Acupuncture and Menopause
17 July 2002,
updated 23 October 2003
As a woman in the midst of menopause, the complexities of treatment choices for
menopause are very real to me. As I read the literature and explore the
treatment possibilities for myself, I am also thinking the perimenopausal and
menopausal women who are in treatment at Turning Point Acupuncture. Each
woman's experience is unique, and her needs are different at different stages
of this process. How can we each make the right treatment choices for
ourselves?
This page reviews the current thinking on the indications for use of
conventional hormone replacement therapy (HRT), the dangers of using HRT, and
outlines alternative strategies including acupuncture and Chinese herbs. As
this is a rapidly changing area, consider this page a work in progress!
Contents
1. Overview
2. Traditional Chinese Medicine (TCM) and menopause
3. Other alternative treatments
4. Links
1. Overview
This year we have read with increasing alarm reports of the perils and
inefficacy of hormone replacement therapy (HRT) for women in and around
menopause. Just this week the front page of the New York Times reported that a
large federal study of HRT in post-menopausal women was abruptly halted because
of an increased risk of invasive breast cancer. Uterine cancer has been an
acknowledged risk for years. The previously touted reasons for taking HRT,
i.e., an overall improvement in women's health that would include reduced risk
of heart disease, prevention of osteoporosis and Alzheimer's disease, have all
recently been called into question. Indeed, studies have shown that while there
is no decrease in heart attacks, there is an increased risk of thromboembolism
(blood clots and strokes). There is also an increased risk (48% higher than the
general population) of gallbladder disease requiring surgery.
The bottom line on this issue appears to be that HRT consisting of estrogen
combined with progesterone is indicated for the short term relief of acute
menopausal symptoms: hot flashes, night sweats and vaginal dryness. The
estrogen relieves the symptoms and the progesterone insures that the lining of
the uterus does not get overdeveloped leading to an increased risk of uterine
cancer. Estrogen taken unopposed is contraindicated in all women except those
who have had a hysterectomy. The lining should be monitored by endometrial
biopsy and /or sonogram. Yearly mammograms are a must.
Recently lower dose estrogen therapy has become available in the form of the
patch and the vaginal ring. Since the estrogen in these sources doesn't have to
go through the liver, they are thought to be safer. Periodic progesterone is
still needed to prevent endometrial overgrowth.
If you decide to go off your HRT, current thinking indicates that slowly
tapering from HRT is less likely to trigger symptoms.
And, to put this myth to rest, long term HRT treatment does not prolong a
youthful appearance and, as is increasingly obvious, is dangerous to your
health.
2. Traditional Chinese Medicine (TCM) and menopause
While menopause is viewed as a disease in Western Medicine, this transitional
time for women is viewed very differently in TCM. When a woman is finished with
her child bearing years, to conserve the woman's Qi (life force energy), the
body shuts down the monthly preparation of the uterus and the subsequent
shedding of blood when a pregnancy does not ensue. This closing of the
"baby making apparatus" allows the woman to retain all of her
resources for herself as she ages. This transition should be relatively
uneventful - and in the East, be it because of diet or lifestyle, it often is.
Here in our city, particularly because of the fast paced, stressful lifestyle
of the urban contemporary woman, there tends to be underlying Qi problems, such
as, kidney yin deficiency and constrained liver Qi. It is beyond the scope of
this webpage to delineate these, but to point out that these underlying
patterns of disharmony give rise to the typical menopausal symptom complex of
hot flashes, night sweats and the like. TCM has described strategies to address
these patterns for 1000's of years. Acupuncture is helpful to balance the Qi
and to strengthen internal organ systems. Chinese herbs can address the
disharmonies. Two formulas in our formulary are frequently used: Three
Immortals addresses the general patterns associated with the menopausal
transition.Great Yin is used for women who exhibit heat symptoms like hot
flashes. ( Dr. Chuan-Min Wangˇ¦ note: I like use Jia Wei Xiao Yao San for both)
TCM treatment for menopause with acupuncture and Chinese herbs can be initiated
while a woman is still on HRT.
3. Other alternative treatments
Black cohosh - to address symptoms
An exciting new double blind study from Germany showed that black cohosh was as
effective in relieving acute menopausal symptoms as estrogen therapy but did
not stimulate the growth of the uterine lining. Furthermore the study
demonstrated that blood lipid levels improved and there was an increase in
bone-specific alkaline phosphatase indicating some benefit in preventing bone
loss. We carry Metagenics Black Cohosh Plus™. (Black Cohosh Root and Rhizome
Extract (Cimicifuga racemosa) 80 mg (standardized to 2.5% [2 mg] triterpene
glycosides as 27-deoxyactein). The dose is one tablet twice daily.
Calcium - to address bone loss
One of the significant benefits of HRT has been in preventing osteoporosis.
Alternatives exist in the Western formulary, such as Fosamax, but many women
find these drugs to be both irritating to the GI tract and inconvenient. Taking
calcium supplementation alone may be inadequate to stimulate bone growth
(osteoblastic activity). Weight bearing exercise is necessary to encourage
that. At Turning Point we are excited about a new calcium product Cal Apatite
Plus® from Metagenics that contains Ipriflavone. Studies have shown that
Ipriflavone works like Fosamax to stimulate bone growth. We recommend this
compound for postmenopausal women whose bone density tests reveal bone loss.
The dosage is 3 tablets twice daily. Cal Apatite Plus® should be taken for a
year and thereafter alternated with a simple calcium hydroxyapatite formulation
(like Cal Apatite® 1000). Menopausal and perimenopausal women with normal bone
density tests should take this formula one tab twice daily. All calcium should
be taken with food as stomach acid is necessary for assimilation.
Soy products - to address cardiac health
Soy protein is controversial at the moment as health professionals around the
world are debating the benefits/risks of soy foods in estrogen driven cancer.
Isoflavones appear to act as selective estrogen receptor modifiers (SERMs) and
compete with endogenous estrogens for binding to estrogen receptors.
Isoflavones' ability to modify these estrogen receptors may be the reason for
the lowered incidence of breast cancer in Asian women who consume soy. Most
studies show that soy does little to decrease the incidence of hot flashes. At
the very least soy is very helpful in promoting cardiac health and lowering
cholesterol. Current thinking is that safe amounts are 21-24 grams of soy
protein and approximately 40-45 milligrams of isoflavones per day. I like to
get my soy protein in the form of a protein drink and usually have one
Ultrameal shake daily. Ultrameal, which we carry in the office, is a complete
food that provides 15 grams of non-GMO soy protein and 17mgs of isoflavones,
comes in delicious flavors and is easy to prepare: 2 scoops, 8 ounces of water
and shake. Great for women on the go.
Other strategies ˇV Some are obvious but bear repeating...
A "healthy" lifestyle, stress reduction and a good diet are to be
encouraged.
To prevent clotting disorders (especially for women who choose to continue on
HRT) smoking must be avoided.
Caffeine, alcohol and spicy foods (aside from their negative effects on the
internal organs) tend to prompt hot flashes.
Weight bearing exercise benefits bone growth.
Aerobic exercise promotes cardiovascular health and controls fat deposition.
Vitamin supplementation, particularly vitamin E in amounts up to 1200 units may
be helpful.