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Efficacy Comparison of Different Acupuncture Treatments for Hot Flashes: A Systematic Review with Network Meta-Analysis. JOURNAL OF ACUPUNCTURE RESEARCH 2021. [DOI: 10.13045/jar.2020.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The objective of this study was to conduct a systematic review and network meta-analysis to evaluate and compare the effectiveness of various types of acupuncture for menopausal hot flashes (HF). Randomized controlled trials (RCTs) were retrieved from 8 electronic databases, and the risk of bias was evaluated for the included studies. Pairwise meta-analysis and network meta-analysis were performed using Review Manager and R software for indirect comparison and ranking, respectively. In total, 23 RCTs (2,302 patients) were eligible for systematic review, of which 10 were included in network meta-analysis. Network meta-analysis showed manual acupuncture (MA) had the highest probability of reducing HF frequency and severity, followed by sham acupuncture (SA), electroacupuncture, usual care, or no treatment; furthermore, warm acupuncture significantly improved menopause-specific quality of life compared with MA or electroacupuncture. Compared with hormone replacement therapy, acupuncture had less efficacy in reducing HF frequency but enhanced menopause-specific quality of life. There was no significant difference between MA and SA in mitigating HF. The existing evidence showed that MA could be used for alleviating menopausal HF. However, it is recommended that more high-quality RCTs should be performed.
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Li T, Zhang Y, Cheng Q, Hou M, Zheng X, Zheng Q, Li L. Quantitative study on the efficacy of acupuncture in the treatment of menopausal hot flashes and its comparison with nonhormonal drugs. Menopause 2021; 28:564-572. [PMID: 33739313 DOI: 10.1097/gme.0000000000001767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare the efficacy of acupuncture to that of sham acupuncture, placebo pills, and nonhormonal drugs to provide the necessary quantitative information for establishing medication guidelines for menopausal hot flashes. METHODS A comprehensive literature search was performed using public databases. Randomized clinical studies on acupuncture therapy for the treatment of hot flashes in menopausal women were identified. A time-course model was established to describe the efficacy characteristics of acupuncture and sham acupuncture, which were compared with the efficacy of nonhormonal drugs and placebo pills reported in the literature. RESULTS A total of 17 studies involving 1,123 participants were included. The quality of all the studies included in the analysis is medium to high, and there was no obvious risk of bias. It was found that the baseline number of hot flashes was an important factor affecting the efficacy of acupuncture and sham acupuncture. After correcting the baseline to eight hot flashes per day, the frequency of hot flashes decreased from baseline for traditional acupuncture (TA), electro-acupuncture (EA), TA&EA (merger analysis of TA and electro-acupuncture), and sham acupuncture were 3.1 (95% confidence interval [CI]: 2.8-3.4), 3.6 (95% CI: 3.2-4.0), 3.2 (95% CI: 2.9-3.5), and 2.6 (95% CI: 2.2-3.0) times/d at week 8, respectively. Compared with findings reported in the literature, we found the efficacy of electro-acupuncture was comparable to that of selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors and neuroleptic agents such as gabapentin and escitalopram. Furthermore, the efficacy of TA&EA (merged) was significantly higher than that of placebo pills (2.3, 95% CI: 1.8-2.9). CONCLUSIONS The efficacy of TA&EA (merged) was higher than that of sham acupuncture and significantly higher than that of placebo pills. The efficacy of electro-acupuncture was higher than that of traditional acupuncture, significantly higher than that of sham acupuncture, and comparable to that of selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors and neuroleptic agents.
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Affiliation(s)
- Ting Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yi Zhang
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qingqing Cheng
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mengyuan Hou
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xijun Zheng
- Zhengzhou University Cancer Hospital and Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Qingshan Zheng
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lujin Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Guo PP, Li P, Zhang XH, Liu N, Wang J, Chen DD, Sun WJ, Zhang W. Complementary and alternative medicine for natural and treatment-induced vasomotor symptoms: An overview of systematic reviews and meta-analyses. Complement Ther Clin Pract 2019; 36:181-194. [PMID: 31383438 DOI: 10.1016/j.ctcp.2019.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Vasomotor symptoms (VMS) are very common in menopausal populations and cancer patients and can cause physical and mental discomfort. We aim to summarize the findings of systematic reviews and meta-analyses (SRs/MAs) that assessed the effectiveness of complementary and alternative medicines(CAMs)on VMS to provide solid evidence for future practice. METHODS PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to May 2019 to identify relevant SRs/MAs. The methodological quality of SRs/MAs and evidence levels of the outcomes were assessed. RESULTS A total of 29 SRs/MAs were reviewed. Evidence has shown that acupuncture, hypnosis, paced respiration, cognitive behavioural therapy, genistein, soy isoflavones, S-equol, combined preparations of black cohosh, and omega-3 supplements could significantly reduce VMS. The methodological quality of the SRs/MAs was moderate or high. CONCLUSION CAMs might be beneficial for reducing VMS, but the evidence levels were not high. Several priorities for future practice were identified.
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Affiliation(s)
- Ping-Ping Guo
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
| | - Ping Li
- Department of Developmental Pediatrics, the Second Hospital of Jilin University, Changchun, Jilin province, 130041, China.
| | - Xue-Hui Zhang
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
| | - Na Liu
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
| | - Jie Wang
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
| | - Dan-Dan Chen
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
| | - Wei-Jia Sun
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
| | - Wei Zhang
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
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Kargozar R, Salari R, Jarahi L, Yousefi M, Pourhoseini SA, Sahebkar-Khorasani M, Azizi H. Urtica dioica in comparison with placebo and acupuncture: A new possibility for menopausal hot flashes: A randomized clinical trial. Complement Ther Med 2019; 44:166-173. [PMID: 31126551 DOI: 10.1016/j.ctim.2019.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/03/2019] [Accepted: 04/03/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The purpose of this research was to investigate the effect of Urtica dioica in comparison with placebo, acupuncture and combined therapy on hot flashes and quality of life in postmenopausal women. METHODS In a double-blinded randomized controlled trial, patients were treated for 7 weeks then followed up 4 weeks. Seventy-two postmenopausal women who reported at least 20 hot flashes attacks per week were randomly allocated into one of the 4 groups of Urtica dioica 450 mg/day and acupuncture 11 sessions (A), acupuncture and placebo (B), sham acupuncture and Urtica dioica (C), and sham acupuncture and placebo (D). The primary outcomes were the change in hot flashes score from baseline to the end of treatment and follow up; and the change in the quality of life (MENQOL) from baseline to the end of treatment. Secondary outcomes included changes in FSH, LH, and ESTRADIOL levels from baseline to the end of treatment. The trial was conducted from October 2017 to July 2018 in Acupuncture clinic of a teaching hospital in Iran. RESULTS A total of 72 women 45-60 years old were enrolled, and 68 were included in the analyses. The median (IQR) hot flashes score decreased in the A group by 20.2 (31.7) and 21.1 (25.1), B group by 19 (18) and 17.3 (27), C group by 14.6 (25.4) and 20.8 (13), and D group by 1.6 (11.6) and 1 (13.3) at the end of treatment and follow up (P < 0.0001, P < 0.0001); no significant difference between A, B and C groups. The mean (SD) of MENQOL score decreased in the A group by 42.6 (21.1), B group by 40.7 (29.8), C group by 37.8 (26.8) and D group by 9.8 (14.3) at the end of treatment (P = 0.001); no significant difference between A, B and C groups. CONCLUSIONS Urtica dioica can decrease menopausal hot flashes and increase the quality of life of postmenopausal women better than placebo-sham control but same as acupuncture. The combination of Urtica dioica and acupuncture did not add to the effects of those therapies.
