Acupuncture Beats Drugs for Hot Flashes, Study Finds

By Emily WillinghamHealthDay Reporter

TUESDAY, Aug. 25, 2015 (HealthDay News) — Needles beat pills for treating hot flashes in breast cancer survivors, according to a new trial that compared acupuncture, “sham” acupuncture, the medication gabapentin and a placebo pill.

Interestingly, sham acupuncture came in second place for effectiveness, the researchers said.

Furthermore, the effects of acupuncture were “significant and enduring for hot flashes while gabapentin’s effect only happened when a patient was taking the medication,” said study first author Dr. Jun Mao, an associate professor of family medicine and community health at the University of Pennsylvania in Philadelphia.

The study was published Aug. 24 in the Journal of Clinical Oncology.

Mao and his colleagues tested the treatments in 120 women who were breast cancer survivors. The women were enduring hot flashes at least twice a day.

Thirty women each received real acupuncture that also included a bit of an electric buzz or the inactive placebo pill, 32 women got sham acupuncture, and 28 women received gabapentin (Neurontin). The drug is typically used to treat seizures and nerve pain.

The women documented their hot flashes in diaries, noting frequency and severity, for 8 weeks of treatment, and then continued to keep track of their hot flashes up to 24 weeks total. The investigators used a hot flash score to see how much frequency and severity changed from when the study started to what the women reported at 8, 12 and 24 weeks.

Acupuncture had the greatest effect on overall hot flash scores at 8 weeks, when all interventions ended, followed by sham acupuncture and then gabapentin. At 24 weeks, 16 weeks after treatments ended, acupuncture was still associated with the greatest reduction in hot flashes. But even those who had sham acupuncture or placebo pills had steeper drops in hot flash scores at 24 weeks than those who took gabapentin.

“The placebo effects for both acupuncture and drugs are quite intriguing, as they both seem to persist over time,” Mao said. “The magnitude of the placebo effect for acupuncture is bigger than for the drug.”

The results with the sham acupuncture, which bested gabapentin, suggest that “there is more than a placebo effect with the sham acupuncture,” said Dr. Gary Deng, interim chief of the integrative medicine service at Memorial Sloan Kettering Cancer Center in New York City. “There is a component of behavior of doing a sham procedure, so it psychologically may trigger a different kind of reaction from patients versus taking the placebo pill.”

Deng pointed out that clinicians have come to realize that the placebo effect is very important in treatment. “In fact, in clinical practice, every doctor uses it all of the time,” he said. “The so-called bedside manner or communication with patients — all of these enhance the effect of the patients feeling they’re getting something.”

No one is quite sure why placebos work for some people and not for others, said Deng. “It’s like psychotherapy,” he added. “Why does it work for some people and not others?” He suggested that differences in anatomy and genetics might be possible explanations, but said “there is a fertile field for further research.”

Some patients might wonder if acupuncture that’s helpful for hot flashes among breast cancer patients might be helpful for the hot flashes associated with natural menopause. But Mao pointed out that hot flashes in breast cancer patients are more common, more severe and longer lasting than menopausal hot flashes.

However, Deng said that both might have similar causes related to lower estrogen levels. “Breast cancer survivors have hot flashes because of hormonal repression,” he said. Menopause also is linked to declining estrogen levels.

One big distinction between the two populations, though, is that breast cancer survivors do not have the option of hormone replacement therapy open to them because those hormones are linked to breast cancer. Some women undergoing natural menopause still might have that option available. For this reason, most studies of acupuncture for hot flashes have focused on breast cancer survivors, Deng explained.

But should a woman undergoing natural menopause try acupuncture for hot flashes?

“For patients suffering symptoms, they can look for all kinds of possible solutions and are better off talking to their doctor to find out what’s most appropriate for them,” Deng said.

More information

Visit the U.S. National Center for Complementary and Integrative Health for more on acupuncture.

Women Age More Quickly Once They Enter Menopause, Studies Suggest

TUESDAY, July 26, 2016 (HealthDay News) — Menopause, and the insomnia that often goes along with it, can speed aging in women, two new studies suggest.

