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Dr. Jones: Hot flushes are experienced by about 85% of menopausal women, and about one in seven women find they interfere significantly with their daily lives. And not everyone can or wants to use prescription therapy. So what are some other options for getting your life back?
This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health. We're going to have a conversation about a few non-medical approaches to hot flushes.
And to help us is Dr. Lisa Taylor-Swanson. She's a PhD and a licensed acupuncturist. She is an assistant professor in health systems and community-based care at the College of Nursing, and an adjunct professor in the Department of Obstetrics and Gynecology at the School of Medicine at the University of Utah. A big long line, but thanks for helping us out here, Lisa.
Dr. Taylor-Swanson: You're welcome, Kirtly. It's a pleasure. Thanks for having me.
Understanding Complementary and Integrative Medicine
Dr. Jones: So let's just start a little bit . . . the term complementary and integrative medicine are terms that resonate with many women who are seeking help with menopausal symptoms. They see themselves as whole women more than just their hot flushes. So what do these terms mean? Help me with that.
Dr. Taylor-Swanson: Well, honestly, they are terms that are changing over time. So in the 20, 25 years that I've been practicing East Asian medicine, including acupuncture, and in the last 10, 15 years that I've been conducting research, things have changed from complementary to using more of the health integrative medicine terms.
And I think that's a nod to really indicate the acknowledgment that a lot of people are using these therapeutics, both in terms of seeing providers, such as myself for acupuncture or a massage therapist for massage, but also using it for self-care as well.
And so I think the term complementary kind of seems like, "Oh, it's sidelined. It's like the little sister kind of feeling." Really, "integrated health" is a little more current term.
But I will say I hope we see things in the coming years move more towards integrated care, where really we can have communication between providers, and shared electronic health records. And so we really integrate pharmaceutical, hormonal, as well as herbal, massage therapy, so on and so forth to really provide whole-person care in a way that's integrated. Right now, it's really fragmented.
Dr. Jones: I think that's really what our patients want. They want to be seen as a whole person, but they want their care providers to be talking to each other. And I think that's really important.
Acupuncture is a Safe and Effective Treatment for Hot Flushes
Well, you are a licensed acupuncturist. Can you talk about acupuncture and hot flashes?
Dr. Taylor-Swanson: Well, there are a few things to say. One, it's safe. As a therapeutic, acupuncture is a very safe intervention. It's worth considering. It's also shown to be effective. It works for hot flushes.
Without getting into the weeds, I will say that most of the research that's been conducted either compares acupuncture to usual care, and then we see big effect sizes. It's so much better than usual care.
But when acupuncture is compared to sham acupuncture, statistically we only see small effect sizes. But that's because a sham is not a sham. It's not inert, so it's honestly a faulty design. And again, that's getting into research speak. But what I can say with complete certainty is it's very safe and it works, and it's definitely worth considering.
Dr. Jones: So sham acupuncture would be kind of . . . well, not really, but sort of the equivalent of the placebo in terms of pill kinds of research.
But there is the sense that there's something about that therapeutic relationship and therapeutic touch and people's own inner physicians that want to make them feel better. And it's really important. You still have to take those steps to have therapeutic, have someone in your space helping you, and you have to believe that you're strong enough to get better.
Well, given that hot flushes last for years, how many sessions do you have? Do you have to keep doing acupuncture for years the way you do hormonal therapy?
Dr. Taylor-Swanson: Well, the good news is, no, not for years and years. The literature is very clear that eight weekly sessions are when women in very large randomized control studies say, "Oh, this was the most improvement they were going to experience," and then kind of plateaued after that. So I always recommend that women consider eight weekly sessions. Really, just signing up for two months of weekly care, and then see how they feel.
But what I would say, going back to that whole-person topic, in my own practice what I've seen over and over is that typically after three, four, or five weekly sessions, my patient and I both know, "Wow, they're feeling so much better." We'll keep working on that symptom, of course, with hot flushes.
But then also they might say, "Oh, gosh, my back is really hurting me," or, "I have migraines too." And so typically, yes, eight weekly sessions, we're going to see improvement in that hot flash, but likely we can start working on other things as well that both get better together. It's exciting.
Dr. Jones: Oh, that's something I have to say that when I start with estrogen . . . There are certainly people for whom hormone replacement therapy does help them with their joint pain, and there's with some of their sleeplessness and some other things.
But they don't always get the time with me. If my therapeutic touch is good, but it only takes 5 minutes with me or 10 minutes, I can't say that I'm really offering the kind of "we're going to do this together" session that I think they would like and deserve.
Well, menopause has many symptoms and aging has many symptoms, and women are seeking an integrated approach to all of them. They don't want you to say, "Well, I'm going to see you for this and you for that." But you and your group have started a new approach for women and you've called it MENOGAP. Can you help me think about that?
