Acupuncture as an Independent or Adjuvant Management to Standard Care for Perimenopausal Depression: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis investigated the efficacy of acupuncture in the treatment of perimenopausal depression, a condition that affects 20–40% of women during the menopausal transition. The perimenopausal period represents a window of vulnerability for the development of depression because of the dynamic hormonal fluctuations that occur in the final years of reproductive life. Many women seek therapeutic alternatives such as acupuncture because of concerns about the risks associated with antidepressants and hormone replacement therapy. The study analyzed 25 randomized clinical trials involving 2,213 women, following rigorous inclusion criteria and Cochrane methodology.

The researchers compared three main scenarios: acupuncture versus sham acupuncture, acupuncture versus standard care (antidepressants and/or hormonal therapy), and acupuncture combined with standard care versus standard care alone. Traditional Chinese acupuncture was used in all studies, including both manual technique and electroacupuncture. The results demonstrated that acupuncture was significantly superior to standard care in reducing the overall scores on the Hamilton Depression Scale, with a standardized mean difference of -0.54. When combined with standard care, acupuncture showed even more pronounced effects, with an SMD of -0.82.

The therapeutic benefits of acupuncture were maintained at follow-up of 2, 4, and 12 weeks, suggesting short-, medium-, and long-term effects. In addition to improvement in depressive symptoms, acupuncture also demonstrated superior efficacy in reducing other menopausal symptoms, as measured by the Kupperman Index. Acupuncture was well tolerated and safe, with mild and much less frequent adverse events compared with standard medications. The most common adverse events related to acupuncture were minor bruises that healed rapidly after needle removal.

By contrast, standard medications caused more significant side effects, including fatigue, palpitations, dizziness, sleep disturbances, dry mouth, and gastrointestinal symptoms. The mechanism of action of acupuncture may involve regulation of neurotransmitters such as serotonin, norepinephrine, and gamma-aminobutyric acid, although effects on sex hormone levels were not consistently different from conventional treatments. The methodological quality of the studies was rated low to moderate, mainly due to the inability to blind acupuncturists and limitations in patient blinding. Heterogeneity across studies was high, but sensitivity analyses confirmed the robustness of the main results.