Monday, June 06, 2011
Craig Amrine, L.Ac. is the owner and operator of Hidden Rhythm
Acupuncture in Tempe, AZ and a leading authority of Cold Laser Therapy.
He can reached through his website at www.hiddenrhythmacupuncture.com
for the Treatment of Menopause
Men, please donâ??t read
this article. But if you do, I urge you
for YOUR safety to keep your opinions to yourself and simply listen. Every month we know know that our female
friends, lovers, girlfriends, wives go through a temporary metamorphosis where
they...change. Women become
extraordinarily moody, their ankles swell, and flannel pajamas or sweatpants
become the accepted form of bedroom attire.
We are indeed talking about a womenâ??s menstrual cycle.
To put it simply, a
womanâ??s menstrual cycle involves the building and ultimate shedding of the the
endometrial lining of the uterus. This
coincides with the development and release of the egg from the ovaries. All of this is dictated by a complex release
of hormones that can have a wide range of physical and emotional effects on the
body. The first half of the menstrual
cycle is called the follicular phase where a follicle containing an egg grows
in the ovaries and the endometrium (lining of the uterus) begins to
thicken. This is spurred by (relatively)
increased levels of FSH (follicle stimulating hormone) from the pituitary and
estradiol (estrogen) from the ovaries.
After 14 days or so, the egg is released into the fallopian tubes from
the follicle in the process called ovulation.
This is accompanied by a jump in luetenizing hormone from the pituitary
and a surge in progesterone from several sources including the corpus
luteum. The corpus luteum is the
residual follicle after it released the egg.
This second half of the cycle is called the luteal phase. If conception has not occurred, the shedding
of the endometrium (lining of the uterus) occurs at the end of this cycle and
typically lasts for 5-7 days. The
overall levels of hormones are dictated by a complex feedback loop involving
the hypothalamus (part of the brain), the pituitary gland, the adrenal glands,
and the ovaries. Upsetting one of these
levels can have dramatic side-effects
Yes, this is a very
simplified version of the menstrual cycle.
Entire books and university courses are written on this subject and the
problems that can arise. So, if you want
more detail, please refer to books and articles specifically written on this
Traditional Chinese Medicine have become extremely well established and proven
in their role to increase fertility, induce labor, and increase libido, but
what can acupuncture do when the menstrual cycle stops? Yes, itâ??s a natural process that virtually
all women will go through and is not itself considered a health issue. The problem is that the ending of the
menstrual cycle can lead to a large number of secondary symptoms. These symptoms may vary greatly and can
include hot flashes, night sweats, insomnia, loss of libido, depression, and
osteoporosis. While hot-flashes may
appear simply inconvenient or embarrassing, osteoporosis can be much more
serious and lead to higher chance of bone fractures.
Menopause can simply be
defined as the loss of a menstrual period.
Specifically, itâ??s the cessation of the menstrual period for at least
one year. It usually happens between the
ages of 49-51 for most women. This is
due to the fact that women are born with a limited supply of ovarian follicles
(precursor to eggs). Over time, the
follicles are lost through ovulation or they simply die off. The decrease in activity within ovaries
coincides with a decrease in the release of ovarian estrogen. Since estrogen levels are part of the
complex feedback loop mentioned earlier, the brain gets confused, resulting in the release of
abnormally high levels of FSH (follicle stimulating hormone) and LH (lutenizing
hormone). Physicians will often use
these high levels of FSH and LH as chemical markers to gauge the health and
longevity of a womenâ??s ovaries. In
addition, levels of progesterone, testosterone, and androstenedione also
So whatâ??s the big deal?
Itâ??s a process that virtually every
woman will undergo, sooner or later.
Unfortunately, these changes in
hormone levels can result in several side-effects; some are simply inconvenient
while others can be more serious.
Side-effects can include: Hot flashes, night sweats, heart palpitations,
vaginal dryness or itching, insomnia, irritability, anxiety, depression, loss
of libido, and loss of bone density (osteoporosis). The severity of symptoms can greatly vary based
on life-style and hereditary factors2.
is Menopause a Problem?
The two most common
concerns are hot-flashes and osteoporosis.
Hot flashes are thought to be the result of problems with the
temperature regulatory centers in the hypothalamus (part of the brain). These centers control vasodilation/vasoconstriction
(opening or closing of blood vessels) and sweating. A loss of circulating estrogen is thought to
cause problems with this temperature feedback loop, leading to periodic and and
intense flashes of heat and sweating2.
