Category: Gynaecology

An American umbrella systematic review assessing the benefits of acupuncture for menopause symptoms, has concluded that evidence from randomised controlled trials supports its use. Data was taken from three systematic reviews covering over 1100 women, and from four randomised controlled trials covering 700 women. There were statistically significant differences associated with acupuncture treatment, either adjunctive or stand-alone, compared with no acupuncture, for reducing vasomotor symptoms eg hot flushes and night sweats, and improving health-related quality of life. Follow-up times varied but some studies demonstrated reductions in hot flush frequency lasting 12 months or more. Differences were smaller or not statistically significant when acupuncture was compared with sham acupuncture.

The authors conclude that the evidence supports the use of acupuncture to treat menopausal vasomotor symptoms, although the clinical benefits may be partly due to non-specific effects.

(Management of Menopause Symptoms with Acupuncture: An Umbrella Systematic Review & Meta-Analysis. Journal of Alternative & Complementary Medicine, April 2018.)

A new study by Brazilian researchers suggests an association between adherence to the Mediterranean diet, and bone density and muscle mass in post-menopausal women. This diet involves a high intake of fruit, vegetables, grains, potatoes, olive oil and seeds, moderately high fish intake, plus low saturated fat, dairy and red meat consumption, and regular but moderate intake of red wine. The Mediterranean diet has previously been linked to a lower risk of heart disease, diabetes and cancer.

A total of 103 healthy women from southern Brazil, average age 55 and who had gone through menopause a mean 5.5 years earlier, underwent measurements of their bone mineral density, total body fat and lean mass. The subjects also completed a food questionnaire about what they had eaten in the past month.

A higher Mediterranean diet score, meaning better adherence to the Mediterranean diet, was significantly associated with higher bone mineral density measured at the lumbar spine, and with greater muscle mass. This association was independent of whether the women had previously used hormone replacement therapy, their smoking behaviour or their current level of physical activity.

(Mediterranean diet is linked to higher muscle mass, bone density after menopause. The Endocrine Society, on-line press release 20 March 2018.)

The largest and most rigorous study of its kind has found that acupuncture significantly reduces the joint pain experienced by women having treatment for early stage breast cancer and taking aromatase inhibitors (eg Arimidex, Aromasin,Femara). These drugs are normally prescribed for post-menopausal women whose breast cancers are hormone receptor-positive, but up to 50% of patients who take them experience significant joint pain and stiffness.

In the multi-centre clinical trial led by researchers at NewYork-Presbyterian Hospital and Columbia University Irving Medical Center, 226 women were randomised to receive either true acupuncture, sham control or no treatment. Sessions were given twice a week for six weeks, then weekly for a further six weeks. After six weeks, the improvement seen in the true acupuncture group compared to the other two groups, was significantly greater, and larger than that exhibited by antidepressants when they are used for cancer pain. Around 30% of control group participants reported a clinically meaningful change, whereas the same figure for the true acupuncture group was 58%. Additionally, unlike the results of drug therapy, the pain relief from acupuncture was still apparent 24 weeks after treatment had ended.

Dr. Katherine Crew, director of the Clinical Breast Cancer Prevention Program at NewYork-Presbyterian/Columbia University Irving Medical Center says “There are so few side effects [to acupuncture] and it’s non-addictive. This has real implications for patients in how patients can address their pain. Our goal now is to make sure patients have access to it and that insurance will cover it, just like they would for a pain medication.”

(NewYork-Presbyterian News, on-line 7 December 2017.

Postscript: Effect of Acupuncture vs Sham Acupuncture or Waitlist Control on Joint Pain Related to Aromatase Inhibitors Among Women With Early-Stage Breast Cancer: A Randomized Clinical Trial. Journal of the American Medical Association, 10 July 2018.)

Researchers in China have found that acupuncture can contribute to clinically relevant improvements in perimenopausal insomnia, both objectively and subjectively. A total of 76 such patients were randomised to receive either ten sessions of acupuncture or sham needling at the same points, over a period of three weeks. After treatment, sleep quality improved by 8.0 points in the acupuncture group versus 1.3 points in the sham group. Insomnia severity scores reduced by 11.3 points in the acupuncture group, and 2.9 points in the sham group.

Further, overnight polysomnography at baseline and completion of treatment, showed that acupuncture significantly improved sleep efficiency and total sleep time, and was associated with both more rapid sleep onset and less waking after falling asleep. No significant differences between baseline and post-treatment were found in the placebo group.

(Acupuncture Improves Peri-menopausal Insomnia: A Randomized Controlled Trial. Sleep, 22 September 2017.)

A research collaboration from Australia and New Zealand investigating the effects of acupuncture for period pain, has shown that it can reduce pain intensity, and its effects are still apparent one year later. A total of 74 women aged 18 to 45 were randomly allocated to one of four treatment combinations: once per week or three times per week, acupuncture or electro-acupuncture. A total of 12 treatments were given over three menstrual cycles. All groups received a treatment in the first 2 days of a period.

After three months of treatment, acupuncture was found to reduce period pain intensity and duration, and this improvement was sustained at one year follow-up. Compared to the electro-acupuncture groups, the manual acupuncture patients required fewer painkillers, otherwise there was little difference between the groups. The authors identify a “lack of satisfaction in standard treatment, leading to an increase in self-care, with women commonly using complementary therapies to deal with their menstrual pain in addition to, or instead of, pharmaceutical pain relief, due to a lack of perceived effectiveness or a dislike of using analgesic medication”.

(The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: An exploratory randomised controlled trial. PLoS One, July 2017.)