Electroacupuncture for the treatment of perimenopausal syndrome: a systematic review and meta-analysis of randomized controlled trials

Objective: To assess the efficacy, comparative effectiveness and safety of electroacupuncture (EA) in the treatment of perimenopausal syndrome (PMS). Methods: Nine databases were searched until June 2019. Only relevant randomized controlled trials (RCTs) of EA for PMS were included. Results: Twelve trials involving 746 women were included. EA and hormone therapy (HT) did not significantly differ in terms of effective rate (risk ratio (RR) = 0.98, 95% confidence interval (CI) = 0.93 to 1.04), Kupperman index (KI) (mean difference (MD) = −0.25, 95% CI = −0.76 to 0.26) and serum levels of follicle-stimulating hormone (FSH) (MD = −3.80, 95% CI = −11.59 to 3.98) or luteinizing hormone (LH) (MD = −2.51, 95% CI = −10.72 to 5.70). Serum estradiol (E2) levels were significantly lower in EA versus HT groups (MD = −60.58, 95% CI = −71.93 to −49.23). Compared with sham EA, EA had a significantly greater effect on reductions in KI (MD = −4.71, 95% CI = −6.57 to −2.86) and hot flushes score/24 h (MD = −2.43, 95% CI = −2.93 to −1.93). There were no significant differences between EA and manual acupuncture (MA) in terms of effective rate (RR = 1.14, 95% CI = 0.98 to 1.33) or serum FSH (MD = −2.87, 95% CI = −29.65 to 23.91), LH (MD = 2.73, 95% CI = −9.65 to 15.11) or E2 (MD = 26.80, 95% CI = −12.06 to 65.65). However, it seemed that EA had a better effect than MA on KI (MD = −2.44, 95% CI = −4.80 to −0.08). Subgroup analyses indicated that EA may have more of a benefit in the pre-menopausal state (hot flushes score/24 h: MD = −1.66, 95% CI = −3.49 to 0.17) compared to post-menopause (p > 0.05). Conclusion: The effect of EA appeared broadly similar to HT and MA in the treatment of PMS, although EA-associated reductions in KI were superior to MA and sham EA, suggesting effects beyond placebo. The evidence base is limited by a small number of eligible studies, risk of bias and clinical/statistical heterogeneity, limiting our ability to draw firm conclusions. As such, additional larger scale, high-quality RCTs are needed.

A Clinical Study of the Effect of Estradiol Valerate on Sleep Disorders, Negative Emotions, and Quality of Life in Perimenopausal Women

In this prospective study, we randomly divided 100 patients with perimenopausal syndrome equally into the control group (n = 50) receiving conventional treatment and the study group (n = 50) receiving estradiol valerate. The indicators observed were endometrial thickness, uterine volume, and the levels of LH (luteinizing hormone), FSH (follicle-stimulating hormone), and E2 (estradiol) of the patients before and after treatment. The Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety/Depression Scale (HAMA/HAMD), Kupperman symptom score, and menopause-specific quality of life (MENQOL) were also applied to assess the sleep quality, negative emotions, severity of the condition, and quality of life of all patients, respectively. Our findings were that estradiol valerate is beneficial in improving serum sex hormone levels, sleep disturbances, negative mood, and quality of life in patients with perimenopausal syndrome and that its safety profile is high enough to warrant clinical promotion.

CLINICAL EVALUATION OF THE EFFECT OF SHTAVARIYADI KSHEERAPAKA ON PERIMENOPAUSAL SYNDROME

Menopause is an important phase in women’s life. However, alteration in hormonal level leads to many undefined anatomical and physiological changes in women. As women spend near one third of their life span after menopause, the consequences of menopause are also experience for a longer period of time. In Ayurveda classics, Artava Nivritti or menopause is considered as a normal physiology of Jaravastha, and hence, its effects on body are not explained directly. The treatments available for menopause in the modern medicine come with many known side effects. According to, the period of menopause belongs to Parihanikala, leading to Vriddhavastha. Therefore, Rasayana can be considered as an effective treatment option. On this basis, a Ksheerapaka named as Shatavariyadi Ksheerapaka has been formulated. It comprises of a mixture of powders of Ashwagandha, Shatavari, Guduchi and Yashtimadhu. Shatavariyadi Ksheerapaka shows significant reduction in the symptoms of perimenopausal syndrome.

Erxian Decoction, a famous Chinese medicine formula, ameliorate depression-like behavior in perimenopausal mice

Aims: The present study was performed in order to find out the anti-depression effect of Erxian Decoction in perimenopausal mice. Background: Erxian Decoction (EXD) has been used in folk medicine for the treatment of perimenopausal syndrome, but it has not been researched on perimenopausal depression. Objective: The present study aimed to evaluate the effect of extraction of Erxian Decoction on perimenopausal depressive mice. Methods: In this study, female ICR mice were randomly divided into 6 groups: Low, medium and high dose of EXD groups (0.5, 1.5, and 4.5 g/kg), soy isoflavones group (250 mg/kg) and Sham group. The mice in the Sham group received sham surgery (within ovaries), and the others were excised with bilateral ovaries and exerted by 28-day chronic mild unpredictable stimulation for the establishment of a perimenopausal depression model. Results: Behavioral tests showed that EXD could relieve depression symptoms and improve spatial memory in mice. Western blotting showed that EXD significantly up-regulated the expression of brain-derived neurotrophic factor (BDNF) and Bcl-2 in hippocampus and estrogen receptors (ERs) in the uterus and adrenals, protecting hippocampal tissue and antagonizing the symptoms of estrogen deficiency in mice, which was further proved within a uterine morphology test. In addition, EXD reduced the serum levels of follicle-stimulating hormone, luteinizing hormone, and interleukin-6. Conclusion: These results indicated that EXD can regulate hormone secretion and recover hippocampal damage in perimenopausal depressed mice. Besides, it can antagonize the symptoms of ovarian hormone deficiency as well as relieve perimenopausal syndrome.

