Oct 26, 2017

Interview Transcript

Dr. Jones: You are having a rocky menopause, hot flushes day and night, and you really don't feel right. There are hormonal options, but what else might work? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: About 85% of American women have hot flashes during the menopause transition. Going from regular hormones, estrogen especially, to no hormones is hard for some women. About 15% of those women with hot flashes find their flashes get in the way of their life. Some women try to wait it out, but we know now that for many women hot flashes can last for years. Of course giving estrogen back in the form of creams, patches, or pills definitely works. In hundreds of randomized trials controlled with placebo estrogen works, but many women don't want this option.

Given that menopause is a given for women all over the world, are there some other traditions and therapy that can help? Today in The Scope studio, we're talking with Dr. Lisa Taylor-Swanson, an assistant professor in the College of Nursing here at the University of Utah. She's going to help us think about some other options.

Welcome to The Scope, Lisa. So tell me a little bit about the research studies that talk about effectiveness of acupuncture, because I know the information about estrogen.

Dr. Taylor-Swanson: Absolutely. I'm happy to. So I started first thinking about my own experience in clinic because I tended to see women got better in terms of their hot flashes, both severity and frequency. And so then again before I had done my PhD, I started reading the literature and thinking about what was being done to really, with scientific rigor, investigate this important question regarding hot flashes experienced by women through the menopausal transition. And happily, there's been a lot of trials over the years conducted mainly here in the U.S., but a couple really rigorous trials also conducted in Norway and in Germany.

And most recently, a paper came out in 2015 that's a systematic review of 12 trials of acupuncture. So they were able to collect all the numbers, basically all those data from over almost 900 women and they found that indeed, acupuncture really does what I saw in clinic. And that is that there were statistically significant findings, findings that matter regarding severity of hot flashes, duration of hot flashes, frequency, and also they looked at quality of life measures whether women felt better psychologically in terms of anxiety, depression, that was all statistically significant, again in that meta-analysis that looked at 12 studies.

So we have some really top-of-the-evidence pyramid evidence showing this is worth considering.

Dr. Jones: Well, so my question as a researcher who's done studies on various kinds of medications for hot flashes, we all use placebo control, meaning we have these wonderful study subjects come in and we tell them they're either going to get placebo or they're going to get the real drug, and we find that placebo really works. Now, I've been thinking more about this since talking to you, and I really wonder whether it's the placebo pill that people think is working for them, or all the attention that comes around being a study subject because we love our study subjects.

They are our research buddies. So how do you know it's really the needle in a certain place doing it or whether it's because you guys are just so nice?

Dr. Taylor-Swanson: That's such a great question. And that's something that I've wondered about as well, and a whole group of researchers actually at the Church of Harvard, Ted Kaptchuk being the lead of that team, have for about a decade now really looked at that question of placebo in general, but also specifically regarding acupuncture. And they had an interesting trial looking at irritable bowel syndrome. I believe it was 70%, 75% of those participants were women because that's common in women in terms of the population of IBS. And they had an interesting design where they had three arms. One was people just had usual care. The second one . . .

Dr. Jones: Usual acupuncture care?

Dr. Taylor-Swanson: Oh, sorry. No. Usual, just standard Western care.

Dr. Jones: Oh, standard Western care. Okay.

Dr. Taylor-Swanson: Yeah, so they went to their physician and had usual medical care. And then the second arm they received acupuncture, but it was what they called limited. So the acupuncturist would just say, "Hello, lay down. Here's the acupuncture," and they inserted the needles and that was that. Then the third group in that study had what they called augmented acupuncture, and honestly, that was more of what is typically provided in clinic.

For example, I spend a half an hour with each patient. So I bring them in and say, "Hey, how are you? How was your hot flashes currently? What's better? What's worse? Has anything new happened this last week?" Or what have you. So there's a lot of conversation that happens in terms of really getting that medical history. And that was the augmented arm in this trial. And lo and behold, unsurprisingly, the folks who just had their standard western care, they had a little bit of improvement. The folks who had the acupuncture and no chatting, they had much more improvement statistically, significantly more than usual care. And then the group that got to chat basically with their acupuncturist as well as receive the acupuncture, they had, yet again, greater levels of improvement than the other two groups.

So it makes me think about healthcare. It's what I thought about 20 years ago as an undergrad. That is that we need to have care in health care, and I think that's across disciplines.

And also I think it's relevant in terms of physician and nurse burnout. A lot of that burn out is because they don't have time to care. They don't have time to know their patients anymore. So I know that's a tangent, but I do think it's important to really know that across all disciplines not only do the patients benefit with that care in health care, but I think the clinicians do too. It's more fun.

Dr. Jones: Right. Exactly. I mean, I loved my clinic because I had time to actually do the kind of care and hear their stories.

Dr. Taylor-Swanson: Right.

Dr. Jones: Well, so if a woman wanted to consider acupuncture, how long would she do it? And remember that now we have data that hot flashes can last for three, five, seven years in a lot of people. So how often do they need the acupuncture? Is it once a week for seven years, or once a week for three times, or how many times?

Dr. Taylor-Swanson: Absolutely. That's a great question and one I often receive. And it's important to know that of course if a woman's had whatever symptoms, say hot flashes for the last couple of years, it certainly would not be a one treatment change for sure. What I tend to recommend is that women receive care weekly, and once they know and their clinician knows there's improvement in frequency, duration, severity, then to try coming every two weeks. And then once again when they notice, "Ah, I'm really feeling better," and once a month, and then maybe just quarterly for a tune-up.

The important thing to know, and this is across whatever the primary concern is, that acupuncture really affects the whole person. So usually, once a woman's hot flashes are getting better, then of course her sleep is going to be a little better, and her mood's going to be a little better. Everything sort of changes together. So it's important to monitor that primary concern of hot flash, but also how she's feeling in general.

Dr. Jones: So we think that women facing a difficult menopause transition should be the drivers of their health care, and even if we didn't think that they will be anyway. So it's good to know that there are options and we thank you, Lisa, for joining us today to help us think some of these things through. And thank you, listeners for joining us on The Scope.

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