“For decades, scientists have disagreed over whether menopause causes aging or aging causes menopause,” said Steve Horvath, senior author of both papers.

“It’s like the chicken or the egg: which came first? Our study is the first to demonstrate that menopause makes you age faster,” said Horvath, a professor of human genetics and biostatistics at the David Geffen School of Medicine at the University of California, Los Angeles.

He and his colleagues said they found that menopause boosts cellular aging by an average of 6 percent.

“That doesn’t sound like much, but it adds up over a woman’s life span,” Horvath added in a UCLA news release.

For example, a woman who began early menopause at age 42 would be a full year older biologically at age 50 than a woman that same age who began menopause at age 50.

Insomnia, which often accompanies menopause, can also lead to faster biological aging, according to the second study.

“Not getting restorative sleep may do more than just affect our functioning the next day; it might also influence the rate at which our biological clock ticks,” said Judith Carroll. She is an assistant professor of psychiatry at UCLA’s Semel Institute for Neuroscience and Human Behavior, and first author of the sleep study.

“In the women we studied, those reporting symptoms such as restless sleep, waking repeatedly at night, having difficulty falling asleep and waking too early in the morning tended to be older biologically than women of similar chronological age who reported no symptoms,” she said.

The studies included more than 5,000 women and were published July 25 in the journals Proceedings of the National Academy of Sciences and Biological Psychiatry.

More information

The American Academy of Family Physicians has more about menopause.

Hot Flashes? Losing Weight May Help


By Denise Mann

MONDAY, July 12 ( — Overweight women who experience hot flashes—the uncomfortable flushing and sweating spells that accompany menopause—may be able to cool those symptoms by losing weight, a new study suggests.

“If you’re a woman who is overweight or obese, you can substantially improve your hot flashes by losing weight through diet and exercise,” says Alison Huang, MD, the lead author of the study and a professor of internal medicine at the University of California, San Francisco.

“Weight loss isn’t just something that will benefit your long-term health 10, 20, or 30 years from now,” she adds. “It can make a real difference in your symptoms and quality of life right now.”

Previous research has shown that women with higher body-mass indexes (BMI) tend to experience worse hot flashes. Until now, however, few studies have tried to measure the immediate effect that weight loss has on symptoms.

Related links:

Stay Cool During a Hot Flash

Why Sex Is Better After Menopause

Can Supplements Ease Menopause Symptoms?

In the new study, which was published in the Archives of Internal Medicine, Dr. Huang and her colleagues re-analyzed data from a study that included about 150 overweight and obese menopausal women who were experiencing urinary incontinence as well as troublesome hot flashes.

Roughly two-thirds of the women were assigned to an intensive program designed to help them lose up to 9% of their body weight. The program included at least 40 minutes of moderate exercise per day, a reduced calorie diet (no more than 1,500 calories daily), and weekly counseling sessions that provided nutrition tips.

Six months later, the women who participated in the weight-loss program were more than twice as likely as the women in the control group to have experienced an improvement in their hot flash symptoms.

And it wasn’t enough to just get more exercise or cut calories—only weight loss itself was linked to fewer hot flash symptoms. For each 11 pounds that a woman lost, she was roughly one-third more likely than women who did not lose weight to experience a decline in the severity or frequency of hot flashes.

Next page: Hot flashes can affect quality of life

Hot flashes (also known as “hot flushes”) aren’t merely a nuisance. They can diminish a woman’s quality of life, and they’ve been linked to an increased risk of depression, anxiety, and insomnia, according to Dr. Huang.

“Once upon a time, many doctors and researchers did not take hot flashes seriously as a health problem,” she says. “But we now know that these symptoms make a real difference in women’s ability to lead active, fulfilling lives during menopause.”

It’s unclear why losing weight would reduce hot flashes. Overweight women tend to have higher levels of estrogen, which could aggravate hot flashes, and some experts have suggested that body fat may prevent women from cooling off during a flash.

