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Category Archives: Gynaecology
A Cochrane Database systematic review by Australian authors, has concluded that acupuncture and acupressure may improve both physical and psychological symptoms of PMS. Five trial results, covering 277 women, were analysed. The results suggest acupuncture can improve overall mood and physical symptoms, compared with sham acupuncture. Quality of evidence was limited by small sample sizes.
(Acupuncture & acupressure for premenstrual syndrome. Cochrane Database of Systematic Reviews, 14 August 2018.)
A large American trial has shown that acupuncture can help postmenopausal women with breast cancer, who experience joint pain (arthralgia) as a side-effect of taking aromatase inhibitor drugs eg anastrozole/arimidex. Researchers randomised 226 such women, mean age 61, across 11 academic centres and clinics, to either true acupuncture, sham acupuncture or a waiting list control. Real or sham acupuncture was given twice a week for 6 weeks, then once a week for a further 6 weeks. All patients were followed up for a further 12 weeks.
Compared with the sham acupuncture and waiting list groups, the true acupuncture group at 6 weeks experienced a statistically significant reduction in their worst joint pain: 58% had at least a two-point pain reduction, compared with 33% in the sham group and 31% in the waiting list group. There were also improvements in average pain and joint stiffness in the true acupuncture group. Even at six month follow-up, average worst pain in the true acupuncture group was lower than in the other two groups.
(Effect of Acupuncture vs Sham Acupuncture or Waitlist Control on Joint Pain Related to Aromatase Inhibitors Among Women With Early-Stage Breast Cancer: A Randomized Clinical Trial. Journal of the American Medical Association, 10 July 2018.)
An American umbrella systematic review assessing the benefits of acupuncture for menopause symptoms, has concluded that evidence from randomised controlled trials supports its use. Data was taken from three systematic reviews covering over 1100 women, and from four randomised controlled trials covering 700 women. There were statistically significant differences associated with acupuncture treatment, either adjunctive or stand-alone, compared with no acupuncture, for reducing vasomotor symptoms eg hot flushes and night sweats, and improving health-related quality of life. Follow-up times varied but some studies demonstrated reductions in hot flush frequency lasting 12 months or more. Differences were smaller or not statistically significant when acupuncture was compared with sham acupuncture.
The authors conclude that the evidence supports the use of acupuncture to treat menopausal vasomotor symptoms, although the clinical benefits may be partly due to non-specific effects.
(Management of Menopause Symptoms with Acupuncture: An Umbrella Systematic Review & Meta-Analysis. Journal of Alternative & Complementary Medicine, April 2018.)
A new study by Brazilian researchers suggests an association between adherence to the Mediterranean diet, and bone density and muscle mass in post-menopausal women. This diet involves a high intake of fruit, vegetables, grains, potatoes, olive oil and seeds, moderately high fish intake, plus low saturated fat, dairy and red meat consumption, and regular but moderate intake of red wine. The Mediterranean diet has previously been linked to a lower risk of heart disease, diabetes and cancer.
A total of 103 healthy women from southern Brazil, average age 55 and who had gone through menopause a mean 5.5 years earlier, underwent measurements of their bone mineral density, total body fat and lean mass. The subjects also completed a food questionnaire about what they had eaten in the past month.
A higher Mediterranean diet score, meaning better adherence to the Mediterranean diet, was significantly associated with higher bone mineral density measured at the lumbar spine, and with greater muscle mass. This association was independent of whether the women had previously used hormone replacement therapy, their smoking behaviour or their current level of physical activity.
(Mediterranean diet is linked to higher muscle mass, bone density after menopause. The Endocrine Society, on-line press release 20 March 2018.)
The largest and most rigorous study of its kind has found that acupuncture significantly reduces the joint pain experienced by women having treatment for early stage breast cancer and taking aromatase inhibitors (eg Arimidex, Aromasin,Femara). These drugs are normally prescribed for post-menopausal women whose breast cancers are hormone receptor-positive, but up to 50% of patients who take them experience significant joint pain and stiffness.
In the multi-centre clinical trial led by researchers at NewYork-Presbyterian Hospital and Columbia University Irving Medical Center, 226 women were randomised to receive either true acupuncture, sham control or no treatment. Sessions were given twice a week for six weeks, then weekly for a further six weeks. After six weeks, the improvement seen in the true acupuncture group compared to the other two groups, was significantly greater, and larger than that exhibited by antidepressants when they are used for cancer pain. Around 30% of control group participants reported a clinically meaningful change, whereas the same figure for the true acupuncture group was 58%. Additionally, unlike the results of drug therapy, the pain relief from acupuncture was still apparent 24 weeks after treatment had ended.
Dr. Katherine Crew, director of the Clinical Breast Cancer Prevention Program at NewYork-Presbyterian/Columbia University Irving Medical Center says “There are so few side effects [to acupuncture] and it’s non-addictive. This has real implications for patients in how patients can address their pain. Our goal now is to make sure patients have access to it and that insurance will cover it, just like they would for a pain medication.”
(NewYork-Presbyterian News, on-line 7 December 2017.
Postscript: Effect of Acupuncture vs Sham Acupuncture or Waitlist Control on Joint Pain Related to Aromatase Inhibitors Among Women With Early-Stage Breast Cancer: A Randomized Clinical Trial. Journal of the American Medical Association, 10 July 2018.)