This recent study (as of 2/09) compared the effectiveness of hormone replacement therapy (HRT) with acupuncture and ear acupressure for the relief of hot flashes. In menopause, the ovaries cease to function and an endocrine feedback ensues which creates the symptoms we associate with menopause such as hot flashes, irritability, and sleep disturbance. HRT replaces the hormones (estrogen and progesterone) the ovaries once produced. It has been associated with increased risk for breast cancer, stroke, heart disease, and blood clots.
Acupuncture Comparable with HRT in Managing Menopausal Symptoms and Regulating Hormones
Acupuncture and Auricular Acupressure in Relieving Menopausal Hot Flashes of Bilaterally Ovariectomized [ovaries removes] Chinese Women: A Randomized Controlled Trial
The objective of this study is to explore the effects of acupuncture and auricular acupressure in relieving menopausal hot flashes of bilaterally ovariectomized Chinese women. Between May 2006 and March 2008, 46 bilaterally ovariectomized Chinese women were randomized into an acupuncture and auricular acupressure group (n = 21) and a hormone replacement therapy (HRT) group (Tibolone, n = 25). Each patient was given a standard daily log and was required to record the frequency and severity of hot flashes and side effects of the treatment felt daily, from 1 week before the treatment started to the fourth week after the treatment ended. The serum levels of follicle stimulating hormone (FSH), LH and E2 were detected before and after the treatment. After the treatment and the follow-up, both the severity and frequency of hot flashes in the two groups were relieved significantly when compared with pre-treatment (P < 0.05). There was no significant difference in the severity of hot flashes between them after treatment (P > 0.05), while after the follow-up, the severity of hot flashes in the HRT group was alleviated more. After the treatment and the follow-up, the frequency of menopausal hot flashes in the HRT group was reduced more (P < 0.05). After treatment, the levels of FSH decreased significantly and the levels of E2 increased significantly in both groups (P < 0.05), and they changed more in the HRT group (P < 0.05). Acupuncture and auricular acupressure can be used as alternative treatments to relieve menopausal hot flashes for those bilaterally ovariectomized women who are unable or unwilling to receive HRT.
Hot flashes occur in the vast majority of post-menopausal women (1). An extensive questionnaire study of 506 women found that 87% had daily hot flashes (2). Hot flashes are episodic and usually accompanied by nausea, dizziness, headache, palpitations, diaphoresis or night sweats (3). Having hot flashes may decrease a woman’s quality of life by decreasing the quality of sleep and aggravating fatigue and depression (4,5). Menopausal hot flashes make most of women seek medical care during the menopausal transition (2). Menopausal hot flashes are related to a psychological or mental disorder in menopausal women and the hormonal changes in these women may be the underlying mechanism (6,7).
For those bilaterally ovariectomized pre-menopausal women, the estradiol (E2) contents in their serum were reduced by 80% (8). The abrupt decline in E2 usually leads to more frequent and severe menopausal symptoms, especially hot flashes. Menopausal hot flashes are also related to enhanced norepinephrine (NE) activity in the hypothalamus, resulting in an abrupt, transient, downward resetting of the normal thermoregulatory response set point (9, 10). Most of the bilaterally ovariectomized Chinese women have difficulty in stopping hormone replacement therapy (HRT) due to the severe menopausal symptoms.
Although HRT historically has been used as the standard treatment for hot flashes (11), many women choose not to initiate or adhere to HRT because of its potential health risks and side effects (12,13). In recent years, non-pharmacological alternative treatments are being requested by more bilaterally ovariectomized women to relieve their menopausal symptoms, especially menopausal hot flashes. A study has demonstrated that acupuncture could induce accumulation of vaginal exfoliative cells, increase the weight of adrenal, and raise the level of serum corticosterone in ovariectomized model rats (14). It is deduced that estrogen levels may be elevated using acupuncture to create compensatory hyperplasia of the adrenal cortex, thereby enhancing the transferring of androgen into estrogen in peripheral tissues (14). In as early as 1995, the acupuncture’s efficacy in relieving menopausal symptoms has been demonstrated (15).
Alternative and complementary therapies, including acupuncture, have been used increasingly in recent years to relieve menopausal symptoms (16–23), although one of them suggested that the used medical acupuncture was not any more effective for reducing menopausal hot flashes than was the chosen sham acupuncture (16). As hot flashes are the most common menopausal symptoms in bilaterally ovariectomized women, it is important to find effective, non-pharmacological treatments to relieve their menopausal hot flashes. This study was designed to explore the effects of acupuncture and auricular acupressure in relieving menopausal hot flashes of bilaterally ovariectomized Chinese women.
Between May 2006 and March 2008, 46 bilaterally ovariectomized Chinese women were recruited through advertisement to complete 12 weeks of intervention with either acupuncture and auricular acupressure or Livial (Tibolone).
