A systematic review of the effects of traditional East Asian medicine on symptom clusters during the menopausal transition

ImportanceGiven that many midlife women use evidence-based non-pharmacologic interventions for symptom management during the menopausal transition and early postmenopause and that many women experience two or more symptoms (symptom cluster), it is important to review recent evidence on said interventions for symptom clusters. This review focuses on randomized clinical trials (RCTs) of traditional East Asian Medicine (TEAM), including acupuncture, acupressure, moxibustion, and Chinese herbal medicine, for hot flashes and one or more co-occurring symptoms experienced during peri- or post-menopause. ObjectiveThe primary objective of the study was to review RCTs (published 2011-2021) of TEAM interventions for hot flashes and at least one other co-occurring symptom, including sleep problems, cognitive function, mood, and pain. Evidence ReviewWe searched Medline, CINAHL Plus, and PsychINFO for RCTs reported in English from July 7, 2011, to December 31, 2021. We included RCTs that assessed women in the menopausal transition or early postmenopause with masking as appropriate; TEAM interventions were studied as the treatment with one or more comparison groups; hot flushes and at least one additional symptom from at least one of the symptom clusters were reported as an outcome (from sleep, mood, cognition, pain symptom groups). Bias was assessed. FindingsOf 409 abstracts identified, 9 RCTs examined the effectiveness of therapies for hot flashes and at least one additional co-occurring symptom. One study reported separately on two TEAM interventions. The maximum trial duration was 6 months (range: 5 weeks - 6 months). Statistically significant improvement was reported in 2 or more symptoms: 5 of 6 studies of acupuncture, one acupressure study, one moxibustion study, 1 of 2 studies of Chinese herbal medicine. Conclusions and RelevanceOur systematic review summarizes the recent literature on TEAM interventions for symptom clusters during the MT and EPM. A majority of studies reported symptom reduction. Overall, our findings highlight the need for further investigation with studies that include whole systems TEAM as each intervention was studied separately in the reviewed trials. Clinical practice often includes concurrent use of acupuncture, moxibustion, CHM, and advice to patients to use self-acupressure. Studying each modality separately is a scientific abstraction that does not reflect clinical practice. Key PointsO_ST_ABSQuestion/ObjectiveC_ST_ABSWhat is the effect of traditional East Asian medicine (TEAM) therapeutics, including acupuncture, acupressure, Chinese herbal medicine, or moxibustion for hot flashes and one or more co-occurring symptoms during the menopausal transition (MT)? FindingsNine RCTs (n=811) evaluating the effects of TEAM therapeutics on MT symptoms were included. Statistically significant improvement was reported in these studies: acupuncture (5 of 6), 1 acupressure study, 1 moxibustion study, and Chinese herbal medicine (1 of 2). MeaningBased on the results of this systematic review, TEAM interventions demonstrate promising improvement of hot flashes and co-occurring symptoms experienced during the MT.