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Affiliation(s)
- Rahele Kargozar
- School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roshanak Salari
- Department of Pharmaceutical Sciences in Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lida Jarahi
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Yousefi
- Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Azam Pourhoseini
- Department of Gynecology and Obstetrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hoda Azizi
- Department of Chinese and Complementary Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Birch S, Lee MS, Alraek T, Kim TH. Overview of Treatment Guidelines and Clinical Practical Guidelines That Recommend the Use of Acupuncture: A Bibliometric Analysis. J Altern Complement Med 2018; 24:752-769. [PMID: 29912569 DOI: 10.1089/acm.2018.0092] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION As positive evidence emerges for the use of an intervention to treat a health problem, the intervention gradually becomes incorporated into treatment guidelines (TGs) or clinical practice guidelines (CPGs) that are related to that health problem. To assess whether this general hypothesis can apply to acupuncture, 96 health problems were identified for which positive conclusions in systematic reviews and meta-analyses regarding the effectiveness of acupuncture have been made and then searched for TGs or CPGs that have recommended the use of acupuncture. METHODS Through August 31, 2017, searches were performed in relevant medical databases and Google using "treatment guideline," "clinical practice guideline," and the names of the 96 medical conditions as search terms. A "snow-balling" search approach was adopted. All positive recommendations were added into the registry. RESULTS A total of 1311 publications were found that recommended using acupuncture published between 1991 and 2017. The number per year reached 50 in 2005 and 100 in 2009. In addition, 2189 positive recommendations were found for the use of acupuncture. Of these, 1486 were related to 107 pain indications and 703 were related to 97 nonpain indications. These recommendations were made by a wide range of groups, such as government health institutions, national guideline, and medical specialty groups. The recommendations came from around the world but were especially abundant in North America, Europe, and Australasia. DISCUSSION AND CONCLUSION Considerably more recommendations were found for the use of acupuncture than are known within the acupuncture or medical communities. A trend by year was also found; a rise in the number of positive statements about acupuncture was typically followed by a rise in the number of recommendations of acupuncture. Thus, the recommendations followed the emergent evidence for acupuncture. Better implementation plans need to be developed for the CPG/TG recommendations about acupuncture to be more effective/efficient.
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Affiliation(s)
- Stephen Birch
- 1 Department of Health Sciences, Kristiania University College , Oslo, Norway
| | - Myeong Soo Lee
- 2 Clinical Medicine Division, Korea Institute of Oriental Medicine , Daejeon, Republic of South Korea
| | - Terje Alraek
- 1 Department of Health Sciences, Kristiania University College , Oslo, Norway .,3 Department of Community Medicine, Faculty of Medicine, National Research Centre in Complementary and Alternative Medicine, UiT The Arctic University of Norway , Tromso, Norway
| | - Tae-Hun Kim
- 4 Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University , Seoul, Republic of Korea
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Acupuncture for menopausal hot flashes: clinical evidence update and its relevance to decision making. Menopause 2018; 24:980-987. [PMID: 28350757 DOI: 10.1097/gme.0000000000000850] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is conflicting evidence on the efficacy and effectiveness of acupuncture for menopausal hot flashes. This article synthesizes the best available evidence for when women are considering whether acupuncture might be useful for menopausal hot flashes. METHODS We searched electronic databases to identify randomized controlled trials and systematic reviews of acupuncture for menopausal hot flushes. RESULTS The overall evidence demonstrates that acupuncture is effective when compared with no treatment, but not efficacious compared with sham. Methodological challenges such as the complex nature of acupuncture treatment, the physiological effects from sham, and the significant efficacy of placebo therapy generally in treating hot flashes all impact on these considerations. CONCLUSIONS Acupuncture improves menopausal hot flashes compared with no treatment; however, not compared with sham acupuncture. This is also consistent with the evidence that a range of placebo interventions improve menopausal symptoms. As clinicians play a vital role in assisting evidence-informed decisions, we need to ensure women understand the evidence and can integrate it with personal preferences. Some women may choose acupuncture for hot flashes, a potentially disabling condition without long-term adverse health consequences. Yet, women should do so understanding the evidence, and its strengths and weaknesses, around both effective medical therapies and acupuncture. Likewise, cost to the individual and the health system needs to be considered in the context of value-based health care.
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Traditional acupuncture for menopausal hot flashes: A systematic review and meta-analysis of randomized controlled trials. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2017.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Li W, Luo Y, Fu W, Lei R. Acupuncture May Improve Quality of Life in Menopausal Women: A Meta-Analysis of Randomized Controlled Trials. Complement Med Res 2017; 25:183-190. [PMID: 29020676 DOI: 10.1159/000479630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This analysis aims to identify, on the basis of the results of randomized controlled trials (RCTs), whether acupuncture therapy can alleviate menopausal symptoms and promote health-related quality of life. METHODS We included RCTs that directly compared any type of acupuncture with sham acupuncture in treating menopause-related symptoms and which were published from January 1, 2010 to December 31, 2016 in 6 electronic databases. Two authors performed this work independently; 'risk-of-bias' assessment and data extraction were also independently performed by these 2 review authors. The outcomes are presented as scores of the menopause rating scale (MRS), which represents the self-assessment of patients. RESULTS Six studies were included. Our analysis found that acupuncture can reduce the MRS score in menopausal women by the end of the treating period (2-3 months, on average) and even in the follow-up period (1-3 months), not only in the total score but also in each subscale score. But the grade of evidence is very low. CONCLUSIONS Both the total score and the subgroup analysis strongly indicated that acupuncture can alleviate menopause-related symptoms. However, the evidence is not very strong. Thus, further studies about the efficiency of acupuncture on menopausal symptoms based on well-designed trials are needed.
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Denlinger CS, Sanft T, Baker KS, Baxi S, Broderick G, Demark-Wahnefried W, Friedman DL, Goldman M, Hudson M, Khakpour N, King A, Koura D, Kvale E, Lally RM, Langbaum TS, Melisko M, Montoya JG, Mooney K, Moslehi JJ, O'Connor T, Overholser L, Paskett ED, Peppercorn J, Rodriguez MA, Ruddy KJ, Silverman P, Smith S, Syrjala KL, Tevaarwerk A, Urba SG, Wakabayashi MT, Zee P, Freedman-Cass DA, McMillian NR. Survivorship, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2017; 15:1140-1163. [PMID: 28874599 PMCID: PMC5865602 DOI: 10.6004/jnccn.2017.0146] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Many cancer survivors experience menopausal symptoms, including female survivors taking aromatase inhibitors or with a history of oophorectomy or chemotherapy, and male survivors who received or are receiving androgen-ablative therapies. Sexual dysfunction is also common in cancer survivors. Sexual dysfunction and menopause-related symptoms can increase distress and have a significant negative impact on quality of life. This portion of the NCCN Guidelines for Survivorship provide recommendations for screening, evaluation, and treatment of sexual dysfunction and menopausal symptoms to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period.
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Chien TJ, Hsu CH, Liu CY, Fang CJ. Effect of acupuncture on hot flush and menopause symptoms in breast cancer- A systematic review and meta-analysis. PLoS One 2017; 12:e0180918. [PMID: 28829776 PMCID: PMC5568723 DOI: 10.1371/journal.pone.0180918] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/23/2017] [Indexed: 11/18/2022] Open
Abstract
Background Many breast cancer patients suffer from hot flush and medical menopause as side effects of treatment. Some patients undergo acupuncture, rather than hormone therapy, to relieve these symptoms, but the efficacy of acupuncture is uncertain. This meta-analysis evaluated the efficacy of acupuncture on hot flush and menopause symptoms in women with breast cancer. Methods A literature search was performed, following the PRISMA Statement and without language restrictions, of 7 databases from inception through March 2017. All selected studies were randomized clinical trials (RCTs) that examined the effect of needle acupuncture on hot flush and menopause symptoms in patients with breast cancer. The methodological quality of these trials was assessed using Cochrane criteria, and meta-analysis software (RevMan 5.2) was used to analyze the data. Results We examined 844 breast cancer patients (average age: 58 years-old) from 13 RCTs. The trials had medium-to-high quality, based on the modified Jadad scale. The meta-analysis showed that acupuncture had no significant effect on the frequency and the severity of hot flush (p = 0.34; p = 0.33), but significantly ameliorated menopause symptoms (p = 0.009). None of the studies reported severe adverse events. Conclusions Acupuncture significantly alleviated menopause symptoms, but had no effect on hot flush. Breast cancer patients concerned about the adverse effects of hormone therapy should consider acupuncture. Further large-scale studies that also measure biomarkers or cytokines may help to elucidate the mechanism by which acupuncture alleviates menopause symptoms in patients with breast cancer.
