Meditation

Meditation is an ancient practice that involves focusing or clearing your mind using a combination of mental and physical techniques. There are various meditation styles, and you can choose one or more types of meditation to help with relaxation, reducing anxiety and stress, calming your mind, or general wellness. Meditation is known to have many benefits including a reduction in symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD). Meditation has also been linked with an improved ability to concentrate and problem-solve, and also with increased resilience and the ability to adapt to and surmount emotional and psychological problems. [6] 

Meditation can be done in many different ways, and forms, including:

• Body-centered meditation: This involves focusing on the physical sensations you can feel throughout your body. It can also be called self-scanning or body-scanning meditation. 
• Contemplation meditation: This involves concentrating your focus on a question or an issue. 
• Emotion-centered meditation: This involves focusing on a specific emotion you are experiencing or that you have experienced. 
• Mantra meditation: This uses a specific phrase, word, or sound to focus the attention. The mantra is repeated over and over, either out loud or silently.
• Meditation with movement: This form uses a focus on breathing, or holding your breath, or performing specific body movements. It can be done seated, lying down, or while in motion, such as walking. 
• Mindfulness meditation: This form of meditation focuses on awareness of the present moment. The goal is to avoid worrying or focusing on the past or the future and instead connect with ‘now’. 
• Visual-based meditation: This form uses visual cues, such as something you can see using your eyes, or using an image in your mind to focus your attention.  [6] [7] 

Different forms of meditation have originated from multiple cultures around the world. Some forms of meditation are religious, while others are not. All types and forms of meditation involve observing your thoughts and focusing your attention.  [6] [7] 

Types of meditation (religious and non-religious) include:

• Buddhist meditation: Several types of meditation originate in Buddhism, which is classified as both a religion and a philosophy. Different types of Buddhism are found in different countries – Theravada Buddhism originated in Southeast Asia, and Zen Buddhism originated in China. Regardless of which type of Buddhism is being practiced, all of them incorporate meditation as a key element, where its main purpose is to achieve ‘self-realization’ – when all of the possibilities of one’s character and personality are fulfilled. This is called Nirvana. 
• Guided meditation: This is a non-religious form of meditation that is led by a teacher or counsellor in person or from a distance using audio technology. It can be practiced individually, or in a group. Guided meditation can be helpful to learn how to keep the mind focused. 
• Transcendental meditation (TM): This non-religious form of meditation originated in India with its founder Maharishi Mahesh Yogi and became very popular in Western cultures in part due to celebrities, such as the Beatles, who practiced and endorsed it. Practicing TM involves silently repeating a mantra, which is a word or phrase, and focusing all the attention on it for two sessions of 15-20 minutes per day while sitting with closed eyes. 
• Yoga meditation:  This meditation is associated with a physical yoga practice. It originated in India. Yoga meditation has religious and non-religious forms.
• Christian meditation: Christianity includes the practice of deep contemplation when attention is focused on a specific question or religious concept. Praying and/or reciting the rosary is an example of this type of meditation.

Mindfulness

Mindfulness is a part of most meditations, but it can also be a stand-alone practice, where the goal is to achieve a mental state of focusing your awareness on the present moment. Your thoughts, feelings, and bodily sensations are acknowledged and accepted without any judgement. In other words, feeling happy is not considered good or bad, it is simply how you feel. Same with feeling other emotions such as anger, sadness, or envy. The feelings are noted but not judged or acted upon. You “sit in the moment, acknowledge the feelings, let them pass”.

Mindfulness is being fully present, aware of where you are and what you’re doing. The great part of being mindful is that you become less reactive and are less likely to be overwhelmed with what is going on around you because you are only attending to the immediate moment instead of looking ahead to what is going to happen next, or looking back and focusing on what just happened. [8]

Being mindful means being fully present. For example, mindful eating is relaxed and slow. Each mouthful is savoured. You are aware of the texture and taste of your food. In contrast, non-mindful eating often results in noticing that your plate or bag of chips is empty without remembering what you ate or how it tasted. Mindfulness can be cultivated – all it takes is slowing down and noticing what is happening in the moment. You can practice mindfulness while you are sitting down, walking around, or even lying down – although it is easy to fall asleep when you lie down mindfully. You can add mindfulness to little breaks in your day, like while you are on hold with the phone company, or when you are sitting at a traffic light. You can also practice being mindful while doing other mind body wellness activities such as yoga or meditation. [3] [4] [5] [8] 

Hypnosis

Hypnosis, also known as hypnotherapy or hypnotic suggestion, creates a deeply relaxed state of focused attention. It is usually performed by a qualified and trained therapist, and it involves using verbal repetition coupled with mental imagery. When you are under the influence of hypnosis, called being in a hypnotic trance, you are calm and deeply relaxed. You are also open to suggestions, although unlike in the movies, you will not leave your therapist’s office and start acting like a chicken.  