Although menopause is associated with changes in the hypothalamic and pituitary hormones that regulate the menstrual cycle, menopause is not a central event, but rather primary ovarian failure (27). As the hypothalamic-pituitary-ovarian axis remains intact during the menopausal transition, FSH levels rise in response to ovarian failure and the absence of negative feedback from the ovary (27). Atresia of the follicular apparatus, in particular the granulosa cells, results in the reduced production of estrogen and inhibin, which leads to the reduced inhibin levels and the elevated FSH levels, a cardinal sign of menopause (27).
Correlations between endocrine levels and symptom severity ratings over time revealed that hot flash severity was significantly and positively related to FSH (28). Investigations of hormonal connections between hot flash severity and reproductive hormones in Study of Women’s Health Across the Nation (SWAN), Melbourne Midlife Women’s Health Project (MMWHP) and Penn Ovarian Aging Study cohorts found that decreased serum E2 and increased serum FSH were associated with the increases in hot flash severity (29–31). In an analysis of SWAN data, which modeled the effects of FSH and E2 (and other reproductive hormones) together, Randolph and colleagues noted that FSH was associated with hot flash prevalence and frequency (7).
It is well known that acupuncture is associated with homeostatic regulation, and possess effects such as buffering hormonal disturbance, modulating ovulation, as well as improving psychological or behavioral abnormity (32–34). Acupuncture in specific acupoints has been found to significantly increase blood concentrations of E2 in the ovariectomized rats (35), while reducing the elevated plasma LH due to ovariectomy (36); in addition, acupuncture also restored the number of gonadotropin-releasing hormone (GnRH) neurons in the ovariectomized rats (35). In another study, acupuncture was found to improve the reproductive disorders induced by ovariectomy in rats through modulating the blood E2 levels (37). Acupuncture may improve the function of the hypothalamic-pituitary-ovarian axis, increase blood adrenogenous androgen level and facilitate its transformation into estrogen by aromatic enzyme in the brain, liver and fat tissues (38–40).
The present study showed that acupuncture and auricular acupressure significantly relieve the severity and frequency of menopausal hot flashes. The levels of FSH decreased significantly and the level of E2 increased significantly in both of the two groups after treatment. As the increased levels of FSH and the lowered level of E2 are mainly associated with hot flashes during the menopausal transition (29–31), it may be partly through decreasing the levels of FSH and increasing the levels of E2 that acupuncture and auricular acupressure alleviate the severity and frequency of menopausal hot flashes of the bilaterally ovariectomized Chinese women. In comparison with HRT, although acupuncture did not change hormone levels as significantly as HRT in this study, the bilaterally ovariectomized women’s own functions may be regulated with the use of acupuncture, while HRT restores the body’s hormone level by exogenous hormones.
Acupuncture has been found to significantly reduce the severity of nocturnal hot flashes in post-menopausal women (19). Standardized and individually tailored acupuncture treatment was also found to significantly decrease the severity of hot flashes in symptomatic post-menopausal women when compared with placebo acupuncture of equal duration (23). Another study showed that acupuncture and applied relaxation significantly reduced the number of menopausal hot flashes (22). The present study showed that acupuncture and auricular acupressure significantly relieve the severity and frequency of menopausal hot flashes. However, as the sample size of the present study was small and the sham-acupuncture was not used, the conclusion may be somewhat limited.
Another study demonstrated that the control interventions were equally as effective as acupuncture in alleviating pain in conditions that are predominantly associated with affective components such as migraines or lower back pain, but not those with a more pronounced sensory component, such as osteoarthritis of the knee or lateral epicondylalgia (54). Some previous research also showed that nearly 40% of the participants in clinical research were able to detect a difference between the active and placebo needles at active points (55). In a clinical study on the effect of acupuncture in treating post-menopausal hot flashes, although they combined the use of placebo needles with sham points in the placebo treatment, a difference in the patients’ expectations of benefit was still found, and they considered finding an optimal placebo for acupuncture remained a challenge for future studies (23). In addition, as most of the middle-aged Chinese people have had experiences receiving acupuncture treatments, it is even more difficult to simulate real acupuncture in clinical researches. This is why the study did not attempt to use sham-acupuncture as a control. Although this may introduce bias into trials, extensive details regarding the baseline characteristics of the recruited women were collected before treatment and between the two groups, no significant difference in the patients’ detailed baseline characteristics existed. Further research with larger samples needs to be conducted.
Acupuncture and auricular acupressure can be used as alternative treatments to relieve menopausal hot flashes for those bilaterally ovariectomized women who are unable or unwilling to receive HRT.
Received May 8, 2008; accepted January 12, 2009
Full article: http://ecam.oxfordjournals.org/cgi/content/full/nep001