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Ask an expert - general - menopause

4 questions

Q:  I have had 4 treatments with acupuncture over the last 6 weeks for menopause symptoms.   My last period was two years ago but I have two small bleeds over the last week and I am concerned. Could acupuncture have triggerd this off?

A:  It is always possible that acupuncture treatment may cause the body's systems, especially hormonal, to re-activate to a degree. This is why we always take great care when treating people with a stable thyroid or Type-2 diabetic medication routine, in case the treatment triggers any residual function and destabilises the regimen.

In cases like yours this is always possible, and even without treatment it is possible to have occasional small bleeds around the menopause, often at long and unpredictable intervals. The occurrence of a bleed now could, indeed, be entirely coincidental. However, if you are at all concerned, you should visit your GP. It is a part of our training to encourage patients to visit their GP for any unexplained or unusual bleeding.

This is quite often a difficult message to get across without being alarmist, as you might imagine. In the vast majority of cases it proves to be completely unexceptional. However, in the rare event that there is something more significant going on, it is better to find out and address it immediately rather than take a 'wait and see' approach.

You might also want to have a chat with your practitioner to see if there is anything in your case history or treatment to date which suggests that this is or has been likely. Some treatments are quite expulsive by nature, and can often cause a kind of cleansing effect on the system. A great deal would depend on the nature and quality of the bleed.

We think, though, that a routine check with your GP would probably be the first and best option. 

We publish a fact sheet on menopause

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/menopausal-symptoms.html

which is refreshingly candid about the chances of treating menopausal symptoms, and refers to a number of papers which seem to provide encouraging results. One of the main reasons which bedevils the results of research is that the treatment is often compared to a 'sham' treatment, and both generate better results than the control group. As a consequence the treatment is said to be 'no better than sham' and all down to a placebo effect. We, however, would say that there is no such thing as 'sham' acupuncture; sticking needles anywhere will generate a result, and it's the difference between good and better treatment. As one of our medical colleagues said, if sham treatment is better than conventional treatment, who cares how it works, just use it!

In  essence, though, we have to say that traditional Chinese medicine has been addressing the problems of the menopause for over 2000 years, and over that time has looked in enormous detail at the kind of energetic changes which occur at this time of life. Interpreting these against the backdrop of the patient's constitutional energy is where the skill of the practitioner lies. This is more than just deciding out of the five causes for a symptom which specific treatment will work best. Chinese medicine treats the person, not the condition, and simply picking off the symptom while leaving the overall balance untreated will in many cases mean that the symptom returns. This is why we are quite concerned about people learning formula treatment for named conditions; sometimes they work, sometimes they don't, and when they don't people wrongly conclude that acupuncture treatment does not work.

The best advice we can offer is that you visit a BAcC member local to you for a brief face to face assessment of what may be possible. Most members do not charge for a short interview, and face to face they can give you a much better idea than we can at a distance of what may be possible. A postcode search facility on our home page will identify the practitioners nearest to where you live and work.

,A:  As well as producing factsheets, we also produce review papers which give our research people a chance to go into a little more depth. The menopause and its symptoms are one of the areas where they have done this, and the paper

http://www.acupuncture.org.uk/arrc/public-review-papers/menopause-and-acupuncture-the-evidence-for-effectiveness.html

makes some very positive noises about the possible benefits of treatment for hot flushes. However, the paper acknowledges that there are a few methodological problems with the field, especially since some of the studies are from China where there less interest in checking whether acupuncture works and more in working out which treatments work better. This does not meet the standards set in the West, and although we have consistently maintained that the randomised double blind control trial from drug testing does not work for acupuncture, it remains the 'gold standard.' This underpins papers like this one

http://www.ncbi.nlm.nih.gov/pubmed/23897589

which tend to portray the glass as half empty rather than half full.

The thing to bear in mind is that the Chinese have been treating menopausal symptoms for over 2000 years. Although the theoretical basis of Chinese medicine is entirely different, based on theories of energy called qi, the Chinese have found ways of understanding the process of change in middle age which underpin a number of syndromes which provide treatment options.

Naturally, these have to be adapted to the individual because from a Chinese medicine perspective everyone is different, i.e. there are no formula treatments where the same needles work for everyone. However, the standard forms of imbalance can be interpreted within the context of the individual's energy to help them deal with the symptoms which arise.

The best advice is always to visit a BAcC member local to you to ask for an informal face to face assessment of what they think may be possible. This will be far more informative than our speculation at one remove, and the practitioner will probably be able to give you a good idea of what frequency and extent of treatment may be necessary. On balance, though, most of us find that we can treat hot flushes to a degree, and the main question we have is more a matter of how much change we can effect and how sustainable it is rather than does it work at all.


 

Q. Have sucessfully had acupuncture for fertility issues. Now in peri- menopause and can't get on with HRT or Prozac. Now cold turkey and hot flashes few and far between. Major issue is the mood swings - I am becoming increaslingly difficult to live with (ask my husband, kids and dog!). Can acupuncture help in this area?

 

A. There's no doubt that the research for treating menopausal symptoms is not conclusive, as our factsheet shows but with the wide variety of symptoms which women experience designing good trials is not that straightforward.
 
One of the great strengths of Chinese medicine, though, is that it can offer an understanding of groups of symptoms in a way which would make no sense in western medicine but which would be immediately clear from the Chinese understanding of functions in the body and their relative levels of balance. A skilled practitioner may be able to make sense of what you are experiencing and attempt to adjust the balance to reduce the severity of the symptoms.
 
The fact that you have had acupuncture before and that it has worked for you is very encouraging. Many people find that they are very receptive to one form of treatment over others, and this can often transfer to new symptoms which arise.

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