Answering your questions when it comes to calcium requirements, mammography screening, mindfulness and insomnia, and effectiveness of acupuncture and Chinese herbs for hot flashes.
Calcium Supplements: Do They Help or Harm?
Current recommendations for calcium intake call for 1,000 mg/day for women ages 19-50 and 1,200 mg/day for women over age 50 to ensure bone health. Given the recent concerns that calcium supplements may raise the risk for cardiovascular disease and kidney stones, women should aim to meet this recommendation mostly by eating a calcium-rich diet and taking calcium supplements only if needed to reach the RDA goal. Often only 500 mg/day is necessary. This dosage would be expected to reduce the risk of hip fracture while having a neutral effect on the risk for heart disease, stroke, kidney stones, and cancer.
Vitamin D (best absorbed as Vitamin D-3) is needed to facilitate the absorption of calcium into the bones. A 1,000mg/day total is recommended as a daily minimum, and many doctors recommend 2,000 I.U./day.
Rethinking Mammography Screening
A recent Canadian study (Miller et al in the British Medical Journal, 2014) reports findings from 25 years of follow-up in a screening mammography trial that started in 1980 and involved approximately 90,000 women ages 40-59, tracking outcomes during the 5-year screening period and subsequent follow-up through 2005.
The findings echoed those of other recent studies of breast cancer screening, which showed that, while more early cancers were detected, there was a high false-positive mammography rate and the overall death rate from invasive breast cancer did not significantly lower in the mammography vs. the no-mammography groups.
These findings, along with recent evidence that frequent breast self-examination probably does not improve breast cancer survival rates, may make one feel a little like a Christian Scientist with appendicitis. My recommendation mirrors that of my fellow menopause practitioners: In average-risk women, screen at least every 2 years beginning at age 50; in women with modestly higher risk (obese, history of fibrocystic breasts, mild family history, etc.), screen every 2 years in the 40s and 1 every year beginning at age 50.
Are Acupuncture and Chinese Herbal Medicine Effective Options for Hot Flashes?
According to a 2007 survey, adults in the U.S. spent an estimated $33.9 billion out of pocket on complementary/alternative medicine (“CAM”) therapy during the past 12 months. Insurance coverage for these therapies is limited, as there is a lack of scientific evidence regarding the cost-effectiveness of these frequently anecdotal remedies. Yet people continue to seek them, and pay for them out of pocket.
One popular therapeutic regimen without a robust amount of scientific evidence is the use of acupuncture and Chinese herbs to treat hot flashes, one of the most bothersome of menopausal interruptions.
A recent epidemiological study by Borrelli and Ernst published in the medical journal Menopause is most welcome. They gathered together all of the reputable scientific evidence on the subject from journal reviews, randomized clinical trials, and epidemiological studies and concluded that most CAM treatments, including acupuncture, soy, and herbal preparations, seem to have only minimal or no effects on hot flashes. Similar to several recent studies in first-tier, peer-reviewed medical literature, they found the evidence to support the effectiveness of these therapies over placebo unconvincing. A recent meta-analysis concluded that convincing evidence for the use of acupuncture for hot flashes was lacking. This analysis found, however, that the placebo effects and relaxation achieved with acupuncture and other CAM therapies may in themselves reduce hot flashes enough to be beneficial. In other well-controlled studies, , a significant reduction in menopausal symptoms was obtained with meridian-controlled vs. “sham” acupuncture. As for the addition of herbal therapy, the investigators did not find any additional benefit.
Summing up, the evidence is mixed. Acupuncture appears to have a beneficial place in the hierarchy of symptomatic menopause therapies and, although the placebo effect is strong, it appears to be effective on its own in some women for symptom reduction. No data is available regarding whether acupuncture confers any of the cardioprotective and cognition protective benefits of estrogen therapy. The addition of Chinese herbal products does not, when subjected to scientific scrutiny, appear to confer significant additional benefit.
Is Mindfulness Effective Against Insomnia After Menopause?
Mindfulness is defined as “being intentionally aware of internal and external experiences occurring at the present moment, without judgment.” Meditation, among other techniques, is utilized to teach, and maintain, mindfulness. Mindfulness techniques have been proven effective in the reducing sleep difficulties.
Drs. Marcelo C. Garcia and his colleagues from Sao Paulo, Brazil conducted a study to determine whether postmenopausal women with insomnia were less mindful than postmenopausal women without sleep difficulties. Published in the medical journal Menopause, they found that postmenopausal women with insomnia were indeed less mindful than a similar group of women who slept well. They determined that mindfulness-based interventions, such as meditation, very well may be beneficial for postmenopausal women.
Active research into all aspects of menopausal therapies continues. I follow this literature, and will report to you on occasion interesting, applicable, and timely information. Stay tuned for ongoing information!