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!
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.