Dr. Huang’s study did have some important weaknesses. Because the women in the study were incontinent the results may not apply to all women, and the researchers surveyed the women about their hot flash symptoms just twice, at the beginning and end of the study.

In addition, a greater percentage of women in the control group dropped out of the study, which could have skewed the results.

Although slimming down is always a good idea for anyone who’s overweight, weight loss may not be a fast or effective enough remedy for women who are suffering through hot flashes, says Lila Nachtigall, MD, a menopause expert and professor of ob-gyn at New York University’s Langone Medical Center.

“I see these women every day, and they are desperate,” she says. “It’s not fair to say losing weight over six months will help, when they need to treat their flushes and treat them within a week or two.”

Low doses of prescription medications, including antidepressants, can help relieve hot flashes in overweight women who need immediate relief, Dr. Nachtigall says, as can hormone therapy, which replaces estrogen and other hormones that decline during menopause.

The safety of hormone therapy has been questioned in recent years, following several studies that linked long-term treatment to an increased risk of breast cancer, stroke, and other health problems. But short-term, low-dose hormone therapy is still appropriate for many women experiencing menopausal symptoms such as hot flashes, Dr. Nachtigall says.

Women who decide to take hormones for menopause hot flashes should do so at the lowest dose and for the shortest period of time possible, experts say. Hot flashes may return when hormone therapy is halted.

Soy No Help for Bone Loss, Hot Flashes

Getty Images

By Amanda Gardner

MONDAY, August 8, 2011 ( — Middle-aged women searching for a safe alternative to hormone therapy to prevent bone loss and ease the symptoms of menopause are in for another letdown.

The latest in a series of disappointing studies finds that soy supplements, an increasingly popular substitute for hormone therapy, do not stave off hot flashes, night sweats, and other uncomfortable menopausal symptoms.

Nor did the supplements reduce the aging-related bone loss that can lead to osteoporosis, the study found.

“Isoflavones, the plant-derived estrogens found in soy, are very weak estrogens, so it is not surprising that they have not shown to be as effective…as hormone therapy,” says the lead author of the study, Silvina Levis, MD, the director of the osteoporosis center at the University of Miami’s Miller School of Medicine.

“Women taking soy isoflavone tablets to alleviate hot flashes and prevent bone loss at the time of menopause might want to reconsider,” she adds.

During menopause a woman’s body produces less estrogen and progesterone. Hormone therapy, which entails replacing one or both of these hormones via medications, significantly reduces menopausal symptoms and helps maintain bone health, but it can also increase the risk of blood clots, stroke, heart disease, and breast cancer.

Related links:

Can Supplements Ease Menopause Symptoms?

11 Foods for Healthy Bones

Stay Cool During a Hot Flash

Soy protein, a fixture of Asian diets, has been considered a possible alternative to hormone therapy for years, ever since researchers observed that women in Asia tend to have lower rates of bone loss and osteoporosis than their counterparts in the West. However, clinical trials of soy in menopausal women have had mixed results.

In the new study, published this week in the Archives of Internal Medicine, 248 menopausal women were randomly assigned to receive a placebo pill or 200 milligrams of soy isoflavone supplements per day—a dose “equivalent to approximately twice the highest intake through food sources in typical Asian diets,” Dr. Levis says.

At the end of the two-year study, bone scans showed no differences in bone mineral density between the two groups. (The amount of bone loss in the study was quite low overall, perhaps because most of the women were overweight, the researchers say; women are generally less susceptible to bone loss if they’re overweight.)

Likewise, the soy supplements did nothing to ward off hot flashes. In fact, 48% of the women who took soy experienced hot flashes, compared with just 31% percent of those in the placebo group. Roughly one-third of the women in the soy group also reported constipation as a side effect, versus 21% in the placebo group.

So if soy isn’t beneficial, what options are women left with?

To prevent bone loss, women should stick with the basics, Levis says. That means getting enough calcium and vitamin D, exercising regularly, and, in some cases, taking bone-strengthening drugs such as bisphosphonates.