Hypnosis is a proven technique to cope with stress and anxiety. It is often used before a stressful event such as medical procedures or performing an activity that normally causes fear (for example, before boarding a plane if you are afraid of flying). 

Hypnosis is regularly used to help with pain control, treating unwanted behaviours (like smoking or bed-wetting), managing the side effects of cancer treatments, and managing mental health conditions such as phobias, post-traumatic stress disorder (PTSD), depression, and anxiety. [9] Hypnosis is considered to be a safe alternative medical treatment, but there may be some side effects including headache, drowsiness, or dizziness. Hypnosis creates a very suggestable mental state, and has been known to cause the creation of false memories – particularly when it is being used as a method to work through childhood trauma or other stressful and traumatic experiences. [9]

Two randomized clinical trials that assessed using five sessions of hypnotherapy to manage hot flashes among breast cancer survivors demonstrated a clinically meaningful (≥69%) reduction in hot flash severity and frequency. These results are comparable to those seen using hormone therapy. In an randomized clinical trial (RCT) of 187 women, hypnosis was found to significantly reduce the frequency of experiencing hot flashes (74% reduction) and daily interference (80% reduction). In addition, hypnosis improved self-reported sleep quality and sexual function. Hypnosis has been recommended by the North American Menopause Society, and others, for the treatment of menopausal symptoms and poses little risk. [10]

Cognitive Behavioral Therapy (CBT)

CBT is a type of talk therapy or psychological treatment that can be used to help women manage hot flashes, depression, and other menopausal symptoms. It has also been shown to be effective for a broad range of other issues including alcohol- and drug-use problems, eating disorders, and multiple types of mental illnesses. CBT has been demonstrated to lead to significant improvements in quality of life (QOL). 

CBT focuses more on present problems, rather than what led to those problems, and developing effective ways to cope with the present situation. The North American Menopausal Society recommends CBT to help reduce the severity of vasomotor symptoms, although they have not found it helpful to manage the frequency of either hot flashes or night sweats. This is because CBT has the potential to impact the way that you think about your hot flashes (how severe they are), but will not impact the physical experience of hot flashes. [10]

CBT is based on the following core principles:

• Psychological problems are often based on incorrect or unproductive ways of thinking.
• Psychological problems are often based on learned patterns of unproductive behavior.
• The suffering caused by psychological problems can be improved by learning different, more positive ways of coping with those problems. [11]

CBT treatment focuses on making changes to patterns of thinking. This is done using the following strategies:

• Learning to recognize distortions and inaccuracies in your thinking that create problems so that you can re-evaluate your thinking using reality as a framework, without the distortions. For example, you may think that nobody likes you because you don’t have plans over the weekend, even though you didn’t make any effort to reach out and organize an outing yourself. 
• Learning to better understand the behavior and motivation of others to help minimize inaccurate thinking. For example, learning to recognize that your friend didn’t say hello when you saw her at the store because she didn’t see you, not because she doesn’t like you. 
• Learning problem-solving skills and how to use them to cope with challenging situations.
• Learning how to develop more confidence in your own abilities. [11] 

CBT treatment also works to change existing behavioral patterns by: 

• Practicing how to face your fears instead of avoiding them.
• Practicing how to manage potentially problematic situations (such as interactions with others) using role playing with a trusted friend or therapist.
• Learning to calm one’s mind and relax one’s body, often with mindfulness and/or meditation techniques. [11]

One study compared the effects of a 6-week CBT intervention to standard follow-up care among 96 female breast cancer survivors and found hot flash interference (bothersomeness) was reduced by 52% on average. The women receiving the standard follow-up care reported a 25% decrease in how bothered they were by their hot flashes. However, the frequency of hot flashes was only reduced by 38% in both groups, showing that CBT was no better than standard follow-up care for reducing the frequency of hot flashes. 

In a second randomized controlled trial (RCT), 65% of women receiving a 4-week CBT intervention and 21% of women in a no-treatment control group, reported clinically-significant improvements in hot flash interference. Here again, CBT did not demonstrate a clinically significant reduction in hot flash frequency.