(bone-loss) is defined as a loss of bone-density that often accompanies
menopause. It is thought to be due to
the decrease in estrogen. Estrogen
effectively mediates or controls the
activity of specific cells designed to break down bone. The cells called osteoclasts are
designed to break down bone to allow more calcium into the blood. These osteoclasts take their orders from
chemical messengers called cytokines (IL-1, IL-6, and TNF). A drop in estrogen seems to cause an increase
in concentration of these osteoclasts because it is no longer there to mediate
these cytokines, resulting in higher cytokine concentration, and ultimately
more osteoclasts 14.
treatment methods include hormone replacement therapy, antidepressants, blood
pressure medication, bisphosphonates, and even anti-seizure medications such as
Gabapentin. These drugs have been found
to reduce hot-flashes and even prevent or reduce bone-loss. The problem with virtually all of these
conventional therapies is the risk of very serious side-effects. For example, hormone replacement therapy
has been proven to be linked to higher rates of breast cancer, heart attacks,
therapies including phytoestrogens (substances that ACT like estrogen on
estrogen receptors in the body) such as isoflavones in Soy, along with herbs
such as black cohosh have been proven to help with menopausal symptoms
including hot flashes. However, they are
not perfect because they may have their own potential side-effects. For example, black cohosh can possibly cause
headaches, rashes, possible weight gains, and vaginal spotting 7,8. Some believe it may increase
chance of liver damage, but more evidence is needed to substantiate this.
The loss of bone
density (osteoporosis) due to menopause has spurred itâ??s own category of drugs
such as bisphophonates (Fosamax, Boniva).
These drugs are designed to slow down the rate of bone thinning and even
increase bone density.
Ironically, these drugs
have several very serious side-effects. The
most serious being that they stunt the
formation of new osteophytes (cells designed to create new bone). This leads to osteonecrosis, or â??rotting of
boneâ?. There are SEVERAL thousands of
lawsuits alleging these drugs cause â??Dead Jawâ? syndrome where the jaw fails to
heal after common dental procedures including extractions, root canals, and
crowns. This can often lead to jaw
infections, and severe disfigurement 4,5. The
FDA has recently also issued a warning that these types of drugs increase the
chance of femoral fractures (broken leg)5. Despite the increasing evidence against this
drug, it continues to be marketed very heavily and is still prescribed by
doctors. Other side-effects have been
reported including stomach problems, rashes,
difficulty breathing, back pain, muscle pain, joint pains, digestive problems,
headaches, upper respiratory infections, bronchitis, urinary tract infections,
and high cholesterol 6. So, if you are thinking of or are already
taking these drugs to fight osteoporosis, STOP!
What are your options?
general, the more natural herbal of botanical alternatives to hormones have
much less severe side-effects than
conventional drug therapies, but as described above, side-effects do indeed
exist. If women were seeking an herbal
solution, Iâ??d recommend either a Chinese herbalist or a Naturopathic Doctor.
well documented that exercise and weight training can reverse bone-loss due to
from a Traditional Chinese Medical Perspective
look at how Traditional Chinese Medicine (TCM) and acupuncture can treat
menopause symptoms, letâ??s discuss how menopause is viewed in TCM. Keep in mind this is a very basic
description in TCM terms and is not designed to be a full lecture on TCM
theory. Suffice it to say that TCM
considers menopause the result of a decline in the vital substance known as
â??Jingâ? (Essence). Stored in the
kidneys, Essence is responsible for growth, development, maturity, and our
overall constitutional vitality. It is
also considered a precursor to all the other vital substances (Qi, Blood, Shen,
etc.). We are born with a limited supply
that cannot be recovered once it is gone.
However, it can be â??fortifiedâ? and nourished a bit through exercises
such as Tai-Chi and Qi-Gong. It is the
underlying foundation for hormone production, bone growth, and reproductive
health. According to the classic TCM
literature, the growth, maturation, and decline of Jing takes place in 7 year
cycles for women (and 8 year cycles for men).
At the 7th cycle (age 49), the Jing declines and womenâ??s menstrual cycle
heart of TCM lies the very basic concept that good mental and physical health
relies on the balance of Yin and Yang within the body. Yin is considered the substantial; the
â??stuffâ? that circulates within the body and has a cooling nature. Yang is considered the function or energy
used to circulate the â??stuffâ? and has a warming nature. At menopause the Yin/Yang balance is
dramatically upset due to a corresponding decline in Kidney Yin
(estrogen). Without the cooling nature
of Yin, the warm nature of Yang will dominate, giving rise to warmth as seen in
mentioned earlier, Jing/Essence dictates bone growth. According to TCM, the Kidneys also play a
role in bone growth and development. A
weakening of the Kidneys and decline in Jing that inevitably come with aging
will eventually lead to problems with bone growth and repair, eventually leading
to bone-thinning. In Western terms, this
manifests as osteoporosis.
