Effect of acupuncture on hot flush and menopause symptoms in breast cancer – A systematic review and meta-analysis.
“…acupuncture is as effective as hormone therapy for alleviating the general symptoms of menopause in breast cancer patients undergoing hormone therapy“
PLoS One. 2017 Aug 22;12(8):e0180918.
A systematic review by Taiwanese authors has found that acupuncture is as effective as hormone therapy for alleviating the general symptoms of menopause in breast cancer patients undergoing hormone therapy. Their meta-analysis examined data from 13 medium-to-high quality RCTs involving 844 breast cancer patients.
The results indicated that acupuncture significantly ameliorated general menopause symptoms including negative mood, sleep problems, pain, headache and dizziness. While meta analysis suggested that acupuncture did not reduce the severity of hot flushes compared with hormone therapy, the side effects of drug therapy are significant and its safety profile is poor by comparison.
The authors suggest that the mechanism by which acupuncture alleviates menopause symptoms might include regulation of cytokines and the autonomic nervous system.
Chinese Herbal Medicine for Premature Ovarian Failure: A Systematic Review and Meta-Analysis
“The pooled data showed an improvement in symptoms in the Chinese Herbal Medicine group compared to that of the HRT group … FSH levels were significantly lower in patients treated with CHM compared to that of patients treated with HRT … There was no significant difference (P > 0.05) observed in E2 and LH levels when CHM and HRT were compared. Conclusions CHM may relieve symptoms of POF partly through decreasing serum FSH levels, this may provide guidance for future studies. “
Article in European Journal of Integrative Medicine 6(3) · June 2014
Introduction Premature ovarian failure (POF), loss of normal ovarian function before the age of 40 commonly results in infertility. This systematic review/meta-analysis evaluates the effectiveness of Chinese herbal treatments on POF.
Methods: Systematic searches of six electronic databases were conducted for articles published through June 2013. All randomized controlled trials which compared Chinese herbal medicine (CHM) as solitary treatment versus hormone replacement therapy (HRT) for POF were included. Measurement of treatment effect was done through pooled odds ratio (OR) of effective cases in the two groups, and weighted mean difference (WMD) of hormonal levels (E2, FSH, LH) after treatment.
Results: This meta-analysis includes 10 randomized controlled trials (RCTs) involving 888 patients in comparing CHM with HRT for the treatment of POF. The pooled data showed an improvement in symptoms in the CHM group compared to that of the HRT group (OR = 2.50, 95% CI: 1.49–4.18, P < 0.001). FSH levels were significantly lower in patients treated with CHM compared to that of patients treated with HRT (≥6 M: WMD = -8.34, 95% CI: -11.96, P < 0.001, -4.71; <6 M: WMD = -5.23, 95% CI: -8.68, -1.78, P = 0.003). There was no significant difference (P > 0.05) observed in E2 and LH levels when CHM and HRT were compared.
Conclusions: Chinese Herbal Medicine may relieve symptoms of Premature Ovarian Failure partly through decreasing serum FSH levels, this may provide guidance for future studies.
Chinese Herbal Medicine for Premature Ovarian Failure: A Systematic Review and… | Request PDF. Available from: https://www.researchgate.net/publication/260155840_Chinese_Herbal_Medicine_for_Premature_Ovarian_Failure_A_Systematic_Review_and_Meta-Analysis [accessed Feb 20 2018].
Effects of traditional Chinese medicine on symptom clusters during the menopausal transition.
The Chinese medicine therapies of “acupuncture, CHM and moxibustion show promising results for the treatment of mood and pain symptoms co-occurring with hot flushes”
Climacteric. 2015 Apr;18(2):142-56. doi: 10.3109/13697137.2014.937687. Epub 2014 Oct 18.
Taylor-Swanson L1, Thomas A, Ismail R, Schnall JG, Cray L, Mitchell ES, Woods NF.
To review controlled clinical trials of traditional Chinese medicine (TCM) therapies for hot flushes and at least one other co-occurring symptom among sleep, cognitive function, mood, and pain.
An experienced reference librarian performed an extensive search of PubMed/Medline, CINAHL Plus, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, AMED, and Alt-Health Watch for randomized, controlled trials reported in English between 2004 and July 2011. Of 1193 abstracts identified, 58 trials examined effectiveness of therapies for hot flushes and at least one additional co-occurring symptom.