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Affiliation(s)
- Tsai-Ju Chien
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Hemato-Oncology, Department of Internal Medicine, Branch of Zhong-xing, Taipei City Hospital, Taipei, Taiwan
- Branch of Linsen, Chinese Medicine and Kunming, Taipei City Hospital, Taipei, Taiwan
- * E-mail: ,
| | - Chung-Hua Hsu
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan
- Branch of Linsen, Chinese Medicine and Kunming, Taipei City Hospital, Taipei, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Yu Liu
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan
- Branch of Linsen, Chinese Medicine and Kunming, Taipei City Hospital, Taipei, Taiwan
| | - Ching-Ju Fang
- Medical Library, National Cheng Kung University, Tainan, Taiwan
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Frange C, Banzoli CV, Colombo AE, Siegler M, Coelho G, Bezerra AG, Csermak M, Naufel MF, Cesar-Netto C, Andersen ML, Girão MJBC, Tufik S, Hachul H. Women's Sleep Disorders: Integrative Care. ACTA ACUST UNITED AC 2017; 10:174-180. [PMID: 29410750 PMCID: PMC5760052 DOI: 10.5935/1984-0063.20170030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The integrative care model is rooted in a biopsychosocial approach. Integrative
is a term which refers to increasing the harmony and coherence of your whole
being, and integrative care is therefore focused on the person, not on either
the disease or a therapy. It is provided collaboratively by a health team
comprising physicians, psychologists, physiotherapists, acupuncturists, and
meditation, nutrition, and floral therapy. Previous studies have demonstrated
that interventions based on the integrative care model improved womens lifestyle
and quality of life. Our aim was to describe the use of complementary and
alternative medicine (CAM) alongside traditional medicine among women with sleep
conditions in our Womens Sleep Disorders Integrative Treatment Outpatient
Clinic. We are sharing our experiences and clinical practice as the model we
developed seems to have both physical and psychological benefits for women with
sleep problems. We discuss the wide range of benefits that result from this type
of complex intervention, and the contextual factors that may influence these
benefits. This will inform future practitioners and we hope to contribute to
quantitative research in the clinical setting. The study highlights the
importance of treating sleep complaints with a caring relationship and a CAM
approach, alongside conventional medicine. Exploration of the lived experience
of CAM and its meaning enables healthcare professionals to gain insights into
the patients needs, preferences, and values. Gynecologists, clinicians, and
health care providers should support and guide patients in their decision to use
CAM by providing evidence-based and comprehensive advice on the potential
benefits, risks and related safety issues of this approach.
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Affiliation(s)
- Cristina Frange
- Universidade Federal de São Paulo, Departament Psychobiology - São Paulo - SP - Brazil
| | | | - Ana Elisa Colombo
- Universidade Federal de São Paulo, Department Gynecology - São Paulo - SP - Brazil
| | - Marcele Siegler
- Universidade Federal de São Paulo, Departament Psychobiology - São Paulo - SP - Brazil
| | - Glaury Coelho
- Universidade Federal de São Paulo, Departament Psychobiology - São Paulo - SP - Brazil
| | - Andréia Gomes Bezerra
- Universidade Federal de São Paulo, Departament Psychobiology - São Paulo - SP - Brazil
| | - Marcelo Csermak
- Universidade Federal de São Paulo, Departament Psychobiology - São Paulo - SP - Brazil
| | | | - Cristiana Cesar-Netto
- Universidade Federal de São Paulo, Departament Psychobiology - São Paulo - SP - Brazil
| | - Monica Levy Andersen
- Universidade Federal de São Paulo, Departament Psychobiology - São Paulo - SP - Brazil
| | | | - Sergio Tufik
- Universidade Federal de São Paulo, Departament Psychobiology - São Paulo - SP - Brazil
| | - Helena Hachul
- Universidade Federal de São Paulo, Departament Psychobiology - São Paulo - SP - Brazil.,Universidade Federal de São Paulo, Department Gynecology - São Paulo - SP - Brazil
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Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause 2016; 22:1155-72; quiz 1173-4. [PMID: 26382310 DOI: 10.1097/gme.0000000000000546] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To update and expand The North American Menopause Society's evidence-based position on nonhormonal management of menopause-associated vasomotor symptoms (VMS), previously a portion of the position statement on the management of VMS. METHODS NAMS enlisted clinical and research experts in the field and a reference librarian to identify and review available evidence. Five different electronic search engines were used to cull relevant literature. Using the literature, experts created a document for final approval by the NAMS Board of Trustees. RESULTS Nonhormonal management of VMS is an important consideration when hormone therapy is not an option, either because of medical contraindications or a woman's personal choice. Nonhormonal therapies include lifestyle changes, mind-body techniques, dietary management and supplements, prescription therapies, and others. The costs, time, and effort involved as well as adverse effects, lack of long-term studies, and potential interactions with medications all need to be carefully weighed against potential effectiveness during decision making. CONCLUSIONS Clinicians need to be well informed about the level of evidence available for the wide array of nonhormonal management options currently available to midlife women to help prevent underuse of effective therapies or use of inappropriate or ineffective therapies. Recommended: Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing VMS. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS, although other selective serotonin reuptake/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine show evidence of efficacy. Recommend with caution: Some therapies that may be beneficial for alleviating VMS are weight loss, mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but additional studies of these therapies are warranted. Do not recommend at this time: There are negative, insufficient, or inconclusive data suggesting the following should not be recommended as proven therapies for managing VMS: cooling techniques, avoidance of triggers, exercise, yoga, paced respiration, relaxation, over-the-counter supplements and herbal therapies, acupuncture, calibration of neural oscillations, and chiropractic interventions. Incorporating the available evidence into clinical practice will help ensure that women receive evidence-based recommendations along with appropriate cautions for appropriate and timely management of VMS.
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Hypolipidemic mechanism of oryzanol components- ferulic acid and phytosterols. Biochem Biophys Res Commun 2016; 476:82-9. [PMID: 27179780 DOI: 10.1016/j.bbrc.2016.05.053] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/10/2016] [Indexed: 11/22/2022]
Abstract
UNLABELLED The effect of oryzanol (well known hypolipidemic component in rice bran oil) and its chemical constituents- ferulic acid (FA) and phytosterols on hypolipidemia were investigated. METHODS AND RESULTS Docking (in silico) studies showed that FA had a better binding ability with lipase while sterols bound well with HMG-CoA reductase. Further in vivo studies of feeding high fat (30%) to rats increased body weights, serum TC, TG, non-HDL-C and reduced HDL-C were observed, compared to normal diet fed group (ND). ORZ treated groups alleviated the lipid profile. Furthermore, increased organ weights, higher intestinal lipase activity, and liver lipid peroxidation was observed in the high-fat group (HF). These effects were ameliorated in oryzanol concentrate fed groups (ORZ). Higher fecal fat was found in ORZ groups, analysis of fecal matter by mass spectroscopy revealed the presence of FA. In vitro, a bile acid binding study supported the strong affinity of sterol towards bile acids. In conclusion, oryzanol in the intestine is cleaved into FA and sterol by intestinal lipase enzymes both lipase and HMG-CoA reductase activities were inhibited, respectively. These hydrolysates eliminated the bile acids, thus lowering lipid profiles.