There is some evidence to suggest that CBT can reduce mild depression in the menopausal transition compared to treatment with a placebo.  CBT has been recommended by the North American Menopausal Society for reducing the bothersomeness of vasomotor symptoms, but not for their frequency. [10] 

There are only a few studies on the mechanisms of how cognitive behavioural therapy (CBT) works. One systematic review investigated neurobiological changes in anxiety disorders resulting from CBT using neuroimaging techniques. The results showed that patients who responded to CBT treatment had modified neural activity in areas activated by their particular anxiety disorder. For example, following CBT, one study in the review showed there was significant and increased activation of the dorsolateral prefrontal cortex region of the brain. Other studies in the review found multiple different areas where brain activity changed, however, the studies themselves were looking at different conditions (spider phobia, PTSD, Obsessive Compulsive Disorder (OCD) and panic disorders), so differences in areas of the brain affected could be a result of differences in the disorders being assessed as well as the neuroimaging techniques used. While more studies are needed, research to date supports the idea that CBT may physically change the brain’s pathways, allowing for changes in how thoughts are processed.   [40]

Biofeedback and Relaxation Training

Biofeedback and relaxation training is a type of physical therapy that helps you learn how your body works and how to respond to it. The basic concept of biofeedback and relaxation training is ‘mind over matter’, where you can learn to change your health by understanding how your body responds to stressful or challenging stimuli. 

Biofeedback works to combat stress and other challenging symptoms that can be influenced by stress using relaxation techniques. It involves consciously manipulating your breathing, heart rate, or other “involuntary” body functions to stop and then reverse your body’s response to stressful situations. 

Biofeedback and relaxation training uses devices that monitor bodily functions. There are several methods of biofeedback including:

• Electromyography (EMG) biofeedback: measures changes in muscle tension over time.
• Thermal or temperature biofeedback: measures changes in body temperature over time.
• Electroencephalography: measures brain wave activity over time.
• Galvanic skin response training: measures changes in the amount of sweat on your body over time.
• Heart variability biofeedback: measures your pulse and heart rate responses over time. [12] 

Once you have gained feedback information about how your body is responding to situations, then you can use relaxation techniques, such as body-scan meditations, guided meditations, deep breathing, or mindfulness exercises, to control your stress responses. [10] [12]

In a systematic review of interventions to relieve hot flashes, reviewers identified seven randomized trials comparing relaxation therapy with an active therapy such as reading or a no-treatment control. Five of the trials reviewed indicated relaxation techniques may reduce the frequency of hot flashes and improve psychological symptoms of menopause. The review authors did note that caution is needed to draw conclusions due to the low study quality and small sample sizes. While it is a step in the right direction that any research is being done in this area, the reality is that improvements in methodology usually build over time, as other studies try to improve on previous work. 

Three RCTs not used in the systematic review above show inconsistent support for the impact of relaxation techniques on menopausal transition symptoms. One study compared relaxation training with women on a waitlist (used as controls) and found that  women receiving immediate treatment (not on the waitlist) reported a 55% reduction in hot flash frequency after 12 weeks. However, findings from a second RCT that compared relaxation training with listening to music among 123 women did not find clinically significant improvements in hot flash frequency for either group of women. A third RCT comparing paced breathing (a type of relaxation training) with regular breathing (the control group) found all groups reported reductions (paced breathing 2×/day = 52%; paced breathing 1×/day = 42%; usual breathing = 46%) in hot flashes over 9 weeks. Relaxation techniques may provide benefit for menopausal symptoms but at this time more evidence is needed to draw scientifically-supported conclusions. [10]

Mindfulness-Based Stress Reduction

Mindfulness Based Stress Reduction (MBSR) is a technique developed by Dr. Jon Kabat-Zinn in 1979 for stress management. It is now used worldwide to treat many different health disorders including anxiety, depression, skin diseases, chronic pain, immune disorders, hypertension, and diabetes. MBSR uses relaxation exercises and techniques, such as mindfulness meditation and yoga, to create awareness and acceptance of the present moment. Traditional MBSR involves 8 weekly group classes of 1.5 hours each, an all-day weekend retreat, and daily at-home practice. [10] [13] 

Research supports the effectiveness of MBSR. Studies have shown that after MBSR therapy there is a significant decrease in anxiety, stress and depression, as well as enhanced quality of life (QOL), in patients with chronic diseases like cancer, hypertension, diabetes, HIV/AIDS, chronic pain and skin disorders. Although the number of randomized controlled trial (RCTs) studies measuring the effect of MBSR is currently insufficient to demonstrate MBSR as a proven intervention to help people suffering from chronic illnesses, the results suggest that MBSR may help a broad range of individuals to cope with their clinical and non-clinical problems. [13] 

The single study (an RCT) looking at MBSR for management of menopausal transition symptoms randomly assigned 110 women to either an MSBR intervention or wait-list control group. The study measured hot flash bothersomeness, hot flash intensity, quality of life, anxiety, and stress. Changes in hot flash bothersomeness and intensity did not show clinically significant improvements, but there was a clinically meaningful improvement in menopause-related quality of life (QOL) and sleep quality. 

