Lisa J Taylor-Swanson , MS, PhD Student Nancy Fugate Woods , PhD, Professor, Dean Emeritus

1. Traditional Chinese Medicine for hot flashes & associated symptoms: Evidence from asystematic review Lisa J Taylor-Swanson, MS, PhD Student Nancy Fugate Woods, PhD, Professor, Dean Emeritus Ellen Mitchell, PhD, Associate Professor Emeritus Janet Schnall, MS, AHI, Librarian 2012 State of the Science Congress on Nursing Science September 13-15, 2012Washington, DC 

2. Background • 80% of women in the US experience menopausal transition (MT) symptoms – usually several symptoms • Hormone therapy concerns have led to increased utilization of Complementary & Alternative Medicine (CAM) • Traditional Chinese Medicine (TCM) used to promote women’s health…for awhile

3. Background • TCM differential diagnoses vary by clusters of symptoms presented – congruent with study design. • No systematic review thus far on TCM for multiple MT symptoms.

4. Purpose • To review studies of TCM used to treat MT clusters of symptoms (hot flashes, sleep, cognitive function, mood & pain) during the menopausal transition and early post-menopause. • To generate information useful for clinicians.

5. Methods • We reviewed 13 controlled clinical trials (CCTs) of TCM’s effects on HFs & at least 1 other associated symptom including sleep, cognitivefunction, mood, and pain. • 8 Acupuncture, 4 Chinese Herbal Medicine (CHM), 1 Moxibustion (“Moxa”) papers. • Women studied were in the menopausal transition and early post-menopause.

6. Description of Studies Study population, location USA, Norway, Korea, Turkey, Netherlands, China, Hong Kong, Australia Multi-center trials Community-based, hospitals Sample sizes29 – 267 Age 45-65 years old Tx 1x - 2x / wk. 4 - 12 wks Controls Sham acu-puncture, self-care advice, usual care, placebo pills, hormone therapy

7. Modalities studied • Acupuncture • Moxibustion • Chinese Herbal medicine (CHM)

8. Results table – CHM & Moxa Between group findings: + P<0.05 or lower NS non-significant NM Not measured

9. Acupuncture Results

10. Results Out of 13 CCTs reviewed – significant between group findings: • 5 CCTs – HFs and 1+ symptom (sleep, pain, mood). (2 acu, 2 CHM, 1 moxa) • Acupuncture, Moxibustion and Kun Bao Wan/Xiao Yao Wan plus counseling showed the most broad results. (1 study each) • 4 CCTs – HFs only

11. Results - Continued • Initial findings of significant improvement with 12 weeks’ acupuncture care were no longer present at 6 & 12 months follow-up. • 5 of 8 CCTs compared acupuncture with sham acupuncture. 1 of these 5 studies found acupuncture and sham acupuncture were both significantly beneficial. (Venzke, 2010). • No reports of serious harm or adverse events.

12. Limitations • Scales used varied: Diary, BDI, MENQOL, Green (HF, psych), WHQ (HF, sleep), MRS (HF, pain, psych) • Dose – What is an “acupuncturedose”? • Sham acupuncture – it is a sham? • Various CHM formulas, doses, durations studied. • TCM as practiced in clinic was not evaluated (many tools used simultaneously). • Traditional Chinese Medicine (TCM) differential dx & others used a standardized protocol.

13. Conclusions • TCM offers promise in the management of hot flashes during the menopausal transition and early post-menopause as a safe & possibly effective tx. • Standardization of study design and methods is needed. • Longitudinal studies needed – what is the effectiveness trajectory? Booster sessions?

14. Thank You! SoN Travel Fund & de Tornyay Center School of Nursing, University of WA National Institute for Nursing Research NIH NR01 04141 and NINR, NIH, P50-NR-02323, P30-NR04001 ARCS Foundation Fellowship Seattle Chapter Lisa J Taylor-Swanson PhD Student & Licensed Acupuncturist ljts369@uw.edu

15. Streitberger needle – sham