Eleven trials (13 publications) examined TCM therapeutics of acupuncture, Chinese herbal medicine (CHM) or moxibustion. Acupuncture trials (eight) yielded mixed results; five trials significantly reduced hot flushes. Of those five trials, one also showed benefit for sleep and pain and two trials found benefit for mood symptoms. Of three CHM trials, three trials had significant findings: one for hot flushes and mood, one for hot flushes and pain, and one for hot flushes, sleep, mood symptoms and pain. Moxibustion and counseling (one trial) significantly reduced hot flushes, mood symptoms and pain. None of the trials reported any serious adverse events.
TCM therapeutics of acupuncture, CHM and moxibustion show promising results for the treatment of mood and pain symptoms co-occurring with hot flushes. Although the controlled clinical trials of TCM therapeutics reviewed here measured multiple symptom outcomes, few report treatment effects in ways that allow clinicians to consider symptom clusters when prescribing therapies. Future studies need to measure and report results for individual symptoms or group like symptoms together into subscales. Controlled clinical trials with larger numbers of participants are essential to allow evaluation of these therapies on hot flushes and multiple co-occurring symptoms.
A negative review for Chinese herbs and menopause
Chinese herbal medicine for menopausal symptoms.
“We found insufficient evidence that Chinese herbal medicines were any more or less effective than placebo or HT for the relief of vasomotor symptoms. Effects on safety were inconclusive. ”
Cochrane Database Syst Rev. 2016 Mar 15;3:CD009023. doi: 10.1002/14651858.CD009023.pub2.
Zhu X1, Liew Y, Liu ZL.
Chinese herbal medicine (CHM) usage is expected to increase as women suffering from menopausal symptoms are seeking alternative therapy due to concerns from the adverse effects (AEs) associated with hormone therapy (HT). Scientific evidence for their effectiveness and safety is needed.
To evaluate the effectiveness and safety of CHM in the treatment of menopausal symptoms.
We searched the Gynaecology and Fertility Group’s Specialised Register of controlled trials, Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), MEDLINE, Embase, CINAHL, AMED, and PsycINFO (from inception to March 2015). Others included Current Control Trials, Citation Indexes, conference abstracts in the ISI Web of Knowledge, LILACS database, PubMed, OpenSIGLE database, and China National Knowledge Infrastructure database (CNKI, 1999 to 2015). Other resources included reference lists of articles as well as direct contact with authors.
Randomised controlled trials (RCTs) comparing the effectiveness of CHM with placebo, HT, pharmaceutical drugs, acupuncture, or another CHM formula in women over 18 years of age, and suffering from menopausal symptoms.
DATA COLLECTION AND ANALYSIS:
Two review authors independently assessed 864 studies for eligibility. Data extractions were performed by them with disagreements resolved through group discussion and clarification of data or direct contact with the study authors. Data analyses were performed in accordance with Cochrane Collaboration guidelines.
We included 22 RCTs (2902 women). Participants were from different ethnic backgrounds with the majority of Chinese origin.When CHM was compared with placebo (eight RCTs), there was little or no evidence of a difference between the groups for the following pooled outcomes: hot flushes per day (MD 0.00, 95% CI -0.88 to 0.89; 2 trials, 199 women; moderate quality evidence); hot flushes per day assessed by an overall hot flush score in which a difference of one point equates to one mild hot flush per day (MD -0.81 points, 95% CI -2.08 to 0.45; 3 RCTs, 263 women; low quality evidence); and overall vasomotor symptoms per month measured by the Menopause-Specific Quality of Life questionnaire (MENQOL, scale 0 to 6) (MD -0.42 points; 95% CI -1.52 to 0.68; 3 RCTs, 256 women; low quality evidence).In addition, results from individual studies suggested there was no evidence of a difference between the groups for daily hot flushes assessed by severity (MD -0.70 points, 95% CI -1.00, -0.40; 1 RCT, 108 women; moderate quality evidence); or overall monthly hot flushes scores (MD -2.80 points, 95% CI -8.93 to 3.33; 1 RCT, 84 women; very low quality evidence); or overall daily night sweats scores (MD 0.07 points, 95% CI -0.19 to 0.33, 1 RCT, 64 women; low quality evidence); or overall monthly night sweats scores (MD 1.30 points, 95% CI -1.76 to 4.36, 1 RCT, 84 women; very low quality evidence). However one study using the Kupperman Index reported that overall monthly vasomotor symptom scores were lower in the CHM group (MD -4.79 points, 95% CI -5.52 to -4.06; 1 RCT, 69 women; low quality evidence).When CHM was compared with hormone therapy (HT) (10 RCTs), only two RCTs reported monthly vasomotor symptoms using MENQOL. It was uncertain whether CHM reduces vasomotor symptoms (MD 0.47 points, 95% CI -0.50 to 1.44; 2 RCTs, 127 women; very low quality evidence).Adverse effects were not fully reported in the included studies. Adverse events reported by women taking CHM included mild diarrhoea, breast tenderness, gastric discomfort and an unpleasant taste. Effects were inconclusive because of imprecise estimates of effects: CHM versus placebo (RR 1.51; 95% CI 0.69 to 3.33; 7 trials, 705 women; I² = 40%); CHM versus HT (RR 0.96; 95% CI 0.66 to 1.39; 2 RCTs, 864 women; I² = 0%); and CHM versus specific conventional medications (such as Fluoxetine and Estazolam) (RR 0.20; 95% CI 0.03 to 1.17; 2 RCTs, 139 women; I² = 61%).
