COGNITIVE DECLINE AND ALZHEIMER’S DISEASE
The risk of cognitive decline, including Alzheimer’s disease (AD), also increases significantly following menopause. A 2019 systematic review and meta-analysis by Huang et al.12 found that acupuncture provided some benefits. It included 13 studies comparing acupuncture with medication alone. The results showed that acupuncture had positive effects on Mini Mental State Examination scores, Ability of Daily Living Scale scores, AD Assessment Scale-Cognition scores, and a high clinical efficacy rate.
MECHANISMS
Acupuncture works via numerous physiological mechanisms, accounting for its diverse effects on the human body. One of the most critical of these is purinergic signalling, a system which utilises adenosine triphosphate (ATP) as a signalling molecule in the regulation of a range of physiological functions. In the short-term, it plays a role in neurotransmission, neuromodulation, and secretion. In the longer-term, it influences proliferation, differentiation, migration, and death, thus directing the activity and fate of cells.[13]
Purinergic receptors have been investigated as potential therapeutic targets in a broad range of disorders, including many which affect peri and post-menopausal women. They include depression and anxiety, sleep disturbances, osteoporosis, endocrine disorders, cardiovascular, and neurodegenerative disease.
In terms of VMS, studies have suggested that acupuncture influences the release of beta-endorphins.7 These neurochemicals are thought to be involved in the pathophysiology of VMS, although this is still not clearly understood.
Acupuncture also appears to influence cortisol, cortisol metabolites, and DHEA levels.10 Cortisol levels tend to increase following menopause, contributing to changes in mood, metabolism, bone density, and cognitive decline. It is, therefore, possible that the same underlying mechanisms play a role in the treatment of VMS, depression, anxiety, sleep disorders, abdominal obesity, osteoporosis, and dementia.
Further suggested mechanisms for acupuncture’s effects on obesity include anti-inflammatory and antioxidant effects, regulating the endocrine system, promoting digestion, and influencing lipid metabolism.[14]
Meanwhile, animal studies have shown that acupuncture may offer some protection against osteoporosis by regulating the OPG/RANK/RANKL signalling pathways. All of these are involved in the protection of
bone tissue.[15]
Finally, MRI studies on patients with AD or mild cognitive impairment have shown that acupuncture activates and deactivates several regions of the brain. They include the basal ganglia, cerebellum, cognitive, visual, and sensorimotor-related areas.[16]
MAINSTREAM APPROACH
Menopause is fast becoming a specialty area. In the past 40 years, our understanding of female endocrinology has improved greatly, expedited by the rapid growth of assisted reproductive therapy. This growth, coupled with women becoming more vocal about their experiences and seeking solutions, has brought menopause to the forefront of both medicine and the media.
The primary mainstream approach to treating menopausal symptoms is hormone replacement therapy (HRT), comprising either estrogen or progesterone monotherapy, or a combination of the two.
HRT has been controversial since the publication of the Women’s Health Initiative[17], which suggested that its use increased the risk of breast cancer, stroke, and pulmonary embolism. However, industry-funded guidelines developed in partnership with clinical specialty groups have pointed to flaws in this study.
Current prescribing guidelines suggest that the benefits of HRT generally outweigh the risks for most women aged 60 or under, or within 10 years of menopause.1 However, there is also evidence that these hormones can increase the risk of breast cancer and ovarian cancer. With so much conflicting information in circulation, the decision regarding whether or not to take HRT is a difficult one. Acupuncture, on the other hand, has a demonstrated track-record of safety and when performed by appropriately trained clinicians, has been found one of the safest treatments in modern medicine.[18]
Therefore, many women are now choosing other modalities, such as acupuncture, as a first-line treatment. Acupuncturists can also play a crucial therapeutic role by helping to inform and support women in adopting beneficial lifestyle changes.