As for hot flashes and night sweats, the anti-seizure drug gabapentin or certain antidepressants in the selective serotonin reuptake inhibitor (SSRI) class may help some women, says Deborah Grady, MD, a professor of medicine at the University of California, San Francisco.

“There’s evidence that some of the SSRIs work, but they don’t seem to work as well as estrogen,” says Dr. Grady, who cowrote an editorial accompanying the study. “That leaves us with estrogen. It’s too bad, but that is the answer.”

5 Reasons Why Some Women Go Through Early Menopause

Maybe you wake up at night drenched in sweat. Or you’re struggling to concentrate, and oh yeah, your period has been MIA. These symptoms are enough to freak any woman out, even when she’s at the right age for menopause, the natural transition to infertility that most women experience around 50. But when these symptoms begin in your 30s, they can be downright scary.

For some women, early menopause is brought on by surgery that removes the ovaries. A woman who carries a BRCA gene mutation, for example, may opt to have her ovaries and fallopian tubes taken out in a preventative salpingo-oopherectomy. (This is the procedure Angelina Jolie had last March, after blood tests revealed possible indicators of early cancer.) The result? Levels of estrogen and other female hormones drop dramatically, which may lead to hot flashes, vaginal dryness, and other telltale signs of menopause.

But one in 100 women will experience these symptoms by the age of 40 for other reasons—which are often hard to pin down. In fact, for about 90 percent of cases a woman never learns the reason why. The technical term for this medical condition is primary ovarian insufficiency (POI). “Basically the ovaries poop out early,” explains Shawn Tassone, MD, an ob-gyn who specializes in integrative medicine at Austin Area Obstetrics, Gynecology, and Fertility.

RELATED: 8 Reasons Sex Is Better After 50

One key sign for diagnosis: skipped or irregular periods for four months. Women with POI (also known as premature ovarian failure) may face more than mood swings and low libido. If they want to have children, they will likely struggle with infertility, and that can be the first sign that something is not right. (That said, some women do continue to have occasional periods for years after a POI diagnosis, and between 5% and 10% do manage to get pregnant.)

Although most of the time POI happens without an obvious cause, there are quite a few things that are known to bring it on—yet many women are unaware of them. Below are the top factors that put you at risk.

Your mom went through early menopause

Or your sister, or your grandmother. POI seems to be genetic: “You tend to see it run in families,” Dr. Tassone says. “It can come from either side.” A 2011 review of studies found that in up to 20 percent of cases, the woman has a family history of the condition.

RELATED: Soothing Yoga Moves for the Menopause Blues

Genetic disorders

FMR1 is a gene that causes Fragile X syndrome, the most common form of inherited intellectual impairment; even if you don’t have the syndrome you can have a mutation on that same gene that causes problems with your ovaries, leading to fragile X-associated primary ovarian insufficiency. According to a report by the National Institutes of Health, this is the case for one in 33 women with POI.

Turner Syndrome (in which a woman has only one X chromosome) is another genetic disorder associated with POI.

Autoimmune disorders

The autoimmune disorder thyroiditis (inflammation of the thyroid gland) has been linked to POI. So has Addison’s Disease, in which the adrenal glands don’t produce enough hormones. In the case of either of these diseases, it’s possible your own immune system may begin to attack the follicles in your ovaries, the small sacs where eggs mature and grow, interfering with their ability to function.

Smoking or other toxin exposure

“Some toxins can bring on premature ovarian failure,” Dr. Tassone says. “Things like cigarettes and pesticides.” Normally we are born with enough primordial follicles (aka the tiny seeds that grow into follicles) to last us until the natural age of menopause, around 50. But exposure to harmful chemicals is thought to cause a woman to run out of follicles sooner rather than later.

Chemotherapy or radiation

Similar to environmental toxins, these cancer treatments can damage the genetic material in ovarian cells. But the damage depends on various factors, like the type of drug and dose of radiation, your age at the time of treatment, and the area of your body that was radiated. Some women may not develop POI until years after undergoing cancer treatment. And some won’t ever get it.