Time-sensitive effects of Zhuang Medicated Thread Moxibustion on Estrogen Level in female perimenopausal Model Rats.

Background: To ascertain the estrogenic effect of Zhuang Medicated Thread Moxibustion (ZMTM) and explore its time-sensitive impact on estradiol in female perimenopausal rats. Methods: Female rats were randomized into four groups of 10 rats, each consisting of the control, model, ZMTM, and acupuncture groups. The perimenopausal syndrome was induced in the last three groups with a daily subcutaneous dose of 80 mg/kg of 4- vinylcyclohexene diepoxide for 15 days. Afterward, rats in the model and control groups were fed routinely, while rats in the ZMTM and acupuncture groups were treated with six ZMTM and acupuncture courses, respectively. The rats’ general condition and estradiol (E2) levels in the rats’ serum were assessed. Results: Following the six courses of treatment, the E2 level in the model group was significantly the lowest, while the regular group was the highest (P < 0.05). There was also a gradual increase in the E2 level of the ZMTM group compared to the model and acupuncture groups, such that after the 5th and 6th courses of treatment, their E2 level was significantly higher than the model and acupuncture groups (P < 0.05). The control group had a better condition than all other groups, while the ZMTM group was better than the model and acupuncture groups. Conclusion: ZMTM can improve perimenopausal induced rats’ estrogen level, and this effect becomes better with each further treatment course.

The Metabolomic Rationale for Treating Perimenopausal Syndrome as Kidney Deficiency

Background. Traditional Chinese medicine (TCM) typically attributes the etiopathogenesis of perimenopausal syndrome (PMS) to kidney deficiency in the TCM stratification system for diagnosis. However, the molecular basis of this classical attribution remains to be investigated. Aim of the Study. By unraveling the responses to TCM treatment for kidney deficiency, the metabolomic link between PMS and kidney deficiency can be evaluated for in-depth understanding of the mechanism of TCM treatment and development of better treatment protocols. Materials and Methods. With naturally aged rats as a model for PMS, the metabolomic response to TCM treatment for kidney deficiency was investigated by 1H NMR. Results. 1H NMR metabolomic evidence of plasma samples demonstrates that treatments with two classical TCM prescriptions for kidney deficiency, decoctions of Yougui and Zuogui, result in modulating the metabolic state of the disease model towards that of rats of younger age. Conclusion. The data support the notion that kidney deficiency is responsible, in part at least, for PMS, and the relevant prescriptions are helpful in dampening the changes in the body’s metabolic states to alleviate symptoms of the disorder.

Ziyin Bushen Decoction Alleviates Perimenopausal Syndrome in Rats by Enhancing Estradiol Production

Perimenopausal syndrome (PMS) has a high incidence rate and affects the physical and mental health of middle-aged and elderly women. The blockage of PMS is significant in improving the health of perimenopausal women. Currently, for PMS prevention and treatment, traditional Chinese medicine (TCM) has become an ideal choice because of its safety and effectiveness. This study aimed to explore the anti-PMS effects of Ziyin Bushen Decoction (DKTP) and the underlying mechanism. Thirty female Wistar rats were divided into 5 groups (n = 6): control group, low-dose DKTP group, medium-dose DKTP group, high-dose DKTP group, and nilestriol group. The estradiol (E2) level in rat peripheral blood was analyzed using an E2 Radioimmunoassay Kit, and uterine morphologic changes were examined by hematoxylin-eosin staining. Learning and memory ability of rats was assessed by Morris water maze (MWM) and novel object recognition (NOR) task. E2 synthesis, metabolism, and transport associated estrogen receptor-alpha (ERα), GnRHR, CYP17, CYP11A1, CYP19, 17βHSD, STS, and SHGB were assessed to explore the E2-promoting mechanism of DKTP during PMS treatment. The loss of learning and memory, the decreased estrous and uterine coefficient, and the presence of histopathological changes suggests a successful establishment of rat PMS model. Following DKTP or nilestriol treatment, the above results were reversed. E2 level in serum, uterine, and ovarian tissues was upregulated upon different concentrations of DKTP treatment, indicating that DKTP promotes the E2 level in a dose-dependent manner. DKTP also increased the expression of ERα, CYP17, CYP11A1, CYP19, 17βHSD, STS, and SHGB while decreased the GnRHR expression in uterine and ovarian tissues, revealing that these key molecules involved in estrogen synthesis, metabolism, and transport in PMS rats. We confirmed the anti-PMS effect of DKTP through enhancing E2 production. Exploring a novel drug based on improving E2 synthesis, metabolism, and transport may represent a novel strategy for PMS prevention and treatment.