MBSR is generally safe and may reduce stress and anxiety and improve sleep quality and quality of life, but does not appear to significantly reduce VMS. [10]

Paced Respiration

This breathing technique is a proven way to regulate your nervous system, calming the mind and the body. When you pace your breathing, studies show that central nervous system activity is slowed and the relaxation response is engaged. [1] Paced respiration is also called box breathing, paced breathing or tactical breathing. Police and military use it so they can focus and function well in high stress, high-risk situations.

Practice paced respiration starts with paying attention to your breath. Feel your chest rise and fall, focus on the way your breath feels as it enters and leaves your nostrils. When you feel focused on breathing, start counting – inhale for 4 counts and exhale for 6 counts. This may feel awkward in the beginning, so continue to practice. You may wish to use a meditation or breathing app (there are many available for free through the app store) when you are learning the technique – some people find it very helpful to have an external counter.

[1] Sood R, Sood A, Wolf SL, Linquist BM, Liu H, Sloan JA, Satele DV, Loprinzi CL, Barton DL. Paced breathing compared with usual breathing for hot flashes. Menopause. 2013 Feb;20(2):179-84. doi: 10.1097/gme.0b013e31826934b6. PMID: 22990758.

Yoga

Yoga originates from Hindu disciplines, but many different forms of yoga have appeared as its popularity has grown globally – according to a 2017 national survey, one in seven adults in the United States practiced yoga in the past 12 months. [14] [15] Yoga, as practiced in North America, typically emphasizes physical postures (asanas), breathing techniques (pranayama), and meditation (dyana). 

There are many many different styles of yoga practice that vary in intensity level, temperature of the session, and use of specific props, such as straps and blocks. All practices generally involve physical poses or movement sequences, conscious regulation of breathing, and mindfulness techniques to increase present awareness or positivity. [10]

Research suggests that yoga may help:

• improve general wellness by relieving stress, improving mental/emotional health, sleep, and balance
• relieve symptoms of the menopausal transition 
• relieve low-back pain and neck pain
• weight loss
• quit smoking
• manage anxiety and/or depressive symptoms
• manage impacts of chronic disease 
• improve quality of life (QOL) [15]

A 2018 evaluation of 13 randomized controlled trial (RCTs) studies (that include more than 1,300 participants) of yoga for menopausal transition symptoms found that yoga reduced physical symptoms, such as hot flashes, as well as psychological symptoms, such as anxiety or depression. [16] [17] Several studies to date suggest that yoga and other meditation-based programs may be beneficial in helping with menopausal symptoms overall, including a reduction in the frequency, intensity and impact (bothersomeness) of hot flashes, an improvement in sleep and mood, and a decrease in stress and physical pain. [2] 

A systematic review looking at five RCTs concluded that there was moderate evidence for the short-term effects of yoga on psychological symptoms in perimenopause. However, no evidence was found to support any improvement of VMS, somatic, urogenital, or combined menopausal symptoms. 

Other RCTs indicate yoga maybe beneficial for psychological symptoms and fatigue related to menopause but the results are inconsistent. For example, 40 women randomly assigned to either a 12-week yoga and meditation intervention or no interventions (usual care) found that yoga significantly reduced menopausal transition symptoms (determined with the Menopause Rating Scale), improved fatigue, and improved quality of life compared with no intervention. 

A different study found that VMS, sexuality, and total scores on the Menopause-specific Quality of Life Questionnaire (MENQOL) were statistically significantly improved in the yoga group compared with the no yoga group. In contrast to these results, an RCT comparing yoga with exercise or usual activity did not show improvements in VMS frequency or bother in the yoga groups compared to a no yoga group.

The variability among studies looking at the benefits of yoga for various health problems makes it hard to draw solid conclusions about its effectiveness. One of the main problems is the number of types of yoga, which vary in their focus on the spiritual and physical elements of yoga. The overall consensus from the compilation of research suggests that yoga is safe and may be effective for psychological symptoms. More research is needed to determine its effects on VMS and other menopausal transition symptoms. [10]

Yoga has been shown to change brain structure by encouraging the development of new neural connections. These changes in structure result in changes in function, with studies showing improvements in learning and memory. As well, brain changes that are associated with regular yoga proactive include improvements in attention, awareness, thought, and language. 

