Thinking about acupuncture or herbs for menopause? Read this first

Hot flushes, night sweats or swinging mood changes are some of the most common symptoms of menopause – the stage of a woman’s life when menstrual periods stop permanently, and she is no longer fertile.

Some women choose to ride out the symptoms. Some choose hormone replacement therapy (HRT), also known as menopausal hormone therapy or MHT. This contains oestrogen, progesterone or combined therapies. Others use complementary therapies.

But do complementary therapies such as acupuncture and herbal medicines actually help?

Remind me, what’s going on with menopause?

Menopause is a normal part of ageing, as is the menopausal transition (or perimenopause), which occurs for several years before it. Some women’s periods stop earlier than others. But most women become menopausal naturally between the ages of 45 and 55.

During menopause, women often have a range of symptoms. These can include hot flushes, night sweats, mood swings, joint discomfort, sleep disturbances, decreased libido, headache or migraine, cardiometabolic disturbances (such as high blood pressure), weight gain, and loss of bone mineral density.

These symptoms can be distressing and can affect women’s quality of life.

Why complementary therapies?

Some women prefer to use complementary therapies alongside conventional treatment, or instead of it, due to side effects of menopausal hormone therapy.

Other women cannot use MHT because of other medical conditions, such as breast cancer, or being at risk of venous thromboembolism (blood clots in the deep veins of the leg, which can be fatal if they travel to the lungs).

But what does the evidence say about complementary therapies used in menopause?

Earlier this year, we and our colleagues published a large review to draw together the evidence. We analysed 158 clinical trials and systematic reviews conducted in women over 40. These studies looked at 86 complementary therapies, such as acupuncture, Chinese herbal medicine, vitamin and nutrient supplements, and mind-body approaches.

Most studies were of low or very low quality. This could be because they included a small number of participants, were not double-blinded (when neither the participants nor the researchers knew which people were given which therapy) and sometimes did not use placebos.

So clinicians don’t have sufficient evidence to recommend them.

Now, the detail

Most studies in the review asked women to report the frequency and severity of their symptoms. Some used questionnaires covering a range of symptoms to give an overall menopause score. Others just asked about hot flushes.

Here are some of the findings.

Black cohosh is a flowering plant that improves overall menopausal scores, and hot flushes. Studies found benefits when taken from four to 52 weeks. Women took different products containing black cohosh, on its own or with other herbs. None of these studies reported serious side effects.

Isoflavones also known as phytoestrogens are found in soy and other legumes, and mimic oestrogen in the body. Soy-derived isoflavones improve hot flushes as well as overall menopausal scores. However in the same study, red clover-derived isoflavones did not reduce hot flushes. Side effects to isoflavones are generally mild and improve quickly without needing medical intervention.

Our ability to make vitamin D from sunlight reduces as we get older. In women, this decline starts at about the same time as menopause. For reducing the risk of fracture, women who have diagnosed osteoporosis need to take 800 IU (international units) vitamin D and 1,200 milligram calcium daily under medical supervision. But vitamin D plus calcium are not recommended to women without osteoporosis and without low vitamin D levels. This is because long-term use (over seven years) may increase the risk of cardiovascular disease (such as a heart attack).

Chinese herbal medicines can be combinations of multiple herbs (often between five and 20) in a formula. Seventy studies, using a variety of formulas, showed taking Chinese herbal medicines for seven days to three months improved menopausal scores and sleep quality. The most common formula was Suan Zao Ren Tang. Short-term use (up to a year) appears to be safe, but there are no studies looking at its longer-term use.

Another meta-analysis on Chinese herbal medicines using Rehmannia as the main herb found 17 studies. When taken for two weeks to three months there was an improvement in overall menopausal scores. No adverse events were reported.

Acupuncture comes in several forms and you can have it with and without other therapies. We found no evidence to recommend regular acupuncture for hot flushes. Acupuncture with Chinese herbal medicines improves sleep quality, but only in perimenopausal women with insomnia. Electro-acupunture is a form of acupuncture that passes a gentle current between two needles into your skin. It improves hot flushes.

In summary, most treatments included in our review did not show enough evidence to be able to recommend them clinically. Complementary therapies including soy-isoflavones, vitamin D, black cohosh and Chinese herbal medicine may help some menopausal symptoms, but more high-quality research is needed to understand how effective and safe these treatments truly are.

So what should I do?

The International Menopause Society recommends that if women in midlife choose complementary therapies, these should be alongside MHT.

So always talk to your GP about your plans, and only consider using the complementary therapies that have good evidence for the symptoms you currently have. Your GP can help you think about the risks and benefits for you, and help you make a decision based on the best available scientific evidence.

A healthy lifestyle – including eating well, staying active, looking after your mental wellbeing, getting restorative sleep, maintaining healthy relationships, and avoiding drugs and alcohol – are all important in menopause care.

These are linked with benefits including fewer hot flushes, a healthier weight, a lower risk of heart disease and diabetes, and a lower risk of falls and fractures.

Complementary therapies should not replace these fundamental lifestyle habits.