EXECUTIVE SUMMARY
Acupuncture treatments can reduce the number of hot flashes and night sweats associated with menopause by as much as 36%, according to recently published data. Additional research is needed to identify individual differences in response to acupuncture, researchers note.
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According to the North American Menopause Society, hot flashes occur in up to 75% of women. Although most women experience them for six months to two years, some women may experience bothersome hot flashes for 10 years or longer.
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Treatment For Hot Flashes Should Be Considered If Symptoms Are Bothersome, Disrupt Sleep, Or Adversely Affect Quality Of Life. Such Therapy Should Be Tailored To Each Patient’s Medical History, Treatment Goals, And Personal Attitudes Toward Menopause And Medication Use.
Acupuncture treatments can reduce the number of hot flashes and night sweats associated with menopause by as much as 36%, according to recently published data.1
According to the North American Menopause Society, hot flashes occur in up to 75% of women. Although most women experience them for six months to two years, some women may experience bothersome hot flashes for 10 years or longer.2
Women are eager to find safe and effective treatments for hot flashes, especially following the results of the Women’s Health Initiative (WHI) that found a number of risks associated with hormone therapy, explains Nancy Avis, PhD, professor of public health sciences at Wake Forest Baptist Medical Center and lead author of the current study. In 2002, the WHI trial of estrogen plus progestin in women with an intact uterus was halted when early data indicated increased risks of breast cancer, coronary heart disease, stroke, and pulmonary embolism outweighed potential benefits.3 In 2004, scientists also ceased the companion trial of estrogen alone in hysterectomized women, due to an increased risk of stroke.4
Researchers in the current study focused on acupuncture because several studies, including their own pilot work, have shown that acupuncture has the potential to reduce hot flashes, says Avis. The scientists wanted to see if acupuncture, as practiced in the community, could be effective at reducing menopausal hot flashes, she explains.
Look at the Trial
The study, funded by the National Institutes of Health, included 209 women ages 45-60 who had not had a menstrual period for at least three months and had on average at least four hot flashes or night sweats per day in the previous two weeks.
Each woman received a baseline assessment and was randomized to one of two groups. Women in the first group received acupuncture treatments during the first six months, then were followed without receiving acupuncture for the second six months. Women in the second group did not receive any acupuncture during the first six months, but did receive acupuncture for the second six months. Each woman was allotted up to 20 treatments within six months, with treatments provided by licensed, experienced acupuncturists.
All participants kept a daily diary on the frequency and severity of their hot flashes, and they answered questionnaires about other symptoms every two months. The primary outcome was mean daily frequency of vasomotor symptoms, with secondary outcomes listed as:
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vasomotor symptom interference with daily life;
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sleep quality;
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depressive symptoms;
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somatic and other symptoms;
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anxiety;
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quality of life.
What were the study’s findings? After six months, the first group reported an average 36.7% decline in frequency of hot flashes compared to baseline measurements. After a year, the benefits persisted, with the group members maintaining an average 29.4% reduction from baseline. Members of the second group reported a 6% increase in symptom frequency during the six months when they were not getting acupuncture, but they had an average 31% reduction in frequency of symptoms after receiving acupuncture during the latter part of the trial. Additional research is needed to identify individual differences in response to acupuncture, researchers note.1
What Are the Options?
According to the North American Menopause Society’s recommendations for clinical care of midlife women, “treatment for hot flashes should be considered if symptoms are bothersome, disrupt sleep, or adversely affect quality of life.”2 Such therapy should be tailored to each patient’s medical history, treatment goals, and personal attitudes toward menopause and medication use, the guidance advises.
Professional societies, including the North American Menopause Society, the American College of Obstetricians and Gynecologists, and the Endocrine Society, support the use of systemic hormone therapy in symptomatic, recently menopausal women who don’t have contraindications, such as an excess risk of breast cancer or cardiovascular disease, and who have a personal preference for such therapy.5,6 For patients in this category who present with moderate-to-severe vasomotor symptoms, a consensus has emerged that the benefits of hormone therapy are likely to outweigh the risks.7 (Contraceptive Technology Update reported on information concerning sound choices on hormonal options. Readers can see the story “Management of your patients’ menopause — Is your care on the right track?” May 2016, at http://bit.ly/1PMuthX.)
The North American Menopause Society brought together experts to take a critical look at all the available studies on herbs, supplements, and other nonhormonal approaches for treating hot flashes. The experts found that besides, perhaps, soy foods and supplements, no other herbal or supplement showed an effect any greater than placebo, notes JoAnn Pinkerton, MD, NCMP, Society executive director.
In its guidance, the Society notes that complementary/alternative medicine approaches, including acupuncture, herbal products, dietary soy, and isoflavone products, may be offered to treat vasomotor symptoms, although clinical trials generally demonstrate benefit for menopausal symptoms similar to that of placebo.2
REFERENCES
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Avis NE, Coeytaux RR, Isom S, et al. Acupuncture in Menopause (AIM) study: A pragmatic, randomized controlled trial. Menopause 2016; 23(6):626-637.
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Shifren JL, Gass ML. NAMS Recommendations for Clinical Care of Midlife Women Working Group. The North American Menopause Society recommendations for clinical care of midlife women. Menopause 2014; 21(10):1038-1062.
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Rossouw JE, Anderson GL, Prentice RL, et al. Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin for healthy postmenopausal women. JAMA 2002; 288:321-333.
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Anderson GL, Limacher M, Assaf AR, et al. Women’s Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. JAMA 2004; 291:1701-1712.
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Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2015; 100:3975-4011.
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Santen RJ, Stuenkel CA, Burger HG, et al. Competency in menopause management: Whither goest the internist? J Womens Health (Larchmt) 2014; 23:281-285.
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Manson JE, Kaunitz, AM. Menopause management — Getting clinical care back on track. N Engl J Med 2016; 374(9):803-806.