RELATED: 15 Factors That Affect a Woman’s Fertility

How Secondhand Smoke Is Linked to Early Menopause and Infertility

By Kathleen DohenyHealthDay Reporter

TUESDAY, Dec. 15, 2015 (HealthDay News) — Smoking and being exposed to secondhand smoke may trigger early menopause and infertility in women, a new study suggests.

Other research has linked smoking with higher rates of infertility and perhaps earlier menopause. However, “secondhand smoke is less researched,” especially among never-smoking women, said study author Andrew Hyland, chair of health behavior at Roswell Park Cancer Institute, in Buffalo, N.Y.

In the study, Hyland and his colleagues evaluated women enrolled in the Women’s Health Initiative, a large study launched in 1991 to look at a variety of health issues in more than 160,000 generally healthy, postmenopausal women.

Hyland’s team looked at information about age of menopause and fertility, along with tobacco exposure, among some of the women enrolled in the study. The investigators evaluated information available on about 88,000 women to look at the fertility effects. They also looked at information on about 80,000 to examine onset of natural, or nonsurgical, menopause.

Both smoking and exposure to secondhand smoke were linked to fertility issues and early menopause (before the typical age of 50), the researchers found.

Compared with never smokers, current or former smokers were 14 percent more likely to be infertile and 26 percent more likely to have early menopause. Early menopause has been linked with a higher risk of death from all causes, Hyland pointed out.

Among never smokers, those exposed to the highest level of secondhand smoke (such as living with a smoker for 10 years or more) were 18 percent more likely to have fertility problems and early menopause, the study found.

Women who had ever smoked reached menopause about 22 months before those who never smoked or never were exposed to smoke. Those exposed to the highest level of passive smoke reached menopause 13 months earlier than those not exposed, the findings showed.

But the study cannot prove cause and effect, Hyland added. “This is an observational study looking at data already collected,” he said. “It [the link] could be something associated with early development and exposure as a young child.”

Smoke interacts with hormones and can have adverse effects as well, he added.

The study was published online Dec. 15 in the journal Tobacco Control.

The findings are a valuable reminder to avoid all smoke, said Patricia Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, N.Y.

“This study provides additional motivation and incentive for women of all ages to avoid smoking and exposure to secondhand smoke, as well as to quit smoking,” she said. Both are associated with premature birth, low birth weight, infant death and certain birth defects, she added.

“This evidence, in addition to the data from the current study, offers health care providers, particularly ob-gyn practitioners, the information needed to counsel women about the hazards of smoking and secondhand smoke, and to encourage cessation,” Folan said.

More information

To learn more about the risk of secondhand smoke, visit the American Cancer Society.

Your Migraines Might Get Worse as You Approach Menopause

FRIDAY, Jan. 22, 2016 (HealthDay News) — For women who suffer migraines, the frequency of these debilitating headaches seems to increase as they approach menopause, a new study finds.

“Changes in female hormones such as estrogen and progesterone that occur during the perimenopause might trigger increased headaches during this time,” said study co-author Dr. Richard Lipton. He is director of the Montefiore Headache Center and vice chair of neurology at Albert Einstein College of Medicine in New York City.

The new research included more than 3,600 women who suffered migraines before and during menopause. The risk of high-frequency migraines (10 or more a month) rose 60 percent during the transitional time into menopause marked by irregular menstrual cycles (perimenopause).

The risk of migraine was highest during the later stage of perimenopause, when women have low levels of estrogen, the study found.

“Women have been telling doctors that their migraine headaches worsen around menopause, and now we have proof they were right,” study author Dr. Vincent Martin, co-director of the Headache and Facial Pain Program at the University of Cincinnati Neuroscience Institute, said in a news release.

There is help for women who have migraines and are approaching menopause, said study co-author Dr. Jelena Pavlovic, an attending physician in neurology at the Montefiore Headache Center and an assistant professor in the neurology department at Albert Einstein College of Medicine.

