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Treatment of menopausal symptoms: concomitant modification of cortisol.

Menopause (New York, N.Y.)·October 2021·Angelo Cagnacci, Anjeza Xholli, Francesca Fontanesi et al.
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Key Finding

Greater reduction in menopausal symptoms across all treatment modalities, including acupuncture, was linearly associated with larger decreases in 24-hour urinary cortisol levels (beta=2.10, P=0.012).

What This Means For You

Researchers studied 69 postmenopausal women experiencing menopausal symptoms to understand whether treatments could reduce both symptoms and stress hormone levels. The women were divided into three groups: one received hormone therapy (estrogen and progestin), another took phytoestrogen supplements (plant-based estrogens), and the third received weekly acupuncture treatments for three months.

The study measured menopausal symptoms using a standardized questionnaire that assessed hot flashes, depression, anxiety, physical complaints, and sexual function. Researchers also measured cortisol, a stress hormone, through 24-hour urine collection. At the beginning of the study, women with higher symptom scores had higher cortisol levels, particularly those experiencing depression and physical symptoms.

After three months of treatment, all three groups showed significant improvements. Menopausal symptom scores decreased by an average of about 6 points, and cortisol levels dropped by an average of 24 micrograms per day. Importantly, the study found a direct relationship: women who experienced greater symptom relief also showed larger decreases in their cortisol levels, regardless of which treatment they received.

This finding suggests that effectively treating menopausal symptoms may have broader health benefits beyond just symptom relief. Lower cortisol levels are associated with reduced stress on the body and may positively affect long-term health outcomes, including cardiovascular health, bone density, and immune function. The study indicates that acupuncture was as effective as hormone therapy and phytoestrogens in achieving these dual benefits of symptom reduction and cortisol normalization.

If you're considering acupuncture for menopausal symptoms, seek treatment from a licensed acupuncturist with experience in women's health.

Clinical Notes for Practitioners

This prospective study examined 69 postmenopausal women treated with either hormone replacement therapy (0.3mg CEE + 1.5mg MPA, n=25), phytoestrogens (75mg isoflavones BID, n=21), or acupuncture (weekly, n=23) for three months. Baseline analysis revealed significant correlation between Greene's Climacteric Scale scores and 24-hour urinary cortisol (P<0.0001), with depression (beta=4.91, 95% CI 2.14-7.7) and somatization (beta=3.04, 95% CI 0.69-5.4) subscales as independent predictors (R²=0.319).

Post-treatment analysis demonstrated significant reductions in both Greene's scores (-5.67±6.8, P=0.0001) and 24-hour cortisol levels (-23.6±45.7μg/24h, P=0.0001) across all treatment modalities. Linear regression analysis revealed treatment-induced cortisol changes correlated with symptom score changes (beta=2.10, 95% CI 0.47-3.73, P=0.012).

Clinical takeaway: Acupuncture demonstrated equivalent efficacy to conventional therapies in reducing menopausal symptoms while simultaneously normalizing cortisol levels, suggesting potential systemic anti-stress effects that may benefit long-term patient outcomes beyond immediate symptom management.

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