Brain imaging technology, such as MRI scans, show that regular yoga practitioners have a thicker cerebral cortex (the area of the brain responsible for information processing) and hippocampus (the area of the brain involved in learn­ing and memory) compared with non-practitioners. While both of these areas of the brain get smaller as you age, the brain scans of older yoga practitioners showed less shrinkage than older people who did no yoga. This suggests that yoga may counteract age-related declines in memory and other cognitive skills. [41]

A review study looking at yoga’s effects on the brain consistently found that yoga practitioners had greater cortical thickness (particularly in the left prefrontal cortex), and higher volumes and density of grey matter (GM) compared to non-practitioners. Further, they found that the longer yoga was practiced, the greater the volume of grey matter. Grey matter is responsible for processing information in the brain, particularly sensory signals. The overall conclusion of this review study is that practicing yoga is linked to changes in brain anatomy, particularly in the frontal cortex, hippocampus, anterior cingulate cortex (ACC), and the insula. [42]

Aromatherapy

Aromatherapy, also referred to as essential oil therapy, uses naturally extracted aromatic essences from plants to therapeutically treat various physiological and psychological problems. Essential oils, also known as volatile oils, are made by steaming or pressing parts of a plant, such as the flowers, bark, leaves, or fruit, to distill and capture the compounds that produce fragrance.  The scented oils are believed to reduce anxiety and increase relaxation, which may be beneficial in easing stressful menopausal symptoms. [10]

While aromatherapy may seem like a recent ‘New Age’ alternative treatment, in fact essential oils have been used therapeutically for almost 6,000 years. Essential oils were used by the ancient Chinese, Indian, Egyptian, Greek, and Roman cultures in cosmetics, perfumes, and drugs. [18]

Aromatherapy oils can be inhaled, where the chemical components in the oil are transmitted by the olfactory nerves directly to the limbic system in the brain. The limbic system contains the amygdala whose main function is creating emotional responses, including feelings of happiness, fear, anger, and anxiety. The essential oils can also be applied to the skin topically. They are not typically ingested. The safest ways to use essential oils include:

• Aromatherapy accessories: These include necklaces, bracelets and keychains that are made with absorbent materials. The essential oils are applied directly to the accessory, allowing you to inhale them throughout the day.
• Body oil: Essential oils can be massaged into skin. Pure essential oils are concentrated and can cause skin irritation. That is why they are usually mixed with a ‘carrier’ oil such as olive, jojoba or coconut oil and then used. 
• Aroma stick: This portable device is called an essential oil inhaler, and they contain an absorbent wick that soaks up the essential oil you are using. [19] 

A small number of people may experience irritation or allergic reactions to certain essential oils, especially people who have reacted badly in the past to using products on their skin. Any essential oil can cause a reaction, but these are the most common oils that are problematic: 

• Oregano oil
• Cinnamon bark oil
• Jasmine oil
• Lemongrass oil
• Ylang-ylang oil
• Chamomile oil
• Bergamot oil

If you get a red, itchy rash or hives after applying essential oils, see your healthcare provider. You may be having an allergic reaction. [19]

Be aware of lower quality essential oils, as the market is flooded with ‘magic potions’ to help with any of your problems. Consider the following tips to help you shop for high quality, pure essential oils:

• Read the label: High quality essential oils will include the Latin name of the plant, information on purity and if other ingredients have been added to it, and the country in which the plant was grown.
• Consider the company: Purchase your oils from a reputable aromatherapy company that’s been around for several years.
• Choose dark-colored, glass containers: Pure essential oils are highly concentrated, enough that they can dissolve plastic bottles over time, ruining the quality of the oil (and making a big mess). Quality essential oils are packaged in small brown or blue glass bottles.
• Avoid “fragrance oils”: These oils, called fragrance or perfume oils, are made from a combination of essential oils and chemicals. They may also be made entirely from chemicals. Look for bottles that contain a single essential oil in its purest form (100% essential oil with no other fillers).
• Compare prices: Essential oils range in price, depending on how involved harvesting and production are. Within any brand there should be a wide variety of prices, so for example sandalwood oils will be more expensive, while sweet orange oil will be on the less expensive end. When you find a rock-bottom price for an expensive essential oil, just remember that it probably isn’t pure or it is long out of date.
• Aromatherapy products are not subject to regulatory approval unless there is a claim for treatment of specific diseases. This is an additional reason to look for high quality, credible retailers. [19] [20] 