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Arroll N, Armstrong S, Aneke KU, Jordan V, Farquhar C. Decision aids for the management of menopausal symptoms. Hippokratia 2015. [DOI: 10.1002/14651858.cd011892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Nicola Arroll
- University of Auckland; Department of Obstetrics and Gynaecology; Private Bag 92019 Grafton Auckland New Zealand 1142
| | - Sarah Armstrong
- University of Auckland; Department of Obstetrics and Gynaecology; Private Bag 92019 Grafton Auckland New Zealand 1142
| | | | - Vanessa Jordan
- University of Auckland; Department of Obstetrics and Gynaecology; Private Bag 92019 Grafton Auckland New Zealand 1142
| | - Cindy Farquhar
- University of Auckland; Department of Obstetrics and Gynaecology; Private Bag 92019 Grafton Auckland New Zealand 1142
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Kim MY, Choi SD, Ryu A. Is complementary and alternative therapy effective for women in the climacteric period? J Menopausal Med 2015; 21:28-35. [PMID: 26046035 PMCID: PMC4452811 DOI: 10.6118/jmm.2015.21.1.28] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/11/2015] [Accepted: 02/25/2015] [Indexed: 12/26/2022] Open
Abstract
Vasomotor symptoms start about 2 years prior to menopause in women who are approaching menopause, and early menopause symptoms appear including emotional disturbance and anxiety, followed by physical changes such as vaginal dryness, urinary incontinence and skin wrinkles. As time progresses, osteoporosis, cardiovascular diseases, and dementia occur consecutively. Hormone therapy is primarily considered for the relief of menopause symptoms in postmenopausal women. However, as hormone replacement has emerged as a therapy that increases the potential risk of thrombosis, cerebral infarction and breast cancer, complementary and alternative medicine has drawn much attention. This study aimed to examine the types and effects of evidence-based complementary and alternative therapies that are currently used.
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Affiliation(s)
- Mi Young Kim
- Department of Obstetrics and Gynecology, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Seung Do Choi
- Department of Obstetrics and Gynecology, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Aeli Ryu
- Department of Obstetrics and Gynecology, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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16
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Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause. Menopause 2015; 22:234-44. [DOI: 10.1097/gme.0000000000000260] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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17
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Taylor-Swanson L, Thomas A, Ismail R, Schnall JG, Cray L, Mitchell ES, Woods NF. Effects of traditional Chinese medicine on symptom clusters during the menopausal transition. Climacteric 2014; 18:142-56. [DOI: 10.3109/13697137.2014.937687] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Peng W, Sibbritt DW, Hickman L, Kong X, Yang L, Adams J. A critical review of traditional Chinese medicine use amongst women with menopausal symptoms. Climacteric 2014; 17:635-44. [PMID: 24678630 DOI: 10.3109/13697137.2014.904850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To provide the first critical review of traditional Chinese medicine (TCM) use amongst symptomatic menopausal women, drawing upon work examining the perspectives of both TCM users and TCM practitioners. METHODS A search was conducted in three English-language databases (MEDLINE, CINAHL and AMED) and three Chinese-language databases (CNKI, VIP and CBM Disc) for 2002-2013 international peer-reviewed articles reporting empirical findings of TCM use in menopause. RESULTS A total of 25 journal articles reporting 22 studies were identified as meeting the review inclusion criteria. Chinese herbal medicine appears to be the most common therapy amongst symptomatic menopausal women, and vasomotor symptoms and emotional changes are the most frequent symptoms for which TCM is sought. However, evidence regarding the prevalence of TCM use and users' profile in menopause is limited. Existing studies are of varied methodological quality, often reporting low response rate, extensive recall bias and a lack of syndrome differentiation. CONCLUSIONS This review provides insights for practitioners and health policy-makers regarding TCM care to symptomatic menopausal women. More nationally representative studies are required to rigorously examine TCM use for the management of menopausal symptoms. Syndrome differentiation of menopausal women is an area which also warrants further attention.
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Affiliation(s)
- W Peng
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney , Sydney, NSW , Australia
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19
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Pirotta M, Ee C, Teede H, Chondros P, French S, Myers S, Xue C. Acupuncture for menopausal vasomotor symptoms: study protocol for a randomised controlled trial. Trials 2014; 15:224. [PMID: 24925094 PMCID: PMC4066294 DOI: 10.1186/1745-6215-15-224] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/30/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hot flushes and night sweats (vasomotor symptoms) are common menopausal symptoms, often causing distress, sleep deprivation and reduced quality of life. Although hormone replacement therapy is an effective treatment, there are concerns about serious adverse events. Non-hormonal pharmacological therapies are less effective and can also cause adverse effects. Complementary therapies, including acupuncture, are commonly used for menopausal vasomotor symptoms. While the evidence for the effectiveness of acupuncture in treating vasomotor symptoms is inconclusive, acupuncture has a low risk of adverse effects, and two small studies suggest it may be more effective than non-insertive sham acupuncture. Our objective is to assess the efficacy of needle acupuncture in improving hot flush severity and frequency in menopausal women. Our current study design is informed by methods tested in a pilot study. METHODS/DESIGN This is a stratified, parallel, randomised sham-controlled trial with equal allocation of participants to two trial groups. We are recruiting 360 menopausal women experiencing a minimum average of seven moderate hot flushes a day over a seven-day period and who meet diagnostic criteria for the Traditional Chinese Medicine diagnosis of Kidney Yin deficiency. Exclusion criteria include breast cancer, surgical menopause, and current hormone replacement therapy use. Eligible women are randomised to receive either true needle acupuncture or sham acupuncture with non-insertive (blunt) needles for ten treatments over eight weeks. Participants are blinded to treatment allocation. Interventions are provided by Chinese medicine acupuncturists who have received specific training on trial procedures. The primary outcome measure is hot flush score, assessed using the validated Hot Flush Diary. Secondary outcome measures include health-related quality of life, anxiety and depression symptoms, credibility of the sham treatment, expectancy and beliefs about acupuncture, and adverse events. Participants will be analysed in the groups in which they were randomised using an intention-to-treat analysis strategy. DISCUSSION Results from this trial will significantly add to the current body of evidence on the role of acupuncture for vasomotor symptoms. If found to be effective and safe, acupuncture will be a valuable additional treatment option for women who experience menopausal vasomotor symptoms. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12611000393954 11/02/2009.
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Affiliation(s)
- Marie Pirotta
- Department of General Practice, University of Melbourne, Australia 200 Berkeley St, Carlton, Victoria 3053, Australia
| | - Carolyn Ee
- Department of General Practice, University of Melbourne, Australia 200 Berkeley St, Carlton, Victoria 3053, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia Diabetes and Vascular Medicine Unit, Monash Health, Wellington Rd, Clayton VIC 3800, Australia
| | - Patty Chondros
- Department of General Practice, University of Melbourne, Australia 200 Berkeley St, Carlton, Victoria 3053, Australia
| | - Simon French
- Canada and Faculty of Health Sciences, School of Rehabilitation Therapy, Queen’s University, Ontario, 99 University Ave, Kingston, ON K7L 3N6, Canada
| | - Stephen Myers
- NatMed-Research Unit, Division of Research, Southern Cross University, Military Road, East Lismore NSW 2480, Australia
| | - Charlie Xue
- School of Health Sciences, RMIT University, 124 Little La Trobe St, Melbourne VIC 3000, Australia
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20
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Baccetti S, Da Frè M, Becorpi A, Faedda M, Guerrera A, Monechi MV, Munizzi RM, Parazzini F. Acupuncture and traditional Chinese medicine for hot flushes in menopause: a randomized trial. J Altern Complement Med 2014; 20:550-7. [PMID: 24827469 DOI: 10.1089/acm.2012.0499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate the effect of acupuncture on hot flushes and other menopause-related symptoms used in an integrated system, including such therapeutic techniques as diet therapy and Tuina self-massage. DESIGN Randomized trial. SETTING Outpatient center. PARTICIPANTS One hundred women in spontaneous menopause with at least three episodes of hot flushes daily were randomly allocated to two treatment groups (50 per group): Women in group A were given diet, self-massage training, and treatment with acupuncture, and women in group B (the control group) were given the same diet and self-massage training, but treatment with acupuncture started 6 weeks after they were enrolled into the study. INTERVENTION Acupuncture treatments were scheduled twice weekly for 6 consecutive weeks. OUTCOME MEASURES Mean change in frequency and/or intensity in menopause-related symptoms were estimated by questionnaire after treatment at week 4. RESULTS Treatment with acupuncture significantly reduced the occurrence of hot flushes and sudden sweating (p<.001). Other symptoms (sleep disorders, tightness in the chest, irritability, bone pain, feeling depressed) significantly improved. CONCLUSIONS Acupuncture in an integrated system that includes therapeutic techniques such as diet therapy and Tuina self-massage can be used to treat hot flushes and selected symptoms in postmenopausal women.