We found insufficient evidence that Chinese herbal medicines were any more or less effective than placebo or HT for the relief of vasomotor symptoms. Effects on safety were inconclusive. The quality of the evidence ranged from very low to moderate; there is a need for well-designed randomised controlled studies.
The use of herbs and hormones together; more or less dangerous?
Concurrent use of Chinese herbal medicine among hormone users and its association with ischemic stroke risk: A population-based study.
“We found that combined use of hormone therapy and Chinese herbal medicine was associated with a lower risk of ischemic stroke. Further study is needed to examine possible mechanism underlying this association.”
J Ethnopharmacol. 2018 Jan 31;216:274-282. doi: 10.1016/j.jep.2018.01.020. [Epub ahead of print]
Concurrent use of Chinese herbal medicine among hormone users and its association with ischemic stroke risk: A population-based study.
Wen SH1, Chang WC2, Hong MK3, Wu HC4.
Previous studies had indicated that hormone therapy (HT) may increase the risk of ischemic stroke (IS) in menopausal women. However, little is known about the benefits and risks of use of Chinese herbal medicine (CHM) in conditions related to hormone use. The aim of this study is to explore the risk of IS in menopausal women treated with HT and CHM.
MATERIALS AND METHODS:
A total of 32,441 menopausal women without surgical menopause aged 40-65 years were selected from 2003 to 2010 using the 2-million random samples of the National Health Insurance Research Database in Taiwan. According to the medication usage of HT and CHM, we divided the current and recent users into two groups: an HT use-only group (n = 4989) and an HT/CHM group (n = 9265). Propensity-score matching samples (4079 pairs) were further created to deal with confounding by indication. The adjusted hazard ratios (HR) of IS were estimated by the robust Cox proportional hazards model.
The incidence rate of IS in the HT/CHM group was significantly lower than in the HT group (4.5 vs. 12.8 per 1000 person-year, p < 0.001). Multivariate analysis results indicated that additional CHM use had a lower risk of IS compared to the HT group (HR = 0.3; 95% confidence interval [CI], 0.21-0.43). Further subgroup analyses and sensitivity analyses had similar findings.
We found that combined use of HT and CHM was associated with a lower risk of IS. Further study is needed to examine possible mechanism underlying this association.
Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials.
“This meta-analysis confirms that acupuncture improves hot flash frequency and severity, menopause-related symptoms, and quality of life (in the vasomotor domain) in women experiencing natural menopause.”
Menopause. 2015 Feb;22(2):234-44. doi: 10.1097/GME.0000000000000260.
Chiu HY1, Pan CH, Shyu YK, Han BC, Tsai PS.
This meta-analysis aims to evaluate the effects of acupuncture on hot flash frequency and severity, menopause-related symptoms, and quality of life in women in natural menopause.
We systematically searched PubMed/Medline, PsychINFO, Web of Science, Cochrane Central Register of Controlled Trials, and CINAHL using keywords such as acupuncture, hot flash, menopause-related symptoms, and quality of life. Heterogeneity, moderator analysis, publication bias, and risk of bias associated with the included studies were examined.
Of 104 relevant studies, 12 studies with 869 participants met the inclusion criteria and were included in this study. We found that acupuncture significantly reduced the frequency (g = -0.35; 95% CI, -0.5 to -0.21) and severity (g = -0.44; 95% CI, -0.65 to -0.23) of hot flashes. Acupuncture significantly decreased the psychological, somatic, and urogenital subscale scores on the Menopause Rating Scale (g = -1.56, g = -1.39, and g = -0.82, respectively; P < 0.05). Acupuncture improved the vasomotor subscale score on the Menopause-Specific Quality of Life questionnaire (g= -0.46; 95% CI, -0.9 to -0.02). Long-term effects (up to 3 mo) on hot flash frequency and severity (g = -0.53 and g = -0.55, respectively) were found.
