Acupuncture and the menopause: the evidence base and how it works

Acupuncture and the menopause; hot flushes

Acupuncture is increasingly used for many different conditions, but one that may not at first be obvious if that of menopausal symptoms, where acupuncture has been shown in studies to be of benefit. Here I will present information on acupuncture for hot flushes, and other menopausal symptoms of sleep quality, mood and anxiety, memory and cognition and general quality of life.

I’ll also discuss theories and scientific studies showing how acupuncture may be achieving these effects.

I will also touch on hot flushes of other causes, in males and females after cancer-treatment using hormonal drugs these can also cause “vasomotor symptoms”, also known as hot flushes.

I’ll discuss how research shows acupuncture to affect the hormonal system, and finally I’ll leave you with some information and links to follow up for the references and bibliography relating to this area.

Hot flushes, also known as “vasomotor symptoms”

Hot flushes are experienced by a high number of women in the menopause, Gjelsvik at al, 2011 state that 36% of women experienced them at least daily.

Acupuncture has been shown to significantly reduce the number and severity of hot flushes in menopausal women (Wyon et al, 1995; Boroud et al, 2009; Chiu, 2015; Park et al, 2009)

Recently, studies have been looking at the role of Calcitonin gene-related peptide (CGRP), which has been found to be elevated in menopausal women experiencing hot flushes (Sharma et al, 2010). Acupuncture has been shown to decrease the urinary secretion of this same substance, (Wyon et al,1995; Zijlstra et al, 2003), suggesting acupuncture may have a regulatory effect on the calcitonin system.

Studies have repeatedly shown that acupuncture has effects on the autonomic nervous system; in particular the body’s natural opioids (Li et al, 2013) it is theorised that this is part of acupuncture’s mechanism of action in improvements in menopausal hot flushes is due to the fact that changes in central opioid activity have been implicated in hot flushes (Wyon et al, 1995).

“We suggest that acupuncture is a viable alternative treatment of vasomotor symptoms in postmenopausal women”. Wyon et al, 2004.

Sleep

Studies have shown acupuncture to be beneficial to sleep in menopausal women (Wyon et al, 2003, Cohen et al, 2003; Chiu et al 2016)

“Acupuncture using menopausal-specific sites holds promise for non-hormonal relief of hot flushes and sleep disturbances.” Cohen et al, 2003.

“Acupuncture is associated with a significant reduction in sleep disturbances in women experiencing menopause-related sleep disturbances”. Chiu et al, 2016.

Quality of life

Studies have also looked at rating quality of life, and found improvements in this for acupuncture in relation to menopausal symptoms, for example anxiety, mood and energy, (Avis et al; Chu et al 2015, Kim et al, 2020).

“Conclusions: This meta-analysis confirms that acupuncture improves hot flush [sic] frequency and severity, menopause-related symptoms, and quality of life (in the vasomotor domain) in women experiencing natural menopause.” Chiu et al, 2015.

Memory and cognition

There is a well-known link between the hormone oestrogen, and memory and cognition.

“Increased levels of oestrogen are associated with increased dendritic spine and synapse density in the hippocampus, a brain area important for learning and memory” Daniel, 2006

Oestrogen is lowered in menopause, and this may be the reason for memory and concentration problems reported by menopausal women.

Studies have shown acupuncture may help improve memory in menopausal women, (Tang et al 2013). This is thought to be due to the fact acupuncture can raise oestrogen levels in the blood (specifically serum estradiol levels) e.g. Shen et al, 2005. Studies in animals support this theory – acupuncture has also been shown to improve learning and memory by increasing brain oestrogen levels in rats (Tang et al,) 2013.

Acupuncture in iatrogenic non-menopausal hot flushes after oncology treatment

This is an increasingly researched area, that oncologists are beginning to suggest acupuncture for. A useful resource in this area is http://www.cancerresearchuk.org/hot-flushes-sweats under the “complementary therapies” section. Acupuncture has been shown to be helpful for men suffering hot flushes as a side-effect of prostate cancer treatment (Beer et al, 2010; Ashmala et al, 2010), and to women suffering hot flushes as a result of breast cancer treatment (Deng et al, 2007; Lesi et al, 2016)

Overall mechanisms of action: hormones

Blood measures before and after a course of acupuncture showed increase estraiol (an oestrogen) and decreased follicle stimulating hormone and luteotrophic hormone (LH), (rises in which are responsible for menopausal symptoms). (Chiu et al, 2016; Xia et al, 2008; Qin, 2013). In menopause, the FSH rises and the oestrogen falls, a combination of which gives rise to the symptoms. Acupuncture may therefore be said to be mediating these hormones to give symptomatic relief.

