in P450 aromatase, and improvement in cognitive functioning are the significant areas of acupuncture therapy. The therapy promising minimal side effects can be used as an adjunct therapy to the actual menopause hormonal therapy. Though HT has submitted a long list of side effects, the studies on efficacy and safety of acupuncture are still not clarified, which becomes a prime reason for advice behind the use of acupuncture as an additional therapy. 

See: Acupuncture helped me with Stress, Insomnia, Anxiety Disorder and weight related problem

References

1. North American Menopause Society. (2010). Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause (New York, NY), 17(2), 242.

2. Wend, K., Wend, P., & Krum, S. A. (2012). Tissue-specific effects of loss of estrogen during menopause and aging. Frontiers in endocrinology, 3, 19.

3. Jacobs, D. M., Tang, M. X., Stern, Y., Sano, M., Marder, K., Bell, K. L., ... & Mayeux, R. (1998). Cognitive function in nondemented older women who took estrogen after menopause. Neurology, 50(2), 368-373.

4. Deng, G., Vickers, A., Yeung, S., & Cassileth, B. (2007). Randomized, controlled trial of acupuncture for the treatment of hot flashes in breast cancer patients. Journal of Clinical Oncology, 25(35), 5584-5590.

5. Thakur, A., Mandal, S. C., & Banerjee, S. (2016). Compounds of natural origin and acupuncture for the treatment of diseases caused by estrogen deficiency. Journal of acupuncture and meridian studies, 9(3), 109-117.

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

BMJ Open 2019;9:e023637. doi: 10.1136/bmjopen-2018-023637


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