Acupuncture for Perimenopause and Menopause

Approximately 60–80% of menopausal women experience hot flashes and sweating and the peak stage of onset occurs during the late menopausal transition and early menopause. It is believed in TCM that hot flashes are mainly caused by kidney Yin deficiency, resulting in excessive kidney fire and Yin deficiency in the liver and kidney, and ascendant hyperactivity of liver Yang. Hence, TCM methods for menopausal hot flashes mainly consist of nourishing Yin and clearing heat in order to regulate neuroendocrine functions.

The Chinese-patented medicine, Heyan Kuntai capsule (HYKT), is widely used to treat these menopausal syndromes. A dual-center, randomized, double-blind, double-dummy, parallel-controlled study was conducted for 3 months in which 147 women were enrolled and 123 completed the trial. Menopausal women were randomly divided into groups receiving either the Kuntai capsule or estradiol valerate. The modified Kupperman index, serum estradiol, and vaginal epithelial cell index were assessed as primary outcomes for evaluating treatment efficacy, and adverse events, such as vaginal bleeding and mastalgia, were also recorded. After treatment, both drugs reduced hot flashes in 92.3% and 96.5% of women, respectively, which was not significantly different (p > 0.05), suggesting that both HYKT and estradiol valerate were effective in alleviating hot flashes.

Another randomized, double-blind, placebo-controlled study was conducted on 31 postmenopausal women in the Netherlands, in which the Chinese medicine Zhibai Dihuang was administered for 12 weeks followed by 4 weeks of treatment discontinuation. At follow-up, researchers evaluated the effect of this treatment on vasomotor symptoms, including hot flashes and night sweating, and found that Zhibai Dihuang significantly improved symptoms compared to a placebo (p < 0.01).

The efficacy of acupuncture in the treatment of hot flashes has been verified by extensive data provided by Chinese and international studies. A prospective and multicenter cohort study using acupuncture to treat 175 patients with hot flashes found that, within 24 h, more than 62% of subjects in the acupuncture group reported improvements in symptoms, whereas only 27% of subjects in the control group reported an improvement.

Among menopausal symptoms, depression and anxiety are the main characteristics of the non-specific psychological syndrome and are considered menopausal mood disorders. The morbidity of mood disorders is higher in menopausal women than in their healthy counterparts in whom regular menstruation occurs during the childbearing age. Modern medicine posits that the cause of mood disorders may be related to a decline in ovarian function and a subsequent reduction in serum estradiol levels, which result in the elevation of serum monoamine oxidase levels. This can further cause increased degradation and metabolic inactivation of dopamine, norepinephrine, and serotonin, as well as the down-regulation of monoamine neurotransmitter activity. Currently, treatment mainly involves antidepressants; however, many studies have reported that hormonal replacement therapy improves mood and cognitive function in women. This can also raise fatigue.

Menopausal mood disorders belong to the TCM disease categories of ‘Lily disease’, ‘hysteria’, and ‘depression’. TCM believes that the pathogenesis of this disease is due to the gradual decline in kidney Qi, thereby resulting in kidney Yin deficiency and liver depression that progresses into liver fire, thus further excessive burning Yin fluid. Together, these conditions manifest as hot flashes, sweating, chest tightness, irritability, and insomnia. Moreover, heart Yin is damaged over time and reduces interactions between the kidney and heart, which aggravates depression and anxiety.

Saikosaponin, the active ingredient of the radix bupleuri in Xiangshao granules, has anti-inflammatory and anti-convulsion effects and can extend sleep duration. It has demonstrated good therapeutic efficacy against anxiety and depression, possibly by affecting serotonin activity in the central nervous system. Wang observed that Xiangshao granules regulated serum neurotransmitter levels, including serotonin, norepinephrine, and epinephrine, thereby indicating that Xiangshao granules may improve menopausal depression by balancing the neuroendocrine system.

A study observing the effects of bilateral acupuncture at the Feishu, Xinshu, Ganshu, Pishu, Shenshu and Geshu points on patients with menopausal depression found that the Hamilton Depression Scale scores at the 6th week of treatment were comparable between the acupuncture group and the fluoxetine hydrochloride group. Notably, acupuncture exhibited better outcomes (p < 0.05) at weeks 2 and 4.