Further information

British Acupuncture Council Factsheet on Menopause: BAcC Menopause Fact Sheet

Shaftesbury Clinic’s curated page on acupuncture for women’s health scoop.it gynaecology and women’s health

References and Bibliography

Gjelsvik B, Rosvold EO, Straand J, Dalen I, Hunskaar S. Symptom prevalence during menopause and factors associated with symptoms and menopausal age. Results from the Norwegian Hordaland Women’s Cohort study. Maturitas. 2011 Dec;70(4):383-90. doi: 10.1016/j.maturitas.2011.09.011. Epub 2011 Oct 26. http://www.ncbi.nlm.nih.gov/pubmed/22033103

Wyon, Y.; Lindgren, R.; Lundeberg, T.; Hammar, M. Effects of Acupuncture on Climacteric Vasomotor Symptoms, Quality of Life, and Urinary Excretion of Neuropeptides among Postmenopausal Women. Menopause: 1995 – Volume 2 – Issue 1 Articles: PDF Only http://journals.lww.com/menopausejournal//Effects_of_Acupuncture_on_Climacteric_Vasomotor

Li, Q; Shi, G-X; Xu, Q; Wang, J; Liu, C-Z; and Wang, L-P Acupuncture Effect and Central Autonomic Regulation Evid Based Complement Alternat Med. 2013; 2013: 267959. Published online 2013 May 26. doi:  10.1155/2013/267959 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677642/

Sudhaa Sharma, Annil Mahajan, and Vishal R. Tandon Calcitonin gene-related peptide and menopause J Midlife Health. 2010 Jan-Jun; 1(1): 5–8. doi:  10.4103/0976-7800.66985 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139267/

Borud, Einar Kristian MD, MPH1; Alraek, Terje PhD1; White, Adrian MD, PhD2; Fonnebo, Vinjar MD, MSc, PhD1; Eggen, Anne Elise PhD3; Hammar, Mats MD, PhD4; Ã…strand, Lotta Lindh RN4; Theodorsson, Elvar MD, PhD4; Grimsgaard, Sameline MD, MPH, PhD1,5  The Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study, a randomized controlled trial  May/June 2009 – Volume 16 – Issue 3.         http://journals.lww.com/menopausejournal/#The_Acupuncture_on_Hot_Flushes_Among_Menopause

Y Wyona, K Wijmaa, E Nedstranda & M Hammara A comparison of acupuncture and oral estradiol treatment of vasomotor symptoms in postmenopausal women Climacteric Volume 7, Issue 2, 2004 pages 153-164 DOI:  10.1080/13697130410001713814

Cohen, Susan M. DSN, C-FNP; Rousseau, Mary Ellen MS, CNM; Carey, Bonnie L. OMD, LAc, RN Can Acupuncture Ease the Symptoms of Menopause? Holistic Nursing Practice: November/December 2003 – Volume 17 – Issue 6 – p 295–299 http://journals.lww.com/hnpjournal/Can_Acupuncture_Ease_the_Symptoms_of_Menopause

Avis, Nancy E. PhD; Coeytaux, Remy R. MD, PhD; Isom, Scott MS; Prevette, Kristen BA; Morgan, Timothy PhD Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial. Menopause: Published Ahead-of-Print doi: 10.1097/GME.0000000000000597 http://journals.lww.com/menopausejournal/Acupuncture_in_Menopause__AIM__study

Chiu, Hsiao-Yean RN, PhD; Pan, Chieh-Hsin RN, MSN; Shyu, Yuh-Kae RN, PhD; Han, Bor-Cheng PhD Tsai, Pei-Shan RN, PhD Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials Menopause: February 2015 – Volume 22 – Issue 2 – p 234–244 doi: 10.1097/GME.0000000000000260  http://journals.lww.com/menopausejournal/Effects_of_acupuncture_on_menopause_related

Chiu, Hsiao-Yean RN, PhD; Hsieh, Yu-Jung RN, MSN; Tsai, Pei-Shan RN, PhD Acupuncture to Reduce Sleep Disturbances in Perimenopausal and Postmenopausal Women: A Systematic Review and Meta-analysis Obstetrics & Gynecology: March 2016 – Volume 127 – Issue 3 – p 507–515 doi: 10.1097/AOG.0000000000001268 http://journals.lww.com/greenjournal/Acupuncture_to_Reduce_Sleep_Disturbances

Tang, C.L. Tang, H.W. Xie, Y.E. Song Electroacupuncture improves learning-memory of rats with low estrogen-induced cognitive impairment Sheng Li Xue Bao, 65 (2013), pp. 26–32 http://www.ncbi.nlm.nih.gov/pubmed/23426510

Shen, Y. Du, L. Yan, Y. Xia, H. Yan, G. Han, et al. http://www.ncbi.nlm.nih.gov/pubmed/15889510

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Grazia Lesi, Giorgia Razzini, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Benedetta Benedetti, Ermanno Rondini, Maria Bernadette Ligabue, Laura Scaltriti, Alberto Botti, Fabrizio Artioli, Pamela Mancuso, Francesco Cardini and Paolo Pandolfi Acupuncture As an Integrative Approach for the Treatment of Hot Flashes in Women With Breast Cancer: A Prospective Multicenter Randomized Controlled Trial (AcCliMaT) Published online before print March 28, 2016, doi: 10.1200/JCO.2015.63.2893 JCO March 28, 2016 JCO632893 http://jco.ascopubs.org/content/early/2016/03/23/JCO.2015.63.2893.short

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