Much of the research into aromatherapy does not support any physical improvements, and most of the evidence for pain reduction and improved healing is anecdotal rather than based on scientific proof. One study found that aromatherapy did not cause any physical effects despite reported improvements in mood. Neither lemon oil nor lavender, two of the most popular essential oils used in therapy, significantly changed pain ratings, heart rate, blood pressure, wound healing, or stress hormone levels. Despite this there are consistent reports of mood improvements across most scientific studies. Studies in animals show sedative and stimulant effects of specific essential oils as well as positive effects on behavior and the immune system. Functional imaging studies in humans, where brain activity is seen directly, support the idea that odors influence the limbic system and its emotional pathways. [20] [21]

Other studies are more supportive of aromatherapy. One study found that 12 weeks of lavender inhalation improved self-reported sleep quality compared with a control based on health education only. A different study used a double-blinded (where neither the patient or the researcher knows which trial they are assigned to) 12-week clinical crossover trial of 100 women and found that lavender essential oil reduced hot flash frequency by 50% compared with <1% reduction in the placebo (diluted milk) control, a clinically significant difference. Three additional RCTs of aromatherapy combined with massage indicate that aromatherapy massage was more beneficial than massage alone or a control treatment in reducing physical (eg, VMS) and psychological (eg, depression) perimenopause symptoms. [10] 

The addition of aromatherapy to other mind body wellness interventions may provide additional symptom relief. However, at this time there is insufficient evidence to support aromatherapy as a stand-alone treatment for menopausal transition symptom management. [10] 

Aromatherapy works by stimulating the olfactory system, which includes all the structures in your body associated with the sense of smell. The olfactory system works by carrying molecules of scent, called odorants, to specialized receptors that can process and interpret them. For example, when you smell lavender oil, molecules of the oil are carried into your nasal cavity and stimulate receptors on your olfactory epithelium. Olfactory sensory neurons running from the receptors carry the information to the olfactory bulb. Special cells, called mitral cells, carry the information to the olfactory cortex, which is the part of the brain that interprets smells. Once the information is received and processed by the olfactory cortex, you will be able to ‘smell’ the scent of lavender. 

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Your mitral cells connect to the olfactory cortex in the brain, but they also carry information to the limbic system, made up of the hippocampus, the amygdala, and the hypothalamus in the brain, all of which are involved in both behavioural and emotional responses.  This connection is the reason that smells are so closely connected to feelings – if you have a positive memory of smelling a special meal cooking, when you smell it again it will trigger positive thoughts. [10][18][21][43]

Reflexology

Reflexology is a specific type of massage performed on the feet and hands that is believed to stimulate corresponding glands and organs. The principle behind reflexology states that there are specific ‘reflex’ points on the hands and feet that correspond to certain body zones. When pressure is applied to these points, disease-causing energy blockages are eliminated, promoting healing. [10] 

Reflexologists use hand and foot charts to guide them as they apply pressure to specific areas. Reflexology is sometimes combined with other hands-on therapies and may be offered by chiropractors and physical therapists, among others.

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There are only two randomized controlled trials (RCTs) looking at reflexology as a therapy for menopausal transition symptoms. These studies compared reflexology with a control therapy using non-specific foot massage. One found no significant differences between non-specific foot massage and reflexology on symptoms of anxiety, depression, and VMS. The other RCT, however, assessed 120 women randomized to reflexology or a control of non-specific foot massage. The results found that VMS and sexual dysfunction symptoms were significantly improved among women receiving foot reflexology compared to control. In fact, hot flash frequency was reduced by 56% after 12 twice-weekly reflexology sessions. Because of the small number of RCTs and inconsistent findings, more research is needed to determine how effective reflexology is for the management of menopausal symptoms. [10] [22] [23]

Homeopathy

Homeopathy, or homeopathic medicine, is a system based on two principles that deviate from traditional western medical approaches. The first is “like cures like” where the belief is that a disease or disorder can be cured by a substance that produces the disease symptoms in healthy patients. In this case, patients are given dilutions of natural substances that would be harmful to a person in ideal health. The concept is that the substance will stimulate a ‘vital response’ (a healing response) in the patient and through that, it will help the body complete its healing. 