This meta-analysis confirms that acupuncture improves hot flash frequency and severity, menopause-related symptoms, and quality of life (in the vasomotor domain) in women experiencing natural menopause.
Effects of Acupuncture on Menopause-Related Symptoms in Breast Cancer Survivors: A Meta-analysis of Randomized Controlled Trials.
“Acupuncture significantly reduced the frequency of hot flashes and severity of menopause-related symptoms immediately after the completion of treatment.”
Cancer Nurs. 2016 May-Jun;39(3):228-37. doi: 10.1097/NCC.0000000000000278.
Chiu HY1, Shyu YK, Chang PC, Tsai PS.
BACKGROUND: Evidence regarding the effects of acupuncture on hot flashes in breast cancer survivors is conflicting. Little is known about the intermediate-term effects of acupuncture on hot flashes and other menopause-related symptoms in breast cancer survivors.
OBJECTIVE: The objective of this study was to evaluate the short-term and intermediate-term effects of acupuncture on menopause-related symptoms and particularly on hot flashes in breast cancer survivors.
METHODS: Electronic databases including EMBASE, PubMed, PsycINFO, Web of Science, CINAHL, Wanfang Data Chinese Database, and China Knowledge Resource Integrated Database from inception until June 15, 2014, were searched. Randomized controlled trials in which acupuncture was compared with sham controls or other interventions according to the reduction of hot flashes or menopause-related symptoms in breast cancer survivors were included.
RESULTS: We analyzed 7 studies involving 342 participants. Acupuncture significantly reduced the frequency of hot flashes and severity of menopause-related symptoms (g = -0.23 and -0.36, respectively) immediately after the completion of treatment. In comparison with sham acupuncture, effects of true acupuncture on the frequency and severity of hot flashes were not significantly different. At 1 to 3 months’ follow-up, the severity of menopause-related symptoms remained significantly reduced (g = -0.56).
Acupuncture yielded small-size effects on reducing hot-flash frequency and the severity of menopause-related symptoms.
IMPLICATIONS FOR PRACTICE:
Acupuncture may be used as a complementary therapy for breast cancer survivors experiencing hot flashes and other menopause-related symptoms; however, whether acupuncture exerts specific treatment effects other than needling or placebo effects needs to be further evaluated.
Electroacupuncture Versus Gabapentin for Hot Flashes Among Breast Cancer Survivors: A Randomized Placebo-Controlled Trial.
J Clin Oncol. 2015 Nov 1;33(31):3615-20. doi: 10.1200/JCO.2015.60.9412. Epub 2015 Aug 24.
In a study concerned specifically with evaluating placebo effects, the authors nonetheless found that “electro-acupuncture may be more effective than Gabapentin, with fewer adverse effects for managing hot flashes among breast cancer survivors; however, these preliminary findings need to be confirmed in larger randomized controlled trials with long-term follow-up.”
Mao JJ1, Bowman MA2, Xie SX2, Bruner D2, DeMichele A2, Farrar JT2.
PURPOSE: Hot flashes are a common and debilitating symptom among survivors of breast cancer. This study aimed at evaluating the effects of electroacupuncture (EA) versus gabapentin (GP) for hot flashes among survivors of breast cancer, with a specific focus on the placebo and nocebo effects.
PATIENTS AND METHODS: We conducted a randomized controlled trial involving 120 survivors of breast cancer experiencing bothersome hot flashes twice per day or greater. Participants were randomly assigned to receive 8 weeks of EA or GP once per day with validated placebo controls (sham acupuncture [SA] or placebo pills [PPs]). The primary end point was change in the hot flash composite score (HFCS) between SA and PP at week 8, with secondary end points including group comparisons and additional evaluation at week 24 for durability of treatment effects.
RESULTS: By week 8, SA produced significantly greater reduction in HFCS than did PP (-2.39; 95% CI, -4.60 to -0.17). Among all treatment groups, the mean reduction in HFCS was greatest in the EA group, followed by SA, GP, and PP (-7.4 v -5.9 v -5.2 v -3.4; P = < .001). The pill groups had more treatment-related adverse events than did the acupuncture groups: GP (39.3%), PP (20.0%), EA (16.7%), and SA (3.1%), with P = .005. By week 24, HFCS reduction was greatest in the EA group, followed by SA, PP, and GP (-8.5 v -6.1 v -4.6 v -2.8; P = .002).
CONCLUSION: Acupuncture produced larger placebo and smaller nocebo effects than did pills for the treatment of hot flashes. EA may be more effective than GP, with fewer adverse effects for managing hot flashes among breast cancer survivors; however, these preliminary findings need to be confirmed in larger randomized controlled trials with long-term follow-up.