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Affiliation(s)
- Sonia Baccetti
- 1 Referring Center for Complementary Medicine , Tuscany Region, San Donnino, Campi Bisenzio, Italy
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21
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Effects of acupuncture and Chinese herbal medicine (Zhi Mu 14) on hot flushes and quality of life in postmenopausal women. Menopause 2014; 21:15-24. [DOI: 10.1097/gme.0b013e31829374e8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Selva Olid A, Martínez Zapata MJ, Solà I, Stojanovic Z, Uriona Tuma SM, Bonfill Cosp X. Efficacy and Safety of Needle Acupuncture for Treating Gynecologic and Obstetric Disorders: An Overview. Med Acupunct 2013; 25:386-397. [PMID: 24761184 DOI: 10.1089/acu.2013.0976] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Acupuncture is being used increasingly to treat gynecologic and obstetric disorders. Objective: The aim of this review was to determine the efficacy and safety of acupuncture for treating pelvic and low-back pain during pregnancy, pain during labor, primary dysmenorrhea, and menopausal symptoms. Design: This is an overview of systematic reviews (SRs) and randomized controlled trials (RCTs). Search strategy: A literature search was conducted, in July 2010, in MEDLINE,® the Cochrane Database of Systematic Reviews, CENTRAL, the Database of Abstracts of Reviews of Effects, and Tripdatabase. Selection criteria: Published SRs and RCTs found during the literature search were included as well as RCTs that were published after completion of the literature search. Analysis: Data from SRs and RCTs that provided quantitative information were pooled. Results: Eight SRs and nine RCTs were included. One SR and 4 RCTs showed that acupuncture reduced pelvic and low-back pain, compared to physiotherapy or usual prenatal care. Results were contradictory when interventions were compared with sham acupuncture. With respect to reduction of pain during labor, two SRs showed no differences between acupuncture and sham acupuncture. None of the three SRs included on primary dysmenorrhea produced conclusive results. Two SRs of studies on menopausal symptoms showed no differences between acupuncture and sham acupuncture. A meta-analysis of three additional RCTs identified a favorable effect of acupuncture for reducing frequency and intensity of hot flashes. Adverse effects were mild and infrequent. Conclusions: Evidence for the efficacy of needle acupuncture for treating the disorders evaluated remains inconclusive. The intervention showed promising results for reducing pelvic and back pain during pregnancy and climacteric vasomotor symptoms, although well-designed studies are needed to make the results more precise and reliable.
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Affiliation(s)
- Anna Selva Olid
- Iberoamerican Cochrane Centre , Biomedical Research Institute CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain . ; Hospital de la Santa Creu i Sant Pau (IIB Sant Pau) Barcelona , Barcelona, Spain
| | - María José Martínez Zapata
- Iberoamerican Cochrane Centre , Biomedical Research Institute CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain . ; Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre , Biomedical Research Institute CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Zoran Stojanovic
- Pneumology Service, University Hospital Germans Trias i Pujol , Barcelona, Spain
| | - Sonia Maria Uriona Tuma
- Preventive Medicine and Epidemiology Service, University Hospital Vall d'Hebron , Barcelona, Spain
| | - Xavier Bonfill Cosp
- Iberoamerican Cochrane Centre , Biomedical Research Institute CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain . ; Universitat Autònoma de Barcelona , Barcelona, Spain
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23
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von Studnitz FS, Eulenburg C, Mueck AO, Buhling KJ. The value of complementary and alternative medicine in the treatment of climacteric symptoms: Results of a survey among German gynecologists. Complement Ther Med 2013; 21:492-5. [DOI: 10.1016/j.ctim.2013.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 07/03/2013] [Accepted: 07/18/2013] [Indexed: 11/29/2022] Open
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24
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Posadzki P, Ernst E. Prevalence of CAM use by UK climacteric women: a systematic review of surveys. Climacteric 2012; 16:3-7. [DOI: 10.3109/13697137.2012.742503] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- P. Posadzki
- Complementary Medicine, Peninsula Medical School,
Exeter, UK
| | - E. Ernst
- Complementary Medicine, Peninsula Medical School,
Exeter, UK
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25
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Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial. Menopause 2012; 19:749-59. [PMID: 22336748 DOI: 10.1097/gme.0b013e31823fe835] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effectiveness of group cognitive behavioral therapy (CBT) and guided self-help CBT in reducing hot flush and night sweat (HF/NS) problem rating at 6 and 26 weeks after randomization. METHODS This was a randomized control trial of 140 women having 10 or more problematic HF/NS a week for at least a month. The primary outcome was HF/NS problem rating (1-10) at 6 weeks after randomization. Secondary outcomes were physiologically measured HF/NS at 6 weeks; HF/NS problem rating at 6 weeks; and frequency, mood (Women's Health Questionnaire), and health-related quality of life (General Health Survey Short Form-36) at 6 and 26 weeks. Intention-to-treat analysis was used, and between-group differences were estimated using linear mixed models. RESULTS Baseline mean (SD) HF/NS weekly frequency was 63.15 (49.24), and problem rating was 5.87 (2.28). Group and self-help CBT both significantly reduced HF/NS problem rating at 6 weeks-group CBT versus no treatment control (NTC; adjusted mean difference, 2.12; 95% CI, 1.36-2.88; P < 0.001) and self-help CBT versus NTC (adjusted mean difference, 2.08; 95% CI, 1.29-2.86; P < 0.001)-and at 26 weeks-group CBT versus NTC (adjusted mean difference, 1.33; 95% CI, 0.54-2.13; P = 0.001) and self-help CBT versus NTC (adjusted mean difference, 1.19; 95% CI, 0.36-2.02; P = 0.005). Group and self-help CBT significantly reduced night sweat frequency at 6 and 26 weeks. There were improvements in mood and quality of life at 6 weeks and improved emotional and physical functioning for group CBT at 26 weeks. CONCLUSIONS These results suggest that CBT delivered in group or self-help format is an effective treatment option for women during the menopause transition and postmenopause with problematic HF/NS.
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26
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Umland EM, Falconieri L. Treatment options for vasomotor symptoms in menopause: focus on desvenlafaxine. Int J Womens Health 2012; 4:305-19. [PMID: 22870045 PMCID: PMC3410701 DOI: 10.2147/ijwh.s24614] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Vasomotor symptoms (VMS), including hot flashes and night sweats, occur in as many as 68.5% of women as a result of menopause. While the median duration of these symptoms is 4 years, approximately 10% of women continue to experience VMS as many as 12 years after their final menstrual period. As such, VMS have a significant impact on the quality of life and overall physical health of women experiencing VMS, leading to their pursuance of treatment to alleviate these symptoms. Management of VMS includes lifestyle modifications, some herbal and vitamin supplements, hormonal therapies including estrogen and tibolone, and nonhormonal therapies including clonidine, gabapentin, and some of the serotonin and serotonin-norepinephrine reuptake inhibitors. The latter agents, including desvenlafaxine, have been the focus of increased research as more is discovered about the roles of serotonin and norepinephrine in the thermoregulatory control system. This review will include an overview of VMS as they relate to menopause. It will discuss the risk factors for VMS as well as the proposed pathophysiology behind their occurrence. The variety of treatment options for VMS will be discussed. Focus will be given to the role of desvenlafaxine as a treatment option for VMS management.
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Affiliation(s)
- Elena M Umland
- Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
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27
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28
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Jones JM, Kohli M, Loprinzi CL. Androgen deprivation therapy-associated vasomotor symptoms. Asian J Androl 2012; 14:193-7. [PMID: 22286861 PMCID: PMC3338189 DOI: 10.1038/aja.2011.101] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 10/10/2011] [Accepted: 11/29/2011] [Indexed: 12/21/2022] Open
Abstract
Androgen deprivation therapy (ADT) is widely used as standard therapy in the treatment of locally advanced and metastatic prostate cancer. While efficacious, ADT is associated with multiple side effects, including decreased libido, erectile dysfunction, diabetes, loss of muscle tone and altered body composition, osteoporosis, lipid changes, memory loss, gynecomastia and hot flashes. The breadth of literature for the treatment of hot flashes is much smaller in men than that in women. While hormonal therapy of hot flashes has been shown to be effective, multiple non-hormonal medications and treatment methods have also been developed. This article reviews current options for the treatment of hot flashes in patients taking ADT.
