Acupuncture Continuing Education

Acupuncture Decreases Insomnia Due To Menopause, Increases Estrogen

Acupuncture benefits sleep, regulates hormone levels, and reduces symptoms associated with menopause. Taipei Medical University (Taiwan) researchers conclude that acupuncture reduces sleep disturbances associated with menopause. In addition, the researchers discovered that needling acupuncture point SP6 (Sanyinjiao) significantly increases estrogen levels. They add that acupuncture’s ability to reduce menopausal related symptoms, including benefitting sleep, is correlated with its ability to regulate endogenous estrogen levels. The findings were published in Obstetrics & Gynecology, a publication by The American College of Obstetricians and Gynecologists.

 

Estrogen Levels 

 

Taipei Medical University researchers analyzed 31 randomized controlled trials with a total patient size of 2,433 participants. The researches discovered a homeostatic regulatory effect of acupuncture on three hormones. The researchers conclude that acupuncture, for both perimenopause and postmenopause, significantly

  • reduces sleep disturbances
  • increases serum estradiol (estrogen)
  • reduces serum follicle-stimulating hormone (FSH)
  • reduces luteinizing hormone (LH)

The researchers note, “acupuncture should be adopted as part of a multimodal approach for improving sleep disturbances in perimenopausal and postmenopausal women.” Menopause refers to the cessation of menstrual cycles and marks the end of reproductive ability. The average age of menopause is 51. [1] According to the National Institutes of Health (NIH), the most common changes associated with perimenopause and menopause include hot flashes, sleep disorders, and mood changes. [2] Additionally, the risk of osteoporosis increases with a decrease in estrogen levels. [3]


At the Healthcare Medicine Institute (HealthCMi), we offer herbal medicine and acupuncture continuing education courses on the treatment of complications associated with menopause. To view a sample of acupuncture CEU/PDA materials, click the following:

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During perimenopause, estradiol and progesterone levels drop while FSH and LH levels increase. “Estrogen has been shown to decrease sleep latency, decrease the number of awakenings after sleep occurs, increase total sleep time and decrease the number of cyclic spontaneous arousals.” [4] A study of postmenopausal woman describes the mechanism of action, indicating that “estradiol production exerts thermoregulation effects by inducing peripheral skin vasodilatation (a major heat loss effector), thereby reducing the core body temperature and subsequently causing the onset of sleep. Moreover, growing evidence from preclinical animal data supports that a nuclear estrogen receptor is present in the sleep-wake regulatory nuclei (eg, hypothalamus-preoptic area), suggesting that a possible direct action of estradiol at the nuclei of the sleep-wake regulatory system.” [5] This suggests that a decrease in estradiol inhibits the body’s ability to regulate temperature, and the inability to decrease body temperature is directly related to difficulty sleeping.

Lack et al. note, “Sleepiness and sleep propensity are strongly influenced by our circadian clock as indicated by many circadian rhythms, most commonly by that of core body temperature. Sleep is most conducive in the temperature minimum phase.” [6] Thus, if estrogen is deficient, the body’s core temperature will not decrease sufficiently, and sleep difficulties will result. Additionally, “progesterone has very profound effects on sleep and is somewhat more straightforward in its effects on sleep than estrogen. Progesterone, when given intravenously, has direct sedative qualities, stimulating benzodiazepine receptors that in turn stimulate the production of the NREM associated gamma-aminobutyric acid (GABA) receptors.” [7]

While none of the studies in this meta-analysis address the effect of progesterone on sleep, “regarding serum estradiol, average pretest and posttest estimates in the acupuncture groups were 27.26 and 42.38 pg/mL and in the control groups were 27.50 and 34.25 pg/mL, respectively. Acupuncture was associated with significant elevations of the serum estradiol level with a pooled difference in means of 7.56 pg/mL.” [8] Although the results of the studies show that acupuncture is more effective than their respective controls for the treatment of sleep disorders due to menopause, the effects vary in magnitude. The researchers found that there was no association between the type of acupuncture used and size of the effect, with one exception: the acupuncture associated changes in serum estradiol. “In terms of moderators of the effect of acupuncture on serum estradiol, studies in which the Sanyinjiao [SP6] acupoint was selected as the acupoint were associated with a significantly larger elevation in serum estradiol level than did those that did not select the same acupoint.” [9] The researchers observed that increases in serum estradiol were correlated with a lower incidence of sleep disorders, making SP6 (Sanyinjiao) an acupoint interest for the treatment of disorders associated with decreased estradiol.

Because of the profound effect that acupuncture has on estrogen levels, it comes as no surprise that acupuncture effectively treats other symptoms associated with menopause, such as hot flashes (flushes). Zhou et al. find acupuncture at SP6 (Sanyinjiao) significantly effective for increasing estradiol and significantly decreasing FSH, and that this hormonal change is accompanied by a substantial decrease in the severity of hot flashes associated with premenopausal women that have had ovariectomies. [10] Sunay et al. note that, for acupuncture treatments of postmenopausal women, “the severity of hot flushes was found to be significantly decreased after treatment.” [11] They found that estrogen “virtually eliminates hot flashes,” [12] and suggest that acupuncture is a good alternative to HRT because of its ability to stimulate endogenous estrogen production.

Chiu et al. note limitations of their study. [13] Only studies published in English and Chinese languages were included. Also, because they analyzed 31 trials [14], there is naturally a diversity in the types of acupuncture used, as well as the duration and frequency of treatments. There is also a wide variety of points chosen across multiple studies, though the most common were three: HT7 (Shenmen), DU20 (Baihui), and SP6 (Sanyinjiao). [15] Metrics also varied across studies: some measured hormone levels, while others used indices such as the Pittsburgh Sleep Quality Index to gather data on the objective or subjective sleep experiences of the patients. Some trials included patients who had previously undergone HRT, or treatment for other conditions such as breast cancer. Some studies’ results were more positive than others. It was found that increased positive patient outcomes was correlated with the use of acupoint SP6 (Sanyinjiao).

