Acupuncture relieves menopausal discomfort in breast cancer patients: A prospective, double blinded, randomized study
Bokmand et al. · The Breast · 2013
Evidence Level
STRONGOBJECTIVE
Evaluate whether acupuncture reduces hot flashes and sleep disturbances in women treated for breast cancer
WHO
94 women with breast cancer (mean age 61 years)
DURATION
5 weeks of treatment + 12 weeks of follow-up
POINTS
PC-6, KI-3, SP-6, and LR-3 (bilateral) - points on the wrist, ankle, and foot
🔬 Study Design
True Acupuncture
n=31
True acupuncture at points PC-6, KI-3, SP-6, LR-3
Placebo Acupuncture
n=29
Superficial acupuncture at sham points
No Treatment
n=34
Control group without intervention
📊 Results in numbers
Significant improvement in hot flashes (acupuncture)
Improvement in hot flashes (placebo)
Statistical significance (hot flashes)
Duration of effect
Percentage highlights
📊 Outcome Comparison
Hot flash reduction (efficacy)
This study showed that true acupuncture can significantly reduce hot flashes and improve sleep in women who have undergone breast cancer treatment. The positive effects appeared as early as the second session and lasted at least 3 months after treatment ended.
Article summary
Plain-language narrative summary
This double-blind randomized controlled trial investigated the efficacy of acupuncture in relieving menopausal symptoms in women treated for breast cancer. The Danish investigators enrolled 94 women with a mean age of 61 years who had bothersome hot flashes and sleep disturbances after cancer treatment. Participants were randomized into three groups: true acupuncture (31 women), placebo acupuncture (29 women), and no-treatment control (34 women). The acupuncture protocol consisted of five weekly sessions of 15-20 minutes, using specific bilateral points: PC-6 (wrist), KI-3 (ankle), SP-6, and LR-3 (foot).
The placebo group received superficial acupuncture at non-meridian points in the same anatomic region. Symptoms were evaluated by a visual analog scale (VAS) of 0-10 for hot flashes and a yes/no questionnaire for sleep disturbances. Plasma estradiol levels were measured to verify whether the effects were hormonally mediated. The results demonstrated that 52% of the women in the true acupuncture group experienced significant improvement in hot flashes, compared with only 24% in the placebo group (p < 0.05).
The effect manifested after the second session and persisted for at least 12 weeks after treatment ended. There was also a statistically significant improvement in sleep quality in the acupuncture group compared with the control groups. Importantly, there was no increase in plasma estradiol levels, ruling out concerns about hormonal stimulation that could increase the risk of cancer recurrence. Adverse effects were minimal and nonspecific.
This study is particularly relevant because women with breast cancer frequently cannot use hormone therapy for menopausal symptoms due to recurrence risk, creating the need for safe therapeutic alternatives. The robust methodology, including placebo and control groups, strengthens the evidence that acupuncture offers real benefits beyond the placebo effect. Limitations include the relatively small sample size and the need for long-term studies to establish the durability of effects.
Strengths
- 1First study with dual control (placebo and no treatment)
- 2Rigorous double-blind design
- 3Estradiol measurement to assess hormonal safety
- 412-week follow-up after treatment
Limitations
- 1Relatively small sample (94 participants)
- 2Homogeneous population (Danish Caucasian women)
- 3Follow-up limited to 12 weeks
- 4Need for replication in diverse populations
Expert Commentary
Prof. Dr. Hong Jin Pai
PhD in Sciences, University of São Paulo
▸ Clinical Relevance
Breast cancer survivors constitute one of the most challenging clinical groups in the management of menopausal symptoms: hormone replacement therapy remains contraindicated in most cases, and the available pharmacologic alternatives — venlafaxine, gabapentin, clonidine — present limited tolerability profiles and partial efficacy. In this scenario, the demonstration of a 52% reduction in hot flash intensity with true acupuncture, maintained for at least 12 weeks after the end of sessions, represents a clinically actionable finding. The protocol used — five bilateral points across five weekly sessions — is reproducible in the office and integrates naturally with multidisciplinary oncologic follow-up. The absence of elevation in serum estradiol eliminates the main objection that oncologists usually raise about acupuncture in this population, opening the way for a more grounded discussion in our team meetings.
▸ Notable Findings
Two findings deserve special attention. First, the rapidity of response: improvement in hot flashes became evident as early as after the second session, which is clinically meaningful for a population frequently frustrated by slow-response treatments. Second, the durability of the effect for at least 12 weeks beyond the end of treatment suggests persistent modification of central neuroendocrine circuits — probably via hypothalamic serotonergic and noradrenergic modulation — and not mere transient symptomatic relief. The three-arm design, with placebo and no-treatment groups, allowed the specific contribution of true acupuncture to be quantified with uncommon precision: the 28-percentage-point difference between true acupuncture and placebo (52% versus 24%) represents a robust therapeutic effect that goes beyond expectancy response. The concomitant improvement in sleep quality, an outcome frequently neglected in oncologic trials, adds practical relevance to the protocol.
▸ From My Experience
At the Pain Center of HC-FMUSP, we regularly see patients referred by breast oncology services with exactly this profile — women on aromatase inhibitors or tamoxifen, with intense hot flashes and insomnia refractory to conventional measures. My experience with this group confirms what this protocol suggests: I usually observe a perceptible response between the second and third sessions, and I typically schedule an initial cycle of eight to ten sessions before evaluating monthly maintenance. I frequently combine systemic acupuncture with auriculotherapy at Shen Men and zero points, which seems to potentiate the effect on sleep. The patient profile that responds best, in my observation, is one with predominantly nocturnal hot flashes and an associated anxiety component. I do not indicate the procedure in patients on active chemotherapy with severe thrombocytopenia. The data on maintenance of effect for 12 weeks post-treatment resonates with what I see in practice: some patients are able to progressively space out sessions without immediate symptom recurrence.
Full original article
Read the full scientific study
The Breast · 2013
DOI: 10.1016/j.breast.2012.07.015
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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