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Affiliation(s)
- Jason M Jones
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
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29
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Fisher TE, Chervenak JL. Lifestyle alterations for the amelioration of hot flashes. Maturitas 2012; 71:217-20. [PMID: 22285470 DOI: 10.1016/j.maturitas.2011.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 12/06/2011] [Indexed: 11/29/2022]
Abstract
Hot flashes are a common complaint among women as they transition through menopause. This article reviews the evidence of lifestyle alterations for the amelioration of hot flashes including obesity, exercise, smoking, relaxation techniques, and acupuncture. Further randomized controlled trials regarding these lifestyle alterations are needed to determine their full potential benefits regarding hot flashes.
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Affiliation(s)
- Thomas E Fisher
- Albert Einstein College of Medicine and Montefiore Medical Center, New York, NY, USA
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30
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Ernst E, Lee MS, Choi TY. Acupuncture in obstetrics and gynecology: an overview of systematic reviews. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2011; 39:423-31. [PMID: 21598411 DOI: 10.1142/s0192415x11008920] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acupuncture is often recommended for obstetrical and gynecological conditions but the evidence is confusing. We aim to summarize all recent systematic reviews in this area. Western and Asian electronic databases were searched for systematic reviews of any type of acupuncture for any type of gynecological conditions. Our own files were hand-searched. Systematic reviews of any type of acupuncture for any type of gynecological conditions were included. Non-systematic reviews and systematic reviews published before 2004 were excluded. No language restrictions were applied. Data were extracted according to predefined criteria and analysed narratively. Twenty-four systematic reviews were included. They relate to a wide range of gynecological conditions: hot flashes, conception, dysmenorrhea, premenstrual syndrome, nausea/vomiting, breech presentation, back pain during pregnancy, and procedural pain. Nine systematic reviews arrived with clearly positive conclusions; however, there were many contradictions and caveats. The evidence for acupuncture as a treatment of obstetrical and gynecological conditions remains limited.
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Affiliation(s)
- Edzard Ernst
- Complementary Medicine, Peninsula Medical School, University of Exeter, UK.
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31
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Complementary and alternative medicine in the treatment of menopausal symptoms. Chin J Integr Med 2011; 17:883-8. [PMID: 22139538 DOI: 10.1007/s11655-011-0932-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Indexed: 10/14/2022]
Abstract
A large number of women will pass through menopause each year. Women in menopausal transition experience a variety of menopausal symptoms. Although hormonal therapy remains the most effective treatment, side effects have been reported by several large studies. An increased number of women seek the use of complementary and alternative medicine (CAM) for treating menopausal symptoms. This review analyzes the evidence from systematic reviews, randomized controlled trials and epidemiological studies of using herbal medicine (Black cohosh, Dong quai, St John's wart, Hops, Wild yam, Ginseng, and evening primrose oil) and acupuncture for the treatment of menopausal symptoms. Evidence supporting the efficacy and safety of most CAM for relief of menopausal symptoms are limited. Future larger and better controlled studies testing the effectiveness of these treatments are needed.
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32
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Baumelou A, Liu B, Wang XY, Nie GN. Perspectives in clinical research of acupuncture on menopausal symptoms. Chin J Integr Med 2011; 17:893-7. [PMID: 22139540 DOI: 10.1007/s11655-011-0930-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Indexed: 11/29/2022]
Abstract
Seventy percentage of perimenopausal and early postmenopausal women will experience menopause symptoms. Primary menopause symptoms in Western countries included hot flashes, insomnia, somatic pain, depression, and fatigue. Hot flashes were most commonly treated. Menopausal hormone replacement therapy (HRT) continues to have a clinical role in the management of vasomotor symptoms, but since 2002 there has been a marked global decline in its use due to concerns about the risks and benefits of HRT; consequently many women with menopause symptoms are now seeking alternatives including acupuncture. Acupuncture has a long tradition of use for the treatment of different menopause symptoms. Its effectiveness has been studied for natural menopause or chemical and surgery induced menopause. Here we provide an update on recent advances in the field for clinicians. The recent systematic reviews on acupuncture in menopausal symptoms suggest that acupuncture is an effective and valuable option for women suffering from menopause. However, the science of acupuncture therapies is still inadequate to sufficiently support the benefits of acupuncture therapies. Finally, we discuss our points of view on clinical trials of acupuncture for menopause symptoms.
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Affiliation(s)
- Alain Baumelou
- Center of Integrated Chinese Medicine, La Pitié Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Paris VI University (Pierre and Marie Curie University), France.
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33
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Chien LW, Liu SJ, Chang Y, Liu CF. Local thermal therapy effects on menopausal symptoms and bone mineral density. J Altern Complement Med 2011; 17:1133-40. [PMID: 22104026 DOI: 10.1089/acm.2010.0635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the effects of local thermal therapy with far-infrared rays (FIR) on menopausal symptoms and bone mineral density (BMD) in postmenopausal women. SUBJECTS AND METHODS A prospective randomized, controlled trial was conducted in female volunteers from communities in Northern Taiwan. The intervention group (n=22) received local thermal therapy with the help of FIR from an FIR emitter, for approximately 20 minutes per day, twice a week, for 20 sessions. They received the therapy on their backs while lying in a supine position. The control group (n=21) received no treatment. The primary outcome was the change in the Perceived Perimenopausal Disturbances Scale, designed for the measurement of menopause-related symptoms (MRS) before and after completion of treatment in a 10-week period. Secondary outcome parameters included serum levels of estradiol (E2) with osteocalcin (OC), and calcaneal BMD by quantitative ultrasound. RESULTS After 10 weeks of intervention, MRS determined by the scale decreased in mean total scores and mean scores for vasomotor, musculoskeletal, urologic, reproductive, and psychologic domains (p<0.05), except for reproductive (sexuality-related) symptoms. In the control group, mean total scores and scores of each domain had no significant difference between baseline and follow-up examination after 10 weeks. There was no significant difference between the quantitative ultrasound parameters in the calcaneus, serum E2, and OC levels either at the baseline or in the changes from the baseline between the intervention and control groups of women (p>0.05). CONCLUSIONS Local thermal therapy with FIR results in a significant reduction of MRS in postmenopausal women. Serum E2, OC levels, and calcaneal BMD showed no significant changes between the two groups. These results suggest that FIR local thermal therapy may be a potential alternative for the management of postmenopausal symptoms.
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Affiliation(s)
- Li-Wei Chien
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
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34
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Morrow PKH, Mattair DN, Hortobagyi GN. Hot flashes: a review of pathophysiology and treatment modalities. Oncologist 2011; 16:1658-64. [PMID: 22042786 DOI: 10.1634/theoncologist.2011-0174] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Many therapies are being studied for the treatment of hot flashes for individuals with cancer, yet few studies have demonstrated safe and effective clinical benefit for those who suffer from this distressing symptom. The purpose of this paper is to assess the current options for the management of hot flashes, examining key endpoints from recent clinical trials and reviewing future directions. Hot flashes are a common stressful symptom for individuals with cancer, particularly women with a history of breast cancer and men with prostate cancer. Lifestyle modifications are proposed as the first step in the management of less severe hot flashes. Several publications have addressed nonhormonal agents as a treatment option for hot flashes. Newer antidepressant and anticonvulsant agents have been studied and show potential in treating vasomotor symptoms. Although many complementary and alternative therapies, including herbal medications and phytoestrogens, have been studied for the treatment of hot flashes, none are clinically recommended at this time. Additionally, further evidence is needed for supportive exercise such as yoga and relaxation techniques. Acupuncture may warrant further investigation in the reduction and severity of hot flashes in both men and women. Hormonal therapies, including estrogens and progestogens, are the most well-known and efficient agents in alleviating hot flashes; however, the safety of these agents is disputable.