Some commonly used preparations include sepia (from cuttlefish ink), lachesis (from venom of the South American Bushmaster), and pulsatilla (from a flower of the same name). Individualized formulas are prepared to treat presenting symptoms.  The second principle is the “Law of minimum dose’ that proposes the lower the dose of the medication, the greater its effectiveness. [10] [24] Homeopathy is a controversial topic given that these principles are not consistent with fundamental scientific concepts as understood in western medicine.

Homeopathic remedies are delivered via sugar pellets placed under the tongue, or as ointments, gels, drops, creams, or tablets. Treatments are tailored to each person, and it is common for different people with the same symptoms to receive different treatments. As well, homeopathy uses a different diagnostic system for determining treatments and it differs from conventional medicine in the way that it recognizes clinical patterns of symptoms. 

At the moment, there is little data from clinically-run randomized controlled trials (RCTs) to  support the effectiveness of homeopathy for any specific health conditions. One study (n = 223) found homeopathy may be beneficial in reducing distress in the menopausal tranisiton. However, a review of homeopathic approaches for menopause showed no convincing evidence for the efficacy of homeopathy in menopause. [10]

The US National Health Interview Survey found that almost 5 million adults and children used homeopathy for various reasons in the previous year, so this is a therapy that needs to be evaluated further for efficacy and safety. There are real concerns, including the fact that some products labeled as homeopathic may contain substantial amounts of active ingredients and cause side effects and drug interactions. [24] A systematic review of case reports and case series concluded that using certain homeopathic products (such as those containing heavy metals like mercury or iron that are not highly diluted) or replacing an effective conventional treatment with an ineffective homeopathic one can cause adverse effects, some of which may be serious. [10] [25]

Acupuncture

Acupuncture techniques come from traditional Chinese medicine and involve insertion of small needles into the skin at certain points on the body, which are called acupoints. Traditional Chinese medicine (TCM) practitioners believe the human body has more than 2,000 acupuncture points connected by pathways or meridians. These pathways create an energy flow (Qi, pronounced CHEE) through the body that is responsible for overall health. When this energy flow is disrupted, it can cause disease. Applying acupuncture to certain points is thought to improve the flow of Qi, thereby improving health. [10]

Acupuncture is done using hair-thin needles that usually cause no pain at all. The needle is inserted until it produces a sensation of pressure or ache. In some types of acupuncture treatment, needles may be heated during the treatment or may have a mild electric current flowing through them (electroacupuncture).  Other forms of stimulation can also be used over the acupuncture points instead of needles including:

• Heat (moxibustion)
• Pressure (acupressure)
• Friction
• Suction (cupping)
• Impulses of electromagnetic energy (electroacupuncture) [26]

Despite the fact that acupuncture is known to be helpful for many conditions, including digestive, emotional and neurological problems, scientific studies are not fully able to explain why it works. 

If you are considering acupuncture, speak with your health care provider first. Make sure that you choose a licensed acupuncturist and understand what the treatments will involve – how many treatments using how many needles over what period of time. Also ask if any other methods, other than needles, will be used. 

There can be risks with acupuncture based on existing conditions. For example, ensure that your acupuncturist knows if you have a bleeding disorder, which increases the chances of bleeding or bruising from the needles. Ask if your practitioner uses electromagnetic pulses during treatment as this can cause a serious interaction if you have a pacemaker. And if you are pregnant or possibly pregnant, know that some acupuncture points may stimulate labour.  [26] [27] 

There have been several RCTs of traditional acupuncture for the treatment of various menopausal transition symptoms. Four of these found no significant difference between acupuncture and a placebo treatment using superficially placed needles or needling at non-acupoints. One study found that an acupuncture plus auricular acupressure intervention (where specific ‘acupoints’ in the ear are stimulated without the use of needles) was not significantly better than a hormone replacement control at improving hot flash severity. Six other studies showed that acupuncture could improve vasomotor, sleep, or somatic (body) symptoms more significantly than placebo. Three studies looked at electro-acupuncture techniques. One of these studies found significant improvements in mood only, and the other two found no significant difference compared to a placebo. More research with precise methods is needed to uncover the true efficacy and the mechanisms behind the benefit some participants receive from acupuncture. [10]

There has been research looking at how acupuncture works based on neuroanatomy and physiology. These studies assess how the acupuncture needles stimulate the central nervous system, which in turn direct the release of chemicals into the bloodstream. These chemicals are carried to the muscles, spinal cord and the brain and thought to stimulate the natural healing abilities of the body. 