control bone growth? On the surface,
anyone with at least a rudimentary understanding of anatomy could say that TCM
was way off in this regard. If you begin
to think about it, however, maybe they were a bit closer to the truth. We know that part of the calcium adsorption/excretion process takes
place in the Kidneys. We also know that
the adrenal glands sit on top of the kidneys and play a huge role in hormone
production responsible for all stages of growth and development. Historically speaking, TCM viewed the adrenal
glands as part of the kidneys. Itâ??s
fascinating that over 2000 years ago, Chinese physicians already knew that this
kidney/adrenal region was strongly connected to growth/development/sexual
development and overall vitality.
What can Acupuncture Really Do?
articles Iâ??ve written cited several studies describing how acupuncture can have
profound effects on hormones, neurotransmitters, and cytokines in emotional,
immune, and inflammatory processes (see â??published articlesâ? page on my
website). We now know that this
influence also affects those hormones and cytokines responsible for womenâ??s
health and menopause.
and Hot Flashes
studies have shown that acupuncture can significantly lower hot-flash
symptoms. A recent study specifically
measured both hormone levels and menopause symptoms as described in the MRS
(Menopause Rating Scale) before and after several weeks of acupuncture. The results were compared to a â??Shamâ? group
that received acupuncture in non-related body points. The results suggested that hot-flashes were
significantly lower in the group treated at â??Realâ? acupuncture points. Interestingly, LH (luetenizing hormone)
levels were lower while estrogen levels were markedly higher after acupuncture
in the â??Realâ? acupuncture group 10.
study compared acupuncture versus Venlafaxine (Effexor) for treatment of
hot-flashes (vaso-motor symptoms) and depressive and quality-of-life symptoms
of menopausal women. This study was
interesting because it was conducted on women who were survivors of breast
cancer. It is commonly understood that
women whoâ??ve already had breast cancer are especially vulnerable to hormone-replacement
therapy because it can increase the cancer returning. As a result, the common solution is to
prescribe them Venlafaxine (Effexor).
Effexor has been proven to lower menopause based hot-flashes. It is a common anti-depressant, however, with a large list of negative side-effects
common to all selective seratonin-reuptake-inhibitors (SSRIâ??s).
clearly demonstrated that acupuncture was AT LEAST as effective in reducing
hot-flashes as Effexor in these patients with breast cancer. The group receiving acupuncture also noted
marked improvements in anxiety, depression, and even an increased sex-drive as
compared to the patients taking Effexor 9. In a follow-up analysis one full year after
the completion of treatments, hot-flash frequency was still significantly lower
in the acupuncture group compared to the Effexor group. In addition, none of the patients in the
acupuncture group experienced several of the negative side-effects reported in
the Effexor group including dry-mouth, decreased appetite, nausea, and
reduces hot-flashes. Patients swear by
it. Studies confirm it. But what about more serious consequences of
menopause such as osteoporosis? While
hot-flashes can be inconvenient, loss of bone density leading to fractures is
much more serious. Can acupuncture
really stop bone loss or possibly increase bone density? The answer is YES! Several studies have been performed on both
animals and humans measuring bone density before and after several acupuncture
treatments. The results have uniformly
demonstrated that acupuncture increases
bone density on post-menopausal patients11,12,13, 15, 16.
does it do this? Earlier in this paper
we briefly describe how a chemical messenger called Interleukin-6 (IL-6) has a
relationship with cells designed specifically to break down bone to allow
calcium to re-enter the blood stream14. Acupuncture has already been proven to have a
strong effect on IL-6 based on several studies where it lowers IL-6 levels in
inflammatory-based conditions 19. It now also appears to influence the IL-6
level and itâ??s control over bone dissolving cells. One particular study looked at this specific
relationship by measuring both the levels of IL-6 and myelogenic osteoclasts
(cells that break down bone). This
particular study showed a significant decrease in the amount of IL-6 and
osteoclasts in patients treated with acupuncture compared to a control group 13.
Natural Solutions ?
these studies, acupuncture is proven to have a strong effect in reducing
menopause symptoms including hot-flashes and osteoporosis. Is there anything else you can do? As mentioned earlier in this article, there
are herbal remedies such as black cohosh that are shown to reduce hot-flashes 7,8. Although they
are considered â??naturalâ?, they are not completely harmless and I would highly
recommend the guidance of a Naturopathic Doctor to discuss both the dose and
any possible side-effects of herbal remedies.
fight osteoporosis, calcium and vitamin supplements are usually
recommended. Up to 1200 to 1500 mg is
recommended daily for menopausal women.