“Physicians can prescribe hormonal therapies that level out these changes that occur during the perimenopause and menopause time periods. If the patient is in early perimenopause, you can give birth control pills that level things out. If they are in the late perimenopause and they start skipping periods, they can be put on estrogen patches,” Pavlovic said.

But hormones may not always be the culprit. Although the number of migraines rose 76 percent during menopause, some headaches may be the result of medication overuse, which is common in this age group, according to Martin.

“Women, as they get older, develop lots of aches and pains, joints and back pain, and it is possible their overuse of pain medications for headache and other conditions might actually drive an increase in headaches for the menopause group,” he said.

About 12 percent of Americans get migraines, and women get them three times more often than men, the researchers said.

The study was published online Jan. 21 in Headache: The Journal of Head and Face Pain.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about migraine.

This Laser Treatment Can Help With Dryness and Painful Sex

A question I’m often asked by my menopausal patients is whether other women experience vaginal dryness too. My answer is simple: “Yes, almost everyone.”

I have been a practicing gynecologist in New York City for more than 20 years, and many of my original patients are now in their 40s, 50s, and 60s.

Perimenopause, which usually begins when a woman is in her 40s, is marked by fluctuating symptoms that may last anywhere from a few months to 10 years. Hot flashes, sleep disruption, and mood changes are all common and expected, and women tend to talk openly about those symptoms with their friends. But when they begin to experience vaginal discomfort—including dryness and burning, urinary symptoms, and painful sex—they often don’t mention it.

They may assume these symptoms (which are collectively known as genitourinary syndrome) are here to say. But the reality is, there are ways to treat the discomfort.

RELATED: 10 Ways to Deal with Painful Sex

For decades the main treatments were moisturizers, lubricants, and estrogen in the form of a ring, vaginal suppository, or topical cream. (The FDA has approved an oral medication as well, called Osphena, though it can cause side effects and its safety in breast cancer survivors is unknown.) Starting with over-the-counter moisturizers and lubricants makes sense, since they are convenient and very safe. But these preparations don’t actually improve the health of the vaginal tissue the way estrogen does. When used regularly, estrogen is safe and effective for most women. But still, many women are concerned about using it. Others forget to use it. And for some breast cancer survivors (especially those taking aromatase inhibitors), its use is controversial.

Fortunately, there is now an excellent new alternative: an in-office laser treatment that was developed for facial skin resurfacing, and has been repurposed and FDA-approved for vaginal therapy. Called the MonaLisa Touch, the laser stimulates the regeneration of collagen, which improves vaginal elasticity and moisture, and helps restore levels of glycogen that are needed for healthy bacteria (called lactobacilli) to flourish. Those bacteria, in turn, help prevent urinary tract infections, which postmenopausal women are prone to get. (I use the MonaLisa Touch in my practice, but have no affiliation with the manufacturer)

The therapy involves three treatments, each six weeks apart. The only anesthesia required is topical. Patients say they feel vibrations, but no pain. The one side effect some women report is temporary irritation around the labia for one or two days. But there have been almost no serious adverse effects from the procedure, which makes it extremely safe. What’s more, the therapy is effective for an impressive 85% to 90% of patients. This is as close to the best result a medical treatment can achieve.

RELATED: Spice Up Your Sex Life With 5 Different Types of Lubes

Testimonials from patients are amazingly positive. Women who were experiencing painful sex are able to reestablish pain-free intimacy with their partners. And symptoms begin to improve as early as the first treatment.

Researchers in Italy have documented the improvements on a cellular level. When they looked at biopsies of vaginal tissue before and after the procedure, they noted that thin tissue had become healthier and thicker, and that new collagen and blood vessels had formed.

So, who is a candidate for the MonaLisa Touch procedure? Any woman who is bothered by vaginal dryness, burning during urination, pain during sex, or recurrent UTIs should consider it. These symptoms are most common in menopausal women, but are also sometimes experienced by younger women receiving treatment for breast cancer. Other conditions that doctors are starting to treat with the laser include mild urinary stress incontinence, urinary urgency and frequency, and lichen sclerosus (a vulvar skin condition).