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Affiliation(s)
- Phuong Khanh H Morrow
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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35
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Kim DI, Jeong JC, Kim KH, Rho JJ, Choi MS, Yoon SH, Choi SM, Kang KW, Ahn HY, Lee MS. Acupuncture for hot flushes in perimenopausal and postmenopausal women: a randomised, sham-controlled trial. Acupunct Med 2011; 29:249-56. [PMID: 21653660 DOI: 10.1136/aim.2011.004085] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the effect of acupuncture in treating hot flushes in perimenopausal or postmenopausal women. METHODS The study was a randomised single-blind sham-controlled clinical trial. Perimenopausal or postmenopausal women with moderate or severe hot flushes were randomised to receive real or sham acupuncture. Both groups underwent a 4-week run-in period before the treatment. The real acupuncture group received 11 acupuncture treatments for 7 weeks, and the control group underwent sham acupuncture on non-acupuncture points during the same period. Both groups were followed for 8 weeks after the end of treatment period. Changes from baseline in the hot flush scores at week 7, measured by multiplying the hot flush frequency and severity, were the primary outcome. Hot flush frequency, severity and menopause-related symptoms measured with the Menopause Rating Scale Questionnaire were regarded as secondary outcomes. RESULTS 54 participants were randomised into the real acupuncture group (n=27) and the sham acupuncture group (n=27). The mean change in hot flush scores was -6.4±5.2 in the real acupuncture group and -5.6±9.2 in the sham group at week 7 from values at the start of the acupuncture treatment (10.0±8.1 vs 11.7±12.6), respectively (p=0.0810). No serious adverse events were observed during the whole study period. CONCLUSIONS Compared to sham acupuncture, acupuncture failed to show significantly different effects on the hot flush scores but showed partial benefits on the hot flush severity. Further consideration is needed to develop appropriate strategies for distinguishing non-specific effects from observed overall effectiveness of acupuncture for hot flushes. Whether acupuncture has point-specific effects for hot flushes should be also considered in designing future researches.
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Affiliation(s)
- Dong Il Kim
- Department of Obstetrics and Gynecology, College of Traditional Korean Medicine, Dongguk University, Seoul 100-715, South Korea.
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Brem S, Kumar NB. Management of treatment-related symptoms in patients with breast cancer. Clin J Oncol Nurs 2011; 15:63-71. [PMID: 21278042 DOI: 10.1188/11.cjon.63-71] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although the benefits of current treatment strategies are well established, many cancer survivors are at risk for developing physiologic and psychological late effects of cancer treatment that might lead to premature mortality and morbidity and compromise their quality of life. Psychological symptoms include anxiety, depression, fatigue, difficulty sleeping, and loss of self-esteem. Physiologic symptoms include pain, numbness, cognitive impairment, weight gain, loss of sexual interest, spontaneous menopause, and peripheral neuropathy. Both length and quality of survival are important end points. The goal of this review is to summarize the psychological and physiologic symptoms related to breast cancer treatment; the prevalence, contributing therapies, and inter-relatedness of these symptoms; current interventions to prevent, ameliorate, or treat these symptoms; and effectiveness and safety of these interventions. The results of this review will identify the gaps in knowledge and assist in the design of assessments and approaches to improve mortality and quality of life and provide the foundation for the development of evidence-based guidelines to standardize palliative care in cancer survivors.
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Affiliation(s)
- Sabrina Brem
- Department of Interdisciplinary Oncology, College of Medicine, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, USA
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Kang HS, Jeong D, Kim DI, Lee MS. The use of acupuncture for managing gynaecologic conditions: An overview of systematic reviews. Maturitas 2011; 68:346-54. [PMID: 21376483 DOI: 10.1016/j.maturitas.2011.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 01/29/2011] [Accepted: 02/01/2011] [Indexed: 11/30/2022]
Abstract
Acupuncture is increasingly popular for the treatment of many medical complaints, including gynaecologic conditions. The aim of this study was to summarise the evidence from systematic reviews (SRs) and meta-analyses assessing the efficacy of acupuncture in treating common gynaecologic conditions. Six electronic databases, including two major English-language databases (PubMed and the Cochrane Library) and four Korean databases, were systematically searched for SRs and meta-analyses concerned with acupuncture and common gynaecologic diseases. The following English search terms were used: (gynaecologic disease in MeSH terms) AND (acupuncture or acup*) AND (systematic review OR meta-analysis). In addition, three Korean traditional medicine journals (The Journal of the Korean Acupuncture and Moxibustion Society, The Journal of Korean Oriental Medicine and The Journal of Oriental Obstetrics and Gynaecology) were searched. The quality of the included studies was assessed using the Overview Quality Assessment Questionnaire. Of the 55 potentially relevant studies that were found, 16 SRs were included in this report. These reviews evaluated the efficacy of acupuncture for treating the side effects of breast cancer chemotherapy, menstrual disturbances, menopausal symptoms, female infertility, uterine fibroids and polycystic ovary syndrome. Acupuncture was clearly beneficial in the management of chemotherapy-induced nausea and vomiting. In addition, current evidence suggests that acupuncture administered close to embryo transfer during in vitro fertilisation treatment improves the rates of pregnancy and live birth. In conclusion, there is no convincing evidence of the efficacy of acupuncture except for specific conditions, which include acupuncture administered with embryo transfer to improve the outcome of in vitro fertilisation and acupuncture for the management of chemotherapy-induced nausea and vomiting. More well-designed trials using rigorous methodology are required to evaluate the efficacy of acupuncture in treating gynaecologic conditions.
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Affiliation(s)
- Hyun-Sun Kang
- Department of Obstetrics & Gynecology, College of Korean Medicine, Dongguk University, Ilsan, South Korea
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Castelo Branco de Luca A, Maggio da Fonseca A, Carvalho Lopes CM, Bagnoli VR, Soares JM, Baracat EC. Acupuncture-ameliorated menopausal symptoms: single-blind, placebo-controlled, randomized trial. Climacteric 2011; 14:140-5. [DOI: 10.3109/13697137.2010.484875] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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A randomised controlled trial of a cognitive behavioural intervention for women who have menopausal symptoms following breast cancer treatment (MENOS 1): trial protocol. BMC Cancer 2011; 11:44. [PMID: 21281461 PMCID: PMC3045984 DOI: 10.1186/1471-2407-11-44] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 01/31/2011] [Indexed: 11/25/2022] Open
Abstract
Background This trial aims to evaluate the effectiveness of a group cognitive behavioural intervention to alleviate menopausal symptoms (hot flushes and night sweats) in women who have had breast cancer treatment. Hot flushes and night sweats are highly prevalent but challenging to treat in this population. Cognitive behaviour therapy has been found to reduce these symptoms in well women and results of an exploratory trial suggest that it might be effective for breast cancer patients. Two hypotheses are tested: Compared to usual care, group cognitive behavioural therapy will: 1. Significantly reduce the problem rating and frequency of hot flushes and nights sweats after six weeks of treatment and at six months post-randomisation. 2. Improve mood and quality of life after six weeks of treatment and at six months post-randomisation. Methods/Design Ninety-six women who have completed their main treatment for breast cancer and who have been experiencing problematic hot flushes and night sweats for over two months are recruited into the trial from oncology and breast clinics in South East London. They are randomised to either six weekly group cognitive behavioural therapy (Group CBT) sessions or to usual care. Group CBT includes information and discussion about hot flushes and night sweats in the context of breast cancer, monitoring and modifying precipitants, relaxation and paced respiration, stress management, cognitive therapy for unhelpful thoughts and beliefs, managing sleep and night sweats and maintaining changes. Prior to randomisation women attend a clinical interview, undergo 24-hour sternal skin conductance monitoring, and complete questionnaire measures of hot flushes and night sweats, mood, quality of life, hot flush beliefs and behaviours, optimism and somatic amplification. Post-treatment measures (sternal skin conductance and questionnaires) are collected six to eight weeks later and follow-up measures (questionnaires and a use of medical services measure) at six months post-randomisation. Discussion MENOS 1 is the first randomised controlled trial of cognitive behavioural therapy for hot flushes and night sweats that measures both self-reported and physiologically indexed symptoms. The results will inform future clinical practice by developing an evidence-based, non-medical treatment, which can be delivered by trained health professionals. Trial Registration Current Controlled Trials ISRCTN13771934
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Borud E, Grimsgaard S, White A. Menopausal problems and acupuncture. Auton Neurosci 2010; 157:57-62. [DOI: 10.1016/j.autneu.2010.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 04/06/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
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Sideras K, Loprinzi CL. Nonhormonal management of hot flashes for women on risk reduction therapy. J Natl Compr Canc Netw 2010; 8:1171-9. [PMID: 20971841 PMCID: PMC3922061 DOI: 10.6004/jnccn.2010.0086] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Hot flashes are very common in women in menopause and can have a detrimental effect on quality of life. Women on risk reduction therapy are particularly prone because treatments, such as tamoxifen, raloxifene, or oophorectomy, have the potential to exacerbate these symptoms. Hormonal treatments, despite the fact that they represent the most effective therapies, are not used for the treatment of hot flashes in these women because of concerns that they may increase the risk for breast cancer. As a result, several nonhormonal therapies have been tested in randomized placebo-controlled trials and shown to be effective, such as paroxetine, venlafaxine, desvenlafaxine, fluoxetine, citalopram, gabapentin, and pregabalin. In addition, several nonpharmacologic therapies have been tested with various successes. An additional consideration is how some of those drugs, especially fluoxetine and paroxetine, interact with the metabolism of tamoxifen. This article discusses these issues, and provides some recommendations regarding use of nonhormonal therapies for treating hot flashes in women on risk reduction therapy, with an emphasis on pharmacogenomic considerations.
