Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials
Chiu et al. · Menopause · 2015
Evidence Level
STRONGOBJECTIVE
To assess the effects of acupuncture on the frequency and severity of hot flashes, menopause-related symptoms, and quality of life
WHO
Women aged 40-60 years in natural menopause, 869 participants total
DURATION
Ranged from 4-12 weeks, with follow-up of up to 3 months
POINTS
Varied points including SP-6, LI-4, HT-7, CV-4, ST-36, KI-3 among others
🔬 Study Design
Acupuncture (various modalities)
n=445
Traditional Chinese acupuncture, electroacupuncture, or acupressure
Control
n=424
Sham acupuncture or usual care
📊 Results in numbers
Reduction in hot flash frequency
Reduction in hot flash severity
Improvement in psychiatric symptoms
Effects persist
📊 Outcome Comparison
Reduction in hot flash frequency
Reduction in hot flash severity
This study shows that acupuncture may be an effective option for women suffering from menopause symptoms, especially hot flashes. The benefits include a reduction in the frequency and intensity of hot flashes, as well as an improvement in overall well-being.
Article summary
Plain-language narrative summary
This meta-analysis evaluated the effects of acupuncture on menopause-related symptoms and quality of life in women going through natural menopause. The researchers conducted a systematic search of several databases through December 2013, identifying 12 high-quality randomized controlled trials that included 869 participants aged 40-60 years. The methodology was rigorous, following established guidelines and including study quality assessment and publication bias analysis. The studies analyzed used different acupuncture modalities, including traditional Chinese acupuncture, electroacupuncture, and acupressure, comparing them with sham acupuncture or usual care.
Treatment duration ranged from 4 to 12 weeks, with total acupuncture doses ranging from 180 to 1,080 minutes. The most commonly used acupuncture points included SP-6, LI-4, HT-7, CV-4, ST-36, and KI-3, among other points traditionally used for menopausal symptoms. The results demonstrated significant effects of acupuncture in reducing hot flash frequency (g = -0.35) and severity (g = -0.44), with 95% confidence intervals not including zero. For menopause-related symptoms measured by the Menopause Rating Scale, acupuncture showed significant improvements in three domains: psychiatric (g = -1.56), somatic (g = -1.39), and urogenital (g = -0.82).
As for quality of life, measured by the Menopause-Specific Quality of Life Questionnaire, there was significant improvement only in the vasomotor domain (g = -0.46). An important finding was that the effects of acupuncture persisted for up to 3 months after treatment, suggesting lasting benefits. Interestingly, no significant differences were found between traditional Chinese acupuncture and other modalities, nor were significant moderating effects observed related to dose, number of sessions, or duration of treatment. The comparative analysis showed that studies using sham acupuncture as a control had smaller effects than those using usual care, suggesting that sham acupuncture may have some therapeutic effect.
The rate of adverse effects was low, with 41.6% of the studies reporting no adverse effects. The clinical implications are promising, suggesting that acupuncture may be considered as adjunctive treatment for menopausal symptoms, especially hot flashes, in addition to hormone therapy and other pharmacological approaches. The authors recommend that future studies use more rigorous designs with better allocation concealment and objective measures of menopausal symptoms, such as hormonal levels.
Strengths
- 1Robust meta-analysis with 12 RCTs and 869 participants
- 2Low heterogeneity between studies
- 3Effects persistent up to 3 months
- 4Low rate of adverse effects
- 5Rigorous assessment of methodological quality
Limitations
- 1Relatively small number of included RCTs
- 2Only one study compared with hormone therapy
- 3Some studies did not provide sufficient outcome information
- 4Difficulty of blinding in acupuncture studies
- 5Heterogeneity in the acupuncture points and protocols used
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Natural menopause represents a concrete therapeutic challenge in clinical practice: a significant proportion of women refuse or have contraindications to hormone therapy, and the available pharmacological alternatives — selective serotonin reuptake inhibitors, gabapentin, clonidine — carry adverse effect profiles that limit adherence. This meta-analysis, by consolidating 12 RCTs with 869 participants between 40 and 60 years of age, offers a reasonable basis for including acupuncture as a structured adjuvant in this armamentarium. The effects on hot flash frequency and severity are modest but consistent, and what seems most applicable in practice is the magnitude of benefit on psychiatric symptoms — irritability, anxiety, dysphoria — which tend to be the most disabling and the least addressed by conventional approaches available outside the hormonal axis. The persistence of effects for up to three months after the end of treatment is clinically useful data when planning discharge and maintenance intervals.
▸ Notable Findings
The effect size for psychiatric symptoms measured by the Menopause Rating Scale (g = -1.56) clearly stands out from the other outcomes and deserves attention. While the reduction in hot flash frequency (g = -0.35) and severity (g = -0.44) sits in a small to moderate magnitude — which is expected in this literature — the psychiatric effect approaches what has conventionally been called a substantial clinical effect. This dissociation suggests that acupuncture may act through central neuromodulatory pathways — likely mediated by endogenous opioids, serotonin, and the hypothalamic-pituitary axis — that transcend simple vasomotor control. Another striking finding is the absence of differences between modalities: traditional Chinese acupuncture, electroacupuncture, and acupressure produced comparable results, which gives some flexibility to the clinician in choosing the protocol without compromising the outcome. The low rate of adverse effects consolidates the safety of the method in this population.
▸ From My Experience
In my practice with menopausal women referred to the rehabilitation service — often after refusal or contraindication to hormone therapy — I tend to observe the first perceptible responses between the third and fifth sessions, especially in relation to sleep quality and emotional lability. Hot flashes tend to respond more gradually, typically perceptible around the sixth to eighth session. The protocol I typically use combines points such as SP-6, HT-7, KI-3, and CV-4, adding electroacupuncture at mixed frequency when there is a more marked dysphoric component. After the initial phase of eight to ten sessions, I usually space out to biweekly or monthly maintenance, which aligns well with the up-to-three-month persistence of effect documented in this meta-analysis. The patient profile that responds best, in my observation, is one with predominant psychiatric symptomatology and good adherence to the multimodal treatment — and I usually associate guidance on regular aerobic physical activity, which synergistically potentiates the neuromodulatory effects.
Full original article
Read the full scientific study
Menopause · 2015
DOI: 10.1097/gme.0000000000000260
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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