MENOGAP: Bridging Gaps in Menopausal Care
Dr. Taylor-Swanson: So MENOGAP is a double entendre. One, it means we've designed this group medical visit to fill a gap in medical care for menopausal women. And then it's also we're delivering it with biomedical care delivered by my esteemed colleagues, primarily Camille Moreno.
Dr. Moreno and I work together. We're an integrated team. That's why it's easy for me to talk about that, a few moments ago regarding integrating care.
The word also means menopausal care with group acupuncture, GAP.
And so what we're doing there is providing top-line care with Dr. Moreno, who's menopause certified, so she can provide that medical management. She provides a doc talk.
And then I provide a doc talk. What is the evidence base on acupressure for self-care? Herbal medicine? So we are sure to be able to provide what's evidenced in kind of like old and new, or east and west.
And what women have said is literally, "This is the best healthcare I have ever received in my entire life. This has improved my symptom experience. I feel more empowered." Also, they know, "Oh my gosh, I can take menopausal hormone therapy and self-acupressure?" We can do many things together. One does not exclude the other.
Benefits of Group Medical Visits
Dr. Jones: Well, how about the group process? Is that part of it? I think we know that people who are socially together and can laugh together and be with other people often find that the burden of their symptoms . . . Maybe the symptoms themselves don't make a dramatic change, but the burden of their symptoms seems to be lifted some. Do you have a sense of that?
Dr. Taylor-Swanson: Oh, boy. Yes. Absolutely, Kirtly. In the cohorts we've worked with so far, not only is it the case that women have said, "Oh, I just feel so much better knowing, one, I'm not going crazy, and two, I'm not alone and feeling like I'm going crazy," but even more so, women said things like . . .
Especially for those who were earlier in the transition, they were perimenopausal, hearing their colleagues who were postmenopausal saying, "Don't worry, you're going to get through this. It actually does get better," gave them so much hope. More so than if Dr. Moreno and I had said, "Oh, don't worry, you'll get there." What do we know? We're not there yet.
But the other women in the group did. And more so they were able to share their expertise with one another, and share insights. It was amazing to hear and to see over just a few/couple weeks with weekly sessions. They really built that rapport and felt comfortable to share, knowing it was confidential and it was a proper medical visit, just as if they were only seeing either Camille or myself.
Cultural Inclusivity in MENOGAP
Dr. Jones: Well, our community is becoming increasingly diverse culturally, and racially, although I don't even like to say racial because I'm not sure what that means anymore genetically. But how do you manage to have people in the room who might come from different backgrounds?
Dr. Taylor-Swanson: Well, we come by it naturally because MENOGAP was developed in close collaboration with a Community Advisory Board comprised of ethnically, racially, and culturally diverse women. We had a whole community of women who said, "Yes, let's work on this together."
And so the intervention itself was inclusive of, for example, our black African American CAB members who said, "Oh, we should do this or that." We had an indigenous Native American woman, two Latinas, three refugees, and some Caucasian women as well. And everyone worked together to provide input about how this intervention should be.
So it's really one that was designed from the get-go with inclusivity in mind, and respect is the main common denominator when we're delivering the MENOGAP intervention.
And then I'll also briefly note that we have two other teams that are working to really make a refined mindful adaptation of MENOGAP. One has been designed with and for indigenous women. So indigenous women both on the team and in the community have adapted MENOGAP even further, calling it Waning Moon. And that's a collaboration with the Urban Indian Center of Salt Lake.
And then a whole other team that Camille and I are working with, again, comprised of Latina and Hispanic women. And then we'll soon pilot test it with community members. That's adapting it in Spanish for community health worker delivery. And it's Mujeres en la Transicion. My Spanish isn't very good, sorry. But "Women in Transition."
How to Join MENOGAP
Dr. Jones: That is really fantastic. And how can women find out more and sign up?
Dr. Taylor-Swanson: Well, they can either look me up at the University of Utah, or Camille. They can also email menogap@umail.utah.edu.
Dr. Jones: So MENOGAP at the University of Utah. Are there any MENOGAPs anywhere else? Is this just a local . . . We're the first and the best? Okay, good.
Dr. Taylor-Swanson: In the whole world, I might say, Kirtly.
Dr. Jones: In the whole world, yes. Be part of a new wave of caring for women as a group. Help each other care for each other. Thanks a lot, Lisa.
And for all of you who are struggling or know someone who struggles with hot flushes or midlife and menopausal symptoms and is looking for a non-medical approach, please join us with our MENOGAP program. Sometimes it takes a village and a community of women to help you find your way.