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Pachman DR, Jones JM, Loprinzi CL. Management of menopause-associated vasomotor symptoms: Current treatment options, challenges and future directions. Int J Womens Health 2010; 2:123-35. [PMID: 21072305 PMCID: PMC2971731 DOI: 10.2147/ijwh.s7721] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Indexed: 12/21/2022] Open
Abstract
Hot flashes are one of the most common and distressing symptoms associated with menopause, occurring in more than 75% of postmenopausal women. They are especially problematic in breast cancer patients since some breast cancer therapies can induce hot flashes. For mild hot flashes, it is proposed that behavioral modifications are the first step in management. Hormonal therapies, including estrogens and progestogens, are the most well known effective agents in relieving hot flashes; however, the safety of these agents is controversial. There is an increasing amount of literature on nonhormonal agents for the treatment of hot flashes. The most promising data regard newer antidepressant agents such as venlafaxine, which reduces hot flashes by about 60%. Gabapentin is another nonhormonal agent that is effective in reducing hot flashes. While many complimentary therapies, including phytoestrogens, black cohosh, and dehydroepiandrosterone, have been explored for the treatment of hot flashes; none can be recommended at this time. Furthermore, there is a lack of strong evidence to support exercise, yoga, or relaxation for the treatment of hot flashes. Paced respirations and hypnosis appear to be promising enough to warrant further investigation. Another promising nonpharmacological therapy, currently under investigation, involves a stellate ganglion block.
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Borrelli F, Ernst E. Alternative and complementary therapies for the menopause. Maturitas 2010; 66:333-43. [DOI: 10.1016/j.maturitas.2010.05.010] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 05/26/2010] [Accepted: 05/26/2010] [Indexed: 12/14/2022]
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Abstract
Acupuncture is increasingly being used in reproductive medicine. This review summarizes the evidence of acupuncture in pain relief for oocyte retrieval, improving pregnancy outcomes of in vitro fertilization treatment, management of ovulation disorders, male subfertility, primary dysmenorrhea, endometriosis and menopausal symptoms. However, most of the studies are nonrandomized uncontrolled trials, case reports or case series. For randomized controlled trials, the sample size is underpowered and blinding of assessors is lacking. Different acupuncture protocols and controls are used. These heterogeneities make it difficult to compare studies and draw any firm conclusions. Further studies should also evaluate the cost-effectiveness of acupuncture and investigate the underlying mechanism of acupuncture treatment.
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Affiliation(s)
- Emily Wing Sze So
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
| | - Ernest Hung Yu Ng
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
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Deligiannidis KM, Freeman MP. Complementary and alternative medicine for the treatment of depressive disorders in women. Psychiatr Clin North Am 2010; 33:441-63. [PMID: 20385346 DOI: 10.1016/j.psc.2010.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Complementary and alternative medicine (CAM) therapies are commonly practiced in the United States and are used more frequently among women than men. This article reviews several CAM treatments for depressive disorders in women, with a focus on major depressive disorder across the reproductive life cycle. The CAM therapies selected for this review (ie, S-adenosylmethionine, omega-3 fatty acids, St John's wort, bright light therapy, acupuncture, and exercise) were based on their prevalence of use and the availability of randomized, placebo-controlled data. Further study is necessary to delineate the role of specific CAM therapies in premenstrual syndrome, premenstrual dysphoric disorder, antepartum and postpartum depression, lactation, and the menopausal transition.
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Affiliation(s)
- Kristina M Deligiannidis
- Depression Specialty Clinic, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, USA
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Effects of acupuncture on hot flashes in perimenopausal and postmenopausal women--a multicenter randomized clinical trial. Menopause 2010; 17:269-80. [PMID: 19907348 DOI: 10.1097/gme.0b013e3181bfac3b] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of acupuncture plus usual care for relief of hot flashes and menopause-related symptoms compared with usual care alone in perimenopausal or postmenopausal women. METHODS A multicenter, randomized, controlled trial was conducted. Perimenopausal or postmenopausal women with average hot flash scores of 10 or higher during the week before the screening visit were enrolled and randomly divided into two groups. The treatment group received 12 sessions of acupuncture and maintained usual care for 4 weeks, whereas the control group underwent usual care alone. Hot flash scores were calculated by multiplying frequency by severity of hot flashes recorded in a daily diary. The primary outcome was the mean change in the average 24-hour hot flash score at week 4 from baseline. The secondary outcome was the mean change in menopause-related symptoms as estimated by the Menopause Rating Scale questionnaire at week 4. Follow-up assessment at week 8 was conducted in the treatment group only. RESULTS The mean change in the average 24-hour hot flash score was -16.57 in the treatment group (n = 116) and -6.93 in the control group (n = 59), a difference of 9.64 (P < 0.0001). The total Menopause Rating Scale score, as well as the subscale scores for the psychological, somatic, and urogenital dimensions of menopause, showed significant improvement in the acupuncture group compared with the control group (P < 0.001). The mean change in the treatment group in the primary outcome was -17.58 at week 8. CONCLUSIONS Our results suggest that acupuncture in addition to usual care is associated with marked clinical improvement in hot flashes and menopause-related symptoms in perimenopausal or postmenopausal women.
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The role of acupuncture in treating menopausal hot flashes. Menopause 2010; 17:228-30. [DOI: 10.1097/gme.0b013e3181d298e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Borud E, White A. A review of acupuncture for menopausal problems. Maturitas 2010; 66:131-4. [PMID: 20060667 DOI: 10.1016/j.maturitas.2009.12.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 12/10/2009] [Indexed: 11/24/2022]
Abstract
Acupuncture is one of the complementary therapies that are increasingly used by women with menopausal hot flushes. Acupuncture can be understood as a form of neurological stimulation. Clinical trials of acupuncture use different control groups according to whether they wish to provide practical information on the role of acupuncture in health care, or theoretical information on the specific needle effect. Controls for the latter research question are highly problematic, and no convincingly inert 'placebo' needle has yet been designed. For natural menopause, one large study has shown acupuncture to be superior to self-care alone in reducing the number of hot flushes and improving the quality of life; five small studies have been unable to demonstrate that the effect of acupuncture is limited to any particular points, as traditional theory would suggest; and one study showed acupuncture was superior to blunt needle for flash frequency but not intensity. For flushes associated with induced menopause, clearly acupuncture is useful for reducing flushes in clinical practice, but there is mixed evidence on the nature of the effect: one trial found genuine acupuncture superior to control needling, but another showed no significant difference between acupuncture and blunt needle. The possible mechanisms of acupuncture for hot flushes are discussed. Current evidence clearly justifies further research into the most cost effective form of acupuncture for treating hot flushes.
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Affiliation(s)
- Einar Borud
- The National Research Center in Complementary and Alternative Medicine, University of Tromsø, Tromsø, Norway.
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