I have spent years encouraging women to treat the vaginal and urinary symptoms of menopause. I’m thrilled to finally be able to offer my patients another choice for treatment of this extraordinarily common and distressful condition.

Cynthia Krause M.D., NCMP (NAMS certified menopause practitioner), is Assistant Clinical Professor in the Department of Obstetrics and Gynecology at the Icahn School of Medicine in New York City.

If Menopause Hits in Your 40s or Sooner, Your Heart Risk May be Higher

THURSDAY, Sept. 15, 2016 (HealthDay News)—Women who enter menopause early may be at greater risk for heart disease and premature death, a new analysis suggests.

To reach this conclusion, the Dutch researchers reviewed 32 studies involving more than 300,000 women. The investigators compared women who were younger than 45 at the start of menopause with those who were aged 45 and older when it began.

Overall, heart disease risk appeared to be 50% greater for the women who were under 45 when menopause began.

Early menopause also appeared to boost the risk of cardiovascular death and death from all causes. But, it showed no association with stroke risk, the study authors said.

However, the study only uncovered an association—not a cause-and-effect connection—between early menopause and heart and death risk.

The study findings were published Sept. 14 online in JAMA Cardiology.

“These findings suggest that women with early onset of menopause may be a group to target for proactive cardiovascular prevention strategies,” said study author Dr. Taulant Muka, of Erasmus University Medical Center in Rotterdam, the Netherlands.

For women in early or premature menopause, that may mean hormone therapy, the researchers said.

Long-term use of the female hormone estrogen has been associated with cancer and stroke risks. Many experts believe the risks outweigh the benefits.

But the advice is different for women who enter menopause before age 45, explained JoAnn Manson. She is co-director of the Connors Center for Women’s Health and Gender Biology at Brigham & Women’s Hospital in Boston.

Since these women have a higher risk of heart disease and osteoporosis, unless there is a “clear reason” to avoid it, experts recommend treatment with estrogen until at least the average age of natural menopause, Manson said.

Menopause typically begins at age 51. However, as many as one in 10 women experiences natural menopause by age 45, the study authors noted.

Also, certain cancer treatments or surgical removal of a woman’s ovaries cause premature menopause.

One in three women worldwide dies from cardiovascular disease. And, for reasons not entirely clear, that risk accelerates in menopause.

Could the dramatic decline in levels of estrogen following menopause be to blame? It’s probably more complicated than that, say the co-authors of an editorial that accompanied the study.

“We don’t know definitively whether the reproductive system is influencing cardiovascular health or cardiovascular disease is influencing the ovary,” said Teresa Woodruff, one of the editorial writers. She is vice chair for research in obstetrics and gynecology at Northwestern University in Chicago.

Manson, her co-author, said the link probably goes in both directions: early menopause boosts heart disease risk and risk factors such as high blood pressure (hypertension) and high cholesterol can damage the blood supply to the ovary and lead to early menopause.

Study author Muka, a postdoctoral researcher, offers a possible explanation for the heightened risk facing women with early menopause: Early loss of ovarian function may activate a system in the body that regulates blood pressure, body fluids and inflammation, he said.

“The inappropriate activation of this system causes hypertension and can damage your heart,” Muka said.

It’s also possible that there may be shared genetic or environmental risk factors that lead to early onset menopause and boost the risk of poor health outcomes, the researchers added.

Muka and his colleagues did pick observational studies for their analysis that evaluated women’s age at onset as well as time since onset of menopause.

And only four studies assessed time since the onset of menopause in relation to cardiovascular risks, and the results were inconsistent.

However, the age-related findings showed a clear link, the investigators said. While early menopausal women faced increased heart and premature death risks, women aged 50 to 54 at the onset had a lower risk of fatal heart disease than women younger than 50.

Based on the findings, “age at menopause might be a predictor of future cardiovascular events and mortality in postmenopausal women,” Muka said.