An important finding of this meta-analysis is that acupuncture is effective for increasing serum estradiol. It is well understood that a decrease in estrogen is responsible for many of the symptoms associated with menopause, including sleep disorders. HRT has commonly been prescribed to treat these symptoms, but it does not come without risks. “Following recent studies showing no cardiac benefit and increased breast cancer, the question of indications for hormonal therapy has become even more pertinent.… While it showed decreased osteoporotic fractures, the absence of cardiovascular benefit, the increase in thromboembolic phenomena and the increased likelihood of incident cancer clearly change the risk/benefit equation for most women.” [16]

Because HRT may result in adverse effects, many women are looking for an alternative that will attenuate symptoms without increasing risks. This study demonstrates that acupuncture provides a safe and effective alternative for the treatment of sleep disorders and other symptoms associated with menopause, especially when the point SP6 (Sanyinjiao) is utilized.

 

Female Reproductive Cycle
We have included the followoing overview of the female reproductive cycle for our readers. Female reproduction is primarily regulated by 4 key hormones: estrogen (in the form of estradiol), progesterone, follicle stimulating hormone (FSH), and luteinizing hormone (LH). The reproductive cycle begins after menstruation, when FSH begins to increase and stimulates the development of follicles in the ovaries. As the follicle develops and readies to release an egg, it produces estrogen.

Once estrogen increases sufficiently, there is a surge of LH, which promotes ovulation. During this stage, estrogen peaks and FSH and LH decrease. The ruptured follicle becomes the corpus luteum and produces progesterone.

The continued high levels of estrogen and progesterone help to generate the endometrium, preparing the uterus for implantation by a fertilized egg. If the egg is not fertilized, the corpus luteum disintegrates and ceases production of progesterone. At this time, the estrogen level decreases. The decline in these two hormones causes the endometrium to shed. Because these hormones are largely produced in the ovaries, women who have undergone ovariectomies may also experience symptoms associated with menopause or early menopause.

 

 

Footnotes
1 nia.nih.gov/health/publication/menopause
2 nia.nih.gov/health/publication/menopause
3 nia.nih.gov/health/publication/menopause
4 Philip S. Eichling and Jyotsna Sahni, “Menopause Related Sleep Disorders,” Journal of Clinical Sleep Medicine 1, no. 3 (2005). pg 292
5 Hsiao-Yean Chiu, Yu-Jung Hsieh, and Pei-Shan Tsai, “Acupuncture to Reduce Sleep Disturbances in Perimenopausal and Postmenopausal Women,” Obstetrics & Gynecology 127, no. 3 (March 2016), pg 513
6 ncbi.nlm.nih.gov/pubmed/18603220
7 Eichling, Menopause Related Sleep Disorders. pg 292
8 Chiu et al, Acupuncture to Reduce Sleep Disturbances. pg 510
9 Chiu et al, Acupuncture to Reduce Sleep Disturbances. pg 511-3
10 Jue Zhou et al., “Acupuncture and Auricular Acupressure in Relieving Menopausal Hot Flashes of Bilaterally Ovariectomized Chinese Women: A Randomized Controlled Trial,” Evidence-Based Complementary and Alternative Medicine 2011 (2011), pg4
11 D. Sunay et al., “The Effect of Acupuncture on Postmenopausal Symptoms and Reproductive Hormones: A Sham Controlled Clinical Trial,” Acupuncture in Medicine 29, no. 1 (March 1, 2011), pg 27
12 Sunay et al, The Effect of Acupuncture on Postmenopausal Symptoms and Reproductive Hormones, pg 30
13 Chiu et al, Acupuncture to Reduce Sleep Disturbances. pg 513
14 Chiu et al, Acupuncture to Reduce Sleep Disturbances. pg 509
15 Chiu et al, Acupuncture to Reduce Sleep Disturbances. pg 510
16 Eichling, Menopause Related Sleep Disorders. Pg 291

 


References
nia.nih.gov/health/publication/menopause

Eichling, Philip S. and Jyotsna Sahni. “Menopause Related Sleep Disorders.” Journal of Clinical Sleep Medicine 1, no. 3 (2005): 291–300.

Chiu, Hsiao-Yean, Yu-Jung Hsieh, and Pei-Shan Tsai. “Acupuncture to Reduce Sleep Disturbances in Perimenopausal and Postmenopausal Women.” Obstetrics & Gynecology 127, no. 3 (March 2016): 507–15. doi:10.1097/aog.0000000000001268.

ncbi.nlm.nih.gov/pubmed/18603220

Zhou, Jue, Fan Qu, Xisheng Sang, Xiaotong Wang, and Rui Nan. “Acupuncture and Auricular Acupressure in Relieving Menopausal Hot Flashes of Bilaterally Ovariectomized Chinese Women: A Randomized Controlled Trial.” Evidence-Based Complementary and Alternative Medicine 2011 (2011): 1–8. doi:10.1093/ecam/nep001.

Sunay, D., M. Ozdiken, H. Arslan, A. Seven, and Y. Aral. “The Effect of Acupuncture on Postmenopausal Symptoms and Reproductive Hormones: A Sham Controlled Clinical Trial.” Acupuncture in Medicine 29, no. 1 (March 1, 2011): 27–31. doi:10.1136/aim.2010.003285.

 

 

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