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Hot flash help: Can acupuncture do the trick?

Dr. Judith Reichman offers insight for women going through menopause.

Q: I'm 52 years old and I just can't stay dry — I have constant hot flashes. Will acupuncture help?

A: You're in good company. The majority of women in the U.S. who go through menopause experience hot flashes. For some it's an interesting "oh, I'm a little hot and sweaty" phenomenon, while for others hot flashes can occur throughout the day and night, affect their ability to function, prevent their make up from staying on, and, most importantly, interrupts their sleep. In other words, hot flashes can be debilitating.

The one therapy we know that successfully alleviates hot flashes is HT (hormone therapy). The gold standard for evaluating the effectiveness of a medicine is the Cochrane Database Review. It showed a 75 percent decrease in hot flash frequency with HT compared to placebo.

So is taking estrogen or HT (estrogen and a progestogen) dangerous? Do the hot flashes warrant a possible risk? This is complicated. If you've had a hysterectomy and take estrogen alone (you don’t need a progestogen to protect the lining of the uterus from abnormal build-up, because there is no uterus), it would appear that doing so for less than five years may also have other positive health effects. Estrogen therapy may decrease plaque buildup in the arteries, and subsequently reduce the risk of cardiovascular disease. It prevents accelerated bone loss, vaginal dryness, skin thinning, and may even be effective in reducing the early onset of Alzheimer's. Recent data seems to indicate that there’s no increase in the risk of breast cancer (a major concern for most women) in those first five years of estrogen therapy.

The Women's Health Initiative, which dealt with older women (with an average age of 63), increased the concern surrounding HT, though. It would seem that adding the progestogen component to HT (in this case a synthetic progestogen called provera) for more than a few years of initial use increased the risk of breast cancer in older women and didn’t decrease the risk of heart attack, stroke, and dementia.

In light of all this research, I generally recommend that my younger menopausal female patients who have bad symptoms, begin HT and use as little estrogen, and if necessary progestogen, as possible. They need to understand, though, that long-term use may increase breast cancer risk and that close follow-up (with yearly mammograms) is necessary.

If you absolutely don't want to use HT, there are numerous studies that have tested other pharmaceuticals, such as antihypertensive medicines (Clonidine), antidepressants, and gabapentin (an anti-seizure drug that also decreases pain). Some of these have shown modest positive results, but they can have significant side effects. There are also over-the-counter biologically-based therapies, such as phytoestrogens, St. John's Wort, vitamin E, black cohosh, dong-quai, ginseng, evening primrose oil, motherwort, licorice, wild yam, and red clover. Overall, however, I'm sorry to say that there's really no good evidence that these herbs and nutritional supplements really work beyond the placebo effect.

Now to get to acupuncture. Animal and human studies have shown acupuncture can stimulate endorphins and neurotransmitters, including serotonin, that help you feel good. It also may regulate the brain production of nitric oxide, which affects pathways in the brain that are connected to your central thermostat. (In the absence of estrogen this thermostat becomes “upset” and  instigates hot flashes.) Now to answer your question: Some studies that have compared acupuncture with sham acupuncture (when needles are used at sites that aren't therapeutic) have found a decrease in hot flashes. Other’s have shown a positive effect with the real thing and less with the “fake” acupuncture. A very recent study, in the illustrious journal Menopause, studied 103 perimenopausal or post-menopausal women who had an average of five or more hot flashes a day. These women were randomized to receive medical or sham acupuncture with twice weekly treatments for five weeks, and then follow-up for seven weeks. No difference was found between the two groups, though both showed an improvement in what was termed their hot flash scores.

So, the question remains: When you stick the acupuncture needles close enough to the energy (qi) pathway, is it the acupuncture that affects the hot flashes or is it a placebo effect? Here is where I admit that I don't know, nor do the editors of the journal. In the end, their statement (in the NIH State-of-the-Science Conference on Management of Menopause-Related Symptoms) was that research is needed on non-medical treatments, including complementary and alternative treatment approaches to menopause management.

Dr. Reichman’s Bottom Line: We're not sure if acupuncture works to relieve hot flashes, but if you want to try it, go ahead. If it helps, let me know.

Dr. Judith Reichman, the TODAY show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of .

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.