Effect of acupuncture on menopausal depressive disorder and serum hormone levels: a systematic review and meta-analysis

This systematic review and meta-analysis evaluated the efficacy of acupuncture in the treatment of menopausal depression, analyzing data from 13 randomized controlled trials that included 1,293 women between 42 and 60 years of age. The research was conducted following PRISMA guidelines, with searches across multiple international and Chinese databases through April 2025.

Menopausal depression affects approximately 33-36% of women during the menopausal transition, resulting from complex interactions between psychosocial factors and hormonal changes. Conventional treatments include hormonal therapy and antidepressants, but these may carry long-term risks, such as increased risk of breast cancer and cardiovascular disease.

The analyzed studies used different acupuncture modalities, including manual acupuncture and electroacupuncture, with commonly used points such as Baihui (GV-20), Guanyuan (CV-4), Sanyinjiao (SP-6), and Yintang (EX-HN3). The treatment period ranged from 4 to 12 weeks, with sessions performed 2 to 5 times per week.

The results demonstrated that acupuncture was significantly superior to control treatments across multiple measures. The clinical efficacy rate was 2.7 times higher in the acupuncture group (OR=2.70, 95% CI [1.63-4.48]). On the Hamilton Depression Rating Scale (HAMD-17), there was significant improvement in depressive symptoms (SMD=-0.28, p<0.0001). Quality of life, measured by the MENQOL scale, also showed statistically significant improvement (SMD=-0.25, p=0.003).

Interestingly, although acupuncture demonstrated clear clinical efficacy, no significant changes were observed in sex hormone levels (FSH, LH, E2) between the groups (p>0.05). This suggests that the therapeutic benefits of acupuncture may be mediated by non-hormonal mechanisms, such as regulation of neurotransmitters (serotonin, norepinephrine) and modulation of the hypothalamic-pituitary-adrenal axis.

The safety profile was favorable, with adverse events comparable between the groups (OR=0.16, p=0.05). Sensitivity analysis revealed a significant reduction in adverse events in the acupuncture group after exclusion of discrepant studies (OR=0.49, p=0.03), suggesting that acupuncture may be safer than conventional treatments.

Subgroup analyses showed that both manual acupuncture and electroacupuncture were effective, although with slightly different adverse-effect profiles. Manual acupuncture had fewer adverse reactions, possibly due to greater adaptability of the stimulus compared to the fixed parameters of electroacupuncture.

Limitations include the relatively small number of studies (13), heterogeneity in interventions (acupuncture protocols, points used, duration), and variations in control groups. Some studies used sham acupuncture, while others employed medications, making interpretation of pooled results difficult.

This evidence positions acupuncture as a promising non-pharmacologic intervention for menopausal depression, offering a therapeutic option with a favorable risk-benefit ratio. The mechanisms of action appear to involve neurotransmitter regulation and modulation of neuroendocrine networks, independent of direct hormonal changes.

Future studies should prioritize larger and standardized clinical trials, with uniform acupuncture protocols, objective biomarkers, and long-term follow-up to better understand the mechanisms involved and optimize clinical practices, offering safer and more diversified therapeutic options for women with menopausal depression.