A Randomized Trial of Acupuncture for Vasomotor Symptoms in Postmenopausal Women

This randomized controlled trial investigated the efficacy of acupuncture in treating vasomotor symptoms (hot flashes and night sweats) in postmenopausal women. The study was conducted between 2000 and 2002 in a rural community in Oregon, USA, recruiting 51 women who completed the research protocol. Participants were randomized to receive 12 weeks of treatment with true traditional Chinese acupuncture (27 women) or placebo acupuncture with non-penetrating needles (24 women). The treatment protocol consisted of two weekly sessions during the first 4 weeks, followed by one weekly session for 8 weeks, totaling 16 sessions of 25 minutes each.

In the true acupuncture group, points based on Traditional Chinese Medicine were used, including BL-23 (Shenshu, 腎俞), BL-20 (Pishu, 脾俞), SP-6 (Sanyinjiao, 三陰交), among others, selected according to each patient's energetic diagnostic pattern. Treatment included manual stimulation to obtain De Qi and electrostimulation at 2 Hz at four bilateral points. The placebo group received special non-penetrating needles developed by Streitberger and Kleinhenz, placed at points outside the acupuncture meridians, with a disabled electrostimulation device to maintain the illusion of treatment. Outcomes were measured through symptom diaries kept by the participants, the Greene Climacteric Scale, and the Beck Depression and Anxiety Inventories, applied at baseline, at week 4, at the end of treatment (weeks 13–14), and 12 weeks after termination (week 24).

The main findings revealed that both groups experienced statistically significant improvements in virtually all parameters measured, including reductions in hot flashes, depressive symptoms, anxiety, and other menopausal symptoms. However, there were no statistically significant differences between the two treatment groups. Approximately 76.5% of participants reported some decrease in hot flashes, regardless of group. When questioned at the end of the study, 73% of participants believed they had received true acupuncture, and there was no significant difference in the ability to correctly identify the type of treatment received between groups.

The clinical implications of this study are complex and raise important questions about the mechanisms of action of acupuncture. The fact that both treatments produced similar benefits suggests several possibilities: placebo acupuncture may not be truly inert and may have its own therapeutic effects, the effects may be attributable to the therapeutic context (attention, relaxation, expectation), or the mechanisms of acupuncture may be broader than traditionally understood. This finding is consistent with other studies in the literature that have compared true acupuncture with superficial acupuncture controls, suggesting that different forms of cutaneous stimulation may activate similar neurophysiological mechanisms. Limitations of the study include a sample size insufficient to detect smaller differences between groups, the absence of a no-intervention control group, the rural setting that may limit generalizability of the results, and the fact that treatments were performed only in the prone position to facilitate masking, which may have limited the efficacy of true acupuncture.

For patients and clinicians, this study suggests that acupuncture, even in its simplest form, may offer benefits in the management of menopausal symptoms, representing a safe and potentially effective alternative to hormone replacement therapy, especially considering the safety concerns raised by the Women's Health Initiative around the same time.