Acupuncture improves the emotion domain and lipid profiles in women with polycystic ovarian syndrome: a secondary analysis of a randomized clinical trial

Polycystic ovary syndrome (PCOS) is a hormonal condition that affects 15% to 20% of women of reproductive age worldwide, making it the most common endocrine disorder in this population. Beyond the widely known reproductive problems, PCOS is frequently associated with metabolic disturbances such as insulin resistance, lipid-profile abnormalities, and obesity, as well as a significant impact on women's quality of life and mental health. Earlier studies have shown that women with PCOS have a higher prevalence of anxiety, depression, and other psychological disorders compared with women without the syndrome. In this context, acupuncture has emerged as a promising complementary therapy, with growing evidence of its efficacy in treating multiple aspects of PCOS, including hormonal regulation, improvement in metabolic profile, and relief of emotional symptoms.

The primary aim of this study was to evaluate the effects of acupuncture on the emotional domain and metabolic parameters of Chinese women with PCOS through a secondary analysis of data collected in a large randomized clinical trial. The methodology involved 926 women diagnosed with PCOS by specific criteria, who were divided into two groups: 458 received true acupuncture and 468 received sham acupuncture. The study was conducted between July 2012 and October 2015 in 27 hospitals in mainland China. To assess quality of life, five validated questionnaires were used: the PCOSQ (specific to PCOS), the SF-36 (general health assessment), the ChiQOL (Chinese quality-of-life instrument), and the Zung anxiety and depression scales.

In addition, blood samples were collected for analysis of metabolic parameters, lipid profile, and serum ions before and after four months of treatment.

The results revealed significant benefits of acupuncture across multiple areas. In the emotional dimension, the group that received acupuncture showed improvement in total SF-36 scores, particularly in the work-related physical function and work-related emotional function domains, as well as increases in total scores and the emotional domain of the ChiQOL questionnaire. As for metabolic and lipid profile, there was a significant reduction in homocysteine, LDL cholesterol, and acne, while lipoprotein A, apolipoprotein A1, and the apolipoprotein A1/apolipoprotein B ratio increased. Interestingly, changes in serum ion levels were also detected, with significant increases in calcium, potassium, and chloride concentrations in the acupuncture group.

An intriguing finding was that the sham acupuncture group also showed some similar improvements, suggesting that even superficial point stimulation can have beneficial physiological effects.

For patients with PCOS and health professionals, these results suggest that acupuncture can be a valuable therapeutic approach as a complement to conventional treatments. The simultaneous improvement in emotional aspects and lipid metabolism is particularly relevant, as it indicates a possible connection between these domains, aligning with the holistic perspective of traditional Chinese medicine that emotional and physical health are interconnected. For patients, this means acupuncture can offer benefits that extend beyond reproductive symptoms, contributing to overall improvement in quality of life and emotional well-being. Clinicians may consider including acupuncture in integrative treatment plans, especially for patients with significant emotional components associated with PCOS or those seeking complementary approaches to conventional pharmacological treatments.

It is important to acknowledge the limitations of this study for an appropriate interpretation of the results. The fact that sham acupuncture also produced some beneficial effects raises questions about the specific mechanisms of acupuncture and the contribution of placebo or non-specific effects. In addition, the inherent subjectivity of the quality-of-life scales used may have influenced the results, even with standardized rater training. The absence of subgroup analyses based on body mass index represents another limitation, since obesity can influence both the emotional and metabolic aspects of PCOS.

Caution is also needed when interpreting the observed correlation between emotional improvement and changes in lipid profile, since the study does not establish direct causal relationships, only associations. Future studies will be needed to clarify the specific mechanisms by which acupuncture influences both emotional well-being and lipid metabolism in women with PCOS, as well as to determine optimal treatment protocols and identify which patients may benefit most from this therapeutic approach.