Investigation of the role of herbal medicine, acupressure, and acupuncture in the menopausal symptoms: An evidence-based systematic review study

This comprehensive systematic review examines three decades of research on the use of complementary and alternative medicine for menopausal symptoms, analyzing 145 high-quality studies published between 1987 and 2019. The study arises from growing concern among women about the adverse effects of hormone replacement therapy, including increased risks of cancer, cardiovascular disease, and thromboembolism. The methodology followed rigorous PRISMA guidelines, using multiple scientific databases to identify relevant studies on herbal medicine, acupuncture, and acupressure in the treatment of menopausal symptoms. The investigators applied specific inclusion criteria and quality assessment scales such as STROBE and CONSORT to ensure the robustness of the analysis.

In the area of herbal medicine, 25 effective medicinal plants were identified, including soy, valerian, black cohosh, red clover, and ginseng. The mechanisms of action mainly involve phytoestrogens, plant compounds that mimic the effects of natural estrogen but with potency 1,000 to 10,000 times lower, providing benefits without the risks of synthetic estrogens. Studies showed that herbal medicine significantly reduced hot flashes, improved sleep quality, increased bone mineral density, and relieved vasomotor symptoms. Asian women, who traditionally consume up to 200 mg of phytoestrogens daily, have lower rates of menopausal symptoms compared with Western women.

As for acupuncture, 18 studies demonstrated efficacy in reducing menopausal symptoms through neurologic, physiologic, and hormonal mechanisms. The technique acts by increasing endorphin activity, modulating hypothalamic thermoregulation, and neutralizing temperature instability in patients with vasomotor syndrome. Studies showed that acupuncture improved sleep quality, reduced depressive and anxious symptoms, relieved dry eyes and metabolic syndrome, and decreased irritability and hot flashes. In some comparative studies, acupuncture was shown to be superior to diazepam for irritability, although alprazolam was more effective for sleep disturbances.

Acupressure, analyzed in 6 clinical trials, was shown to be a non-invasive and safe technique that can be performed by professionals or by patients themselves. Based on Traditional Chinese Medicine, it uses digital pressure at specific points along the 12 main meridians and 361 acupressure points. Proposed mechanisms include activation of myelinated nerve fibers, stimulation of neural centers in the spinal cord, midbrain, and hypothalamic-pituitary axis, resulting in increased endorphins and hormonal modulation. Studies showed improvement in sleep quality, reduction in hot flashes, and overall relief of menopausal symptoms.

Despite the predominantly positive results, some studies reported the inefficacy of certain plants such as soy for mood, flaxseed for cholesterol, and dong quai for vasomotor symptoms, highlighting individual variability and the need for therapeutic personalization. Adverse effects were rare but included mild gastrointestinal problems with black cohosh, drug interactions with kava and ginseng, and isolated cases of hepatotoxicity. The clinical implications are significant, offering safe alternatives for women who cannot or prefer not to use hormone therapy. The World Health Organization recognizes these modalities as valid ways to improve menopausal symptoms and general well-being.

The study suggests that the integrated use of these therapies with conventional medical care may represent a new treatment model. Limitations include focus on English-language publications, possible selection bias, methodologic variability between studies, and the need for greater protocol standardization. The authors recommend future studies with more rigorous blinding methods, greater standardization of doses and protocols, and investigation of therapeutic combinations to optimize results. This review represents a valuable contribution to evidence-based medicine in women's health, providing a solid scientific foundation for the use of complementary therapies in the comprehensive management of menopausal symptoms.