The findings were published online Sept. 14 in the journal JAMA Cardiology.

The study was sponsored and funded by Metagenics Inc., a California-based maker of nutritional supplements.

More information

Visit the U.S. Office on Women’s Health for more on early menopause.

Got Hot Flashes? Acupuncture May Offer Major Relief, Study Finds

If you are struggling to deal with hot flashes, here is some good news: A new study suggests acupuncture might help you feel better. While the alternative medicine practice didn’t work for everyone, researchers from Wake Forest University found it was effective for many. 

Almost 80% of women get hot flashes, night sweats, or both during . For more than half of women, those unpleasant symptoms last 7 to 10 years and can majorly affect sleep, comfort, and quality of life.

Hormone therapy is currently the most effective treatment for hot flashes, but it’s associated with health risks and side effects, so many women seek alternative treatments. Unfortunately, herbal supplements and dietary remedies can have side effects of their own, and studies on their effectiveness have been mixed.

Recent research has suggested that acupuncture can provide hot-flash relief for breast cancer patients, and this new randomized trial offers further evidence that it may work for menopausal women, as well.

The study, published this week in the journal Menopause, included 209 women ages 45 to 60, who were going through or had recently gone through menopause. All women had at least four hot flashes or night sweats per day, on average.

RELATED: The Best Sheets to Keep You Cool All Night Long

The participants were divided into two groups; about 20% of the women received usual care from their doctor over the next six months, while the other 80% received usual care plus 20 acupuncture treatments.

The study authors based their study results on how the participants felt after eight weeks, which equaled about eight acupuncture treatments on average. At that point, 47% of the women in the acupuncture group reported a 47% reduction in hot flashes and 12% reported a major reduction (85%) in symptoms.

That’s the good news. The treatment wasn’t as promising for everyone, however: Another 37% of women showed only a minimal (9.6%) reduction in hot-flash frequency—and 4% said the number of hot flashes they’d experienced had actually doubled.

In the non-acupuncture group—which had been instructed to keep doing what they’d been doing to treat their hot flashes, but to not start any new treatments—about 80% of the women reported a small decrease, just 10%, in symptom frequency at Week 8.

RELATED: 5 Perimenopause Symptoms Every Woman Should Know

For the women who did benefit from acupuncture, most felt improvement after about three or four weeks. “Women will know pretty quickly if acupuncture will work for them,” said lead author Nancy Avis, PhD, professor of public health sciences at Wake Forest School of Medicine, in a press release.

Experts aren’t sure why acupuncture seems to help hot flashes, but some speculate that it prompts blood vessel dilation and stimulates the release of painkilling endorphins, or that it triggers the production of stress and mood-regulating hormones. Acupuncture may also have an effect on the brain’s hypothalamus, Avis told Health, which helps control the body’s response to temperature changes. 

It’s also possible that the “placebo effect” influenced the results, she says, since the women knew they were getting treatment that could potentially reduce their symptoms. (Sometimes researchers use “sham acupuncture”—the insertion of needles in parts of the body not thought to be helpful—as a control group for these types of studies because a treatment of any kind, whether it’s real or not, can make people feel better.) 

“However, we did not find that women who had greater expectations that acupuncture would help their hot flashes did any better than women who had lower expectations,” Avis says.

The study was funded by the National Center for Complementary and Integrative Health, part of the National Institutes of Health.

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The researchers had hoped to identify why some women benefited from the treatment while others didn’t, but they were unable to definitively pinpoint any unifying characteristics. There was some indication that women who responded best to acupuncture had low levels of , anxiety, and perceived , but those results were not statistically significant.

They hope that future research will allow them to determine these characteristics, providing further guidance that doctors and acupuncture practitioners can use to advise patients and clients.

Until then, acupuncture may still be a promising option for women—not just because it may actually work, but because it has fewer side effects than medication; it’s sometimes even covered by insurance.

“Women bothered by hot flashes and night sweats may want to give acupuncture a try as a relatively low-cost, low-risk treatment,” Avis says.