Effect of acupuncture on hot flush and menopause symptoms in breast cancer- A systematic review and meta-analysis

This systematic review and meta-analysis represents an important milestone in the evaluation of acupuncture as a complementary treatment for menopausal symptoms in women with breast cancer. The researchers analyzed 13 randomized clinical trials involving 844 patients, providing the most robust evidence available on this topic to date in 2017. The study was motivated by the urgent need for safe alternatives to hormone therapy, which is contraindicated for many breast cancer survivors because of the risk of recurrence. The methodology rigorously followed PRISMA guidelines, searching seven databases from inception to March 2017, with no language restrictions.

Inclusion criteria were rigorous, accepting only studies that used true needle acupuncture, excluding TENS or other forms of stimulation. Methodological quality was assessed using Cochrane criteria and the modified Jadad scale, with most studies showing medium-to-high quality. The results revealed an interesting pattern: although acupuncture did not demonstrate significant efficacy in reducing the frequency (p=0.34) or severity (p=0.33) of hot flushes specifically, it provided significant improvement in overall menopausal symptoms (p=0.009) measured by the Kupperman index and similar scales. This index evaluates 21 aspects including sleep disturbances, paresthesias, depression, joint pain, palpitations, headache, tingling, dizziness, and irritability.

The difference in results may be explained by the fact that hot flushes are a specific symptom with a complex pathophysiological mechanism involving hypothalamic thermoregulatory dysfunction, whereas other menopausal symptoms may respond better to the neuromodulatory effects of acupuncture. The researchers propose that acupuncture may act through modulation of the autonomic nervous system, counterbalancing the sympathetic hyperactivation characteristic of menopause, and through endorphin stimulation that regulates neurotransmitters such as serotonin and norepinephrine. Important safety aspects were documented: no serious adverse events were reported in any study, only minor effects such as mild bleeding or bruising at the needle insertion site. This contrasts significantly with the known risks of hormone therapy, including increased cardiovascular and cancer recurrence risks.

The included studies varied in duration from 4 to 12 weeks, with different treatment protocols, ranging from twice-weekly to weekly sessions. The most commonly used acupuncture points included SP-6 (Sanyinjiao), LI-4 (Hegu), ST-36 (Zusanli), KI-3 (Taixi), CV-4 (Guanyuan), and LR-3 (Taichong), following both traditional Chinese medicine principles and modern research findings on neuromodulation.