One of the first scientific breakthroughs in understanding the mechanism of how acupuncture works was the discovery that acupuncture generates a signal to the brain that results in the release of endorphins. If acupuncture can stimulate the release of endorphins, it is thought to stimulate the release of other neurotransmitters as well. 

Acupuncture has also been shown to directly stimulate tissues around the needle insertion point,  impacting blood flow and triggering improved or increased natural healing mechanisms. An analgesic effect of pain relief around the insertion points has also been observed. [26] [44] 

Meditative Movement – Tai Chi

Tai chi (pronounced TIE CHEE) originated in China centuries ago. Tai chi, sometimes called meditation in motion, uses slow, flowing body movements, coupled with deep breathing to achieve mental and physical balance, relaxation, focus, and awareness. [2] It is a noncompetitive, self-paced system of gentle physical exercise and stretching where each posture flows into the next without pause, so that your body is in constant motion.

Tai chi has many different styles, with each different style emphasizing various tai chi principles and methods. Some styles may focus on health maintenance (internal tai chi), while others focus on the martial arts aspect of tai chi (external tai chi). Tai chi focuses on internal energy and using internal (core) muscles by initiating all movements from the dantian. Dantian are the “qi [chi] focus flow centers”, important focal points for meditative and exercise techniques. [28]

One study looking specifically at the impact of tai chi on bothersome menopausal symptoms assessed 40 otherwise healthy Australian women. These women reported significant improvement in night sweats, hot flashes, abdominal discomfort and fatigue following a 16-week tai chi program. The findings showed a 50% reduction in the number of women reporting hot flashes and a 42% reduction in women reporting night sweats. [29] Another review study found significant evidence for tai chi improving body pain, quality of life (as measured with the RAND Short Form 36 Health Survey (SF-36)), and the spinal bone mineral density (BMD) in perimenopausal women. [30] 

Meditative Movement – Qigong

Qigong (pronounced CHEE GONG) originated in China thousands of years ago as a form of martial art. It uses exercises to optimize energy flow within the body, mind, and spirit, with the goal of improving and maintaining health and well-being. Qigong has both mental and physical components that involve regulating the mind and breath, and the body’s movement and posture.

Most forms of qigong include the following:

• Slow, long, and deep breathing that may alternate between abdominal breathing to breathing combined with speech sounds.
• Gentle and smooth movements that produce relaxation.
• Focusing one’s attention and visualization to calm and regulate the mind. [31] 

Qigong can be active or passive. Active, or dynamic qigong techniques focus primarily on body movements, especially movements of the whole body or arms and legs. Passive, or meditative qigong techniques are practiced in any posture that can be maintained over time with almost no body movement. Meditative qigong involves breathing and mind exercises. [31]

An observational study looking at the effect of a 12-week 30-minute-per-day qigong exercise program on perimenopausal symptoms and sleep quality in perimenopausal women found that both symptoms and sleep quality improved in women practicing for either 6 weeks and 12 weeks. The findings suggest that the longer qigong is practiced, the greater the improvement in sleeping quality and perimenopause symptoms. [32]

Traditional Chinese Medicine (TCM) and East Asian Medicine

Traditional Chinese and East Asian medicine can include the use of herbs, self-massage, acupuncture, diet, or meditative movement, all of which are connected by the use of ancient techniques and the belief in qi (life force energy) and yin and yang (harmony between opposite forces).

Research on TCM is hard to interpret, given the breadth of treatments and techniques that fall under the umbrella of Traditional Chinese medicine. One study assessed a Chinese herbal medicine formula and found the herbal treatment significantly improved hot flash frequency compared to a placebo control group. However, hot flash reduction was even larger in a third group using hormone replacement therapy. Two other trials reported no significant difference between hormone replacement therapy and Chinese herbs in reducing self-reported VMS, anxiety, and depression. Yet another study using Japanese traditional medicine found greater improvement in VMS and psychological symptoms for a control trial using an antidepressant (Paroxetine) than with the herbal treatment. [10] 

One RCT used acupuncture in combination with traditional Chinese medicine and found that this combination significantly improved hot flash frequency, irritability, and sleep problems compared to the waitlist control group. Several other RCTs found no significant difference between Chinese medicinal herbs and placebo groups in hot flash severity, hot flash frequency, sleep quality, or menopause related quality of life symptoms. [10] 

All combined, there is some scientific evidence that traditional Chinese and East Asian medicine can be effective in relieving menopausal transition symptoms, but drawing overall conclusions is difficult because of the differences in study designs, study quality and types of treatment. In addition, the authors do not have access to Chinese-language research study publications. [10] [33]