Dairy and dark green vegetables are good sources of calcium. Supplements of Calcium and vitamin D are also
good sources. While calcium carbonate is
the most common and cheapest, it is the least easily adsorbed. I recommend calcium citrate or calcium
malate. While being slightly more
expensive, they are more easily adsorbed 18 .
one of the absolute least expensive way to fight and even reverse bone-loss is
through weight training. Various studies
have proven that regular strength-training in post menopausal women for at least 1 year can increase bone
mass from 1 to 9 percent 7,17. Yes, this regiment does take
work, but there are zero side-effects and itâ??s cheap!
are going or will be going through menopause no longer have to suffer, or
anticipate this change with dread. There
are several natural, safe, and effective options including acupuncture to
reduce symptoms of menopause.
Acupuncture has been repeatedly proven to lower both intensity of
hot-flashes and reverse the effects of osteoporosis. Itâ??s inexpensive, safe, and proven to work.
1 Maryanne Travaglione, Menopausal Hot
Flashes: A Case Report, Oriental
Medicine-A Publication of Pacific College of Oriental Medicine, Spring 2011
9 Eleanor M.
Walker, Alba I. Rodriguez,
Beth Kohn, Ronald M. Ball,
Jan Pegg, Jeffrey R. Pocock,
Ramon Nunez, Ed Peterson, Susan Jakary
and Robert A. Levine,
Acupuncture Versus Venlafaxine for the Management of Vasomotor Symptoms in
Patients With Hormone Receptorâ??Positive Breast Cancer: A Randomized Controlled
Trial: JCO (Journal of Critical
Oncology) February 1, 2010 vol. 28 no. 4 634-640
10 Didem Sunay, Muruvvet Ozdiken,
Ali Seven, Yalcin Aral,
The Effect of
Acupuncture on Postmenopausal Symptoms and Reproductive Hormones: A Sham
Controlled Clinical Trial: Acupunct Med
(Acupuncture in Medicine) 2011;29:27-31 doi:10.1136/aim.2010.003285
11 Zhao LH, Nong ZN, Zhong X, Pang Y, Liang JS, Li XD, Ye FW, Effects
of warm needle moxibustion on bone mass density and biochemical indexes of bone
metabolism in patients of postmenopausal osteoporosis: Zhongguo Zhen Jiu. 2008
Dec;28(12):897-900,Department of Acupuncture, The First Affiliated Hospital of
Guangxi University of TCM, Nanning 530023, China. firstname.lastname@example.org
12 Ou-yang, Gang et
al, The Influence of Acupuncture on Postmenopausal Female Bone Density, Zhong Yi Za Zhi (Journal of Chinese Medicine),
#2, 2001, p. 88
13 Liu X, Shen L, Wu M, Wu B, Gao L, Hu W, Zhang A, Effects
of acupuncture on myelogenic osteoclastogenesis and IL-6 mRNA expression, J Tradit Chin Med.
Pacifici, Editorial: Cytokines, Estrogen, and Postmenopausal
Osteoporosisâ??The Second Decade, Endocrinology, June 1, 1998 vol. 139 no. 6 2659-266
15 Ma J, Yun-guang H, Zhang DH.Effects
of acupuncture on bone metabolism and serum estradiol level in
ovariectomy-induced osteoporosis rats, Zhen Ci Yan Jiu. 2008 Aug;33(4):235-9: College of Acu-moxibustion
& Massage, Chengdu University of Chinese Medicine, Chengdu 610075, China. email@example.com
16 Wei YF, Liu YL, Zhang SH, Wang ZO, Liu Y, Wang HC, Yao JF, Li F, Wang CH
Effect of electroacupuncture on
plasma estrin and bone mineral density in ovariectomized rats: Zhen Ci Yan Jiu. 2007 Feb;32(1):38-41: Xijing
Hospital, Fourth Military Medical University, Xi'an 710032, China. firstname.lastname@example.org
17 Dani Veracity, Bone density sharply enhanced by
weight training, even in the elderly, August 06, 2005,
Yim1, Hyun Lee2, Kwon-Eui Hong2, Young-Il Kim2, Byung-Ryul Lee2, Chang-Gue Son3 and Jung-Eun Kim1, Electro-acupuncture at acupoint ST36 reduces inflammation and
regulates immune activity in Collagen-Induced Arthritic Mice, 1Department of Meridian and Acupoint, 2Department of Acupuncture and Moxibustion
and 3East-West Cancer Center
of Dunsan Hospital, College of Oriental Medicine, Daejeon university, South
Korea, Advance Access Publication 18 August 2006