title: A pilot randomized, single-blind, placebo-controlled trial of traditional acupuncture for vasomotor symptoms and mechanistic pathways of menopause.
abstract: OBJECTIVE
  The aim of this study was to conduct a pilot study for the feasibility of planning a definitive clinical trial comparing traditional acupuncture (TA) with sham acupuncture (SA) and waiting control (WC) on menopause-related vasomotor symptoms (VMS), quality of life, and the hypothalamic-pituitary-adrenal axis in perimenopausal and postmenopausal women.
  
  
  METHODS
  Thirty-three perimenopausal and postmenopausal women with at least seven VMS daily were randomized to TA, SA, or WC. The TA and SA groups were given three treatments per week for 12 weeks. Outcomes included the number and severity of VMS, Menopause-Specific Quality of Life Questionnaire, Beck Depression Inventory, Spielberg State-Trait Anxiety Instrument, Pittsburgh Quality Sleep Index, 24-hour urine cortisol and metabolites, and adrenocorticotropic hormone stimulation testing.
  
  
  RESULTS
  Both the TA and SA groups demonstrated improved VMS trends compared with the WC group (Δ -3.5 ± 3.00 vs -4.1 ± 3.79 vs -1.2 ± 2.4, respectively; P = 20) and significantly improved Menopause-Specific Quality of Life Questionnaire vasomotor scores (Δ -1.5 ± 2.02 vs -1.8 ± 1.52 vs -0.3 ± 0.64, respectively; P = 0.04). There were no psychosocial group differences. Exit 24-hour urinary measures were lower in the TA versus the SA or WC group in total cortisol metabolites (4,658.9 ± 1,670.9 vs 7,735.8 ± 3,747.9 vs 5,166.0 ± 2,234.5, P = 0.03; respectively) and dehydroepiandrosterone (41.4 ± 27.46, 161.2 ± 222.77, and 252.4 ± 385.40, respectively; P = 0.05). The response data on adrenocorticotropic hormone stimulation cortisol also trended in the hypothesized direction (P = 0.17).
  
  
  CONCLUSIONS
  Both TA and SA reduce VMS frequency and severity and improve VMS-related quality of life compared with WC; however, TA alone may impact the hypothalamic-pituitary-adrenal axis. This association is viewed as preliminary and hypothesis generating and should be explored in a large clinical trial.
authors.affiliation: Department of Medicine, Cedars-Sinai Heart Institute, Los Angeles, CA 90048, USA. jeannette.painovich@cshs.org
authors.forename: Jeannette M
authors.initials: JM
authors.lastname: Painovich
authors.forename: Chrisandra L
authors.initials: CL
authors.lastname: Shufelt
authors.forename: Ricardo
authors.initials: R
authors.lastname: Azziz
authors.forename: Yuching
authors.initials: Y
authors.lastname: Yang
authors.forename: Mark O
authors.initials: MO
authors.lastname: Goodarzi
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Braunstein
authors.forename: Beth Y
authors.initials: BY
authors.lastname: Karlan
authors.forename: Paul M
authors.initials: PM
authors.lastname: Stewart
authors.forename: C Noel Bairey
authors.initials: CN
authors.lastname: Merz
mesh_terms: D015670:Acupuncture Therapy; D005260:Female; D019584:Hot Flashes / Q000517:prevention & control*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D047648:Perimenopause / Q000502:physiology; D010865:Pilot Projects; D010913:Pituitary-Adrenal System / Q000502:physiology; D010919:Placebos; D017698:Postmenopause / Q000502:physiology; D011788:Quality of Life; D016037:Single-Blind Method; D011795:Surveys and Questionnaires
chemical_list: D010919:Placebos