Oriental medicine was used for more than 2,500 years and includes treatment with acupuncture, herbs, and movement. Although diagnosis and treatment are highly individualized, from the perspective of oriental medicine, menopause is often associated with deficiencies in qi, blood, and jing. Acupuncture is one of the best-studied CAM modalities, but more studies of higher quality are needed regarding its application to the menopausal patient. The existing studies on acupuncture and menopausal symptoms are mixed. In a systematic review, which included 11 trials and 763 women, concluded that while some studies showed greater benefit with acupuncture than hormone therapy for reducing vasomotor symptoms, many showed no benefit (92). Another systematic review drew the same conclusions (93). In a randomized controlled trial of 267 women comparing individualized acupuncture plus self-care to self-care alone, both the frequency and the intensity of hot ﬂashes significantly decreased in the acupuncture arm. Overall, this group had significant improvement in vasomotor, sleep, and somatic symptoms (94). One uncontrolled study, which explored the experience of more than 300 women, found that 97% of women reported that acupuncture improved their symptoms, and 51% reported being symptom free (95). In a pilot study looking at the use of acupuncture in patients being treated with tamoxifen, 15 patients were followed for 6 months (96). Patients were evaluated before and after 1, 3, and 6 months of treatment. There was significant improvement in anxiety, depression, and somatic and vasomotor symptoms. Libido was not affected. A study with 45 women with breast cancer found significantly decreased hot ﬂashes with electroacupuncture (97). This is a promising area for those patients whose options for treatment of these symptoms are limited.
In the hands of a competent practitioner, acupuncture is a safe CAM modality. If menopausal patients are interested in exploring this technique as part of their plan for managing symptoms and understand the lack of comprehensive studies, it is reasonable to support a trial of acupuncture with a qualified practitioner. Because many of the herbal treatments in oriental medicine can be estrogenic, it is best to avoid them if the patient is taking any form of hormonal therapy.
“Natural” Hormones There is increasing confusion around the myriad hormonal options for patients. Because many hormonally active compounds are available over the counter, physician awareness about these issues is essential, especially in light of the findings of the Women’s Health Initiative and the large number of women seeking “alternatives.”
There is a dominant belief in the culture that natural is “good” and synthetic is “bad.” A natural product is any product with principal ingredients that are of animal, mineral, or vegetable origins. Natural products may have no resemblance to the ingredients in their natural state. For example, conjugated equine estrogens are natural products. They do not resemble anything natural or native to the human body. It is useful to make this distinction with patients. Very often patients requesting “natural hormones” are uncertain about what they are actually requesting. Most patients, when using this term, are looking for bioidentical hormones, or hormones that are molecularly identical to the hormones their ovaries produce.