Acupuncture for symptoms in menopause transition: a randomized controlled trial

This multicenter randomized controlled trial investigated the efficacy of electroacupuncture versus sham electroacupuncture in the treatment of symptoms during the menopausal transition. Conducted at 12 hospitals in mainland China, the study enrolled 360 women aged 40-55 years experiencing symptoms such as hot flashes, sweating, sleep disturbances, anxiety, and vaginal dryness during the menopausal transition. Participants were randomized to receive real or sham electroacupuncture, with 24 sessions over 8 weeks, followed by 24 weeks of follow-up. The electroacupuncture group received treatment at points CV-4, ST-25 bilateral, EX-CA1 bilateral, and SP-6 bilateral, with electrical stimulation at 10/50 Hz for 30 minutes.

The sham group received blunted needles at non-points, without skin penetration or electrical stimulation. The primary outcome was the change in the Menopause Rating Scale (MRS) at week 8. The results showed that both groups demonstrated improvement in menopausal symptoms. At week 8, the electroacupuncture group had a 6.3-point reduction on the MRS, while the sham group had a 4.5-point reduction, resulting in a between-group difference of only 1.8 points.

Although this difference was statistically significant, it was well below the minimal clinically important difference of 5 points. For hot flashes, measured by the 24-hour score, the electroacupuncture group showed a reduction of 3.6 points compared with 2.5 points in the sham group, a difference of 1.2 points that was also below the clinical significance threshold. Notably, for quality of life measured by the MENQOL questionnaire, the between-group differences were 5.7 points at week 8, 7.1 at week 20, and 8.4 at week 32, all exceeding the clinically important difference of 4 points. This suggests that, although electroacupuncture may not significantly relieve specific menopausal symptoms, it may have a positive impact on overall quality of life.

The effects of both treatments appeared to persist throughout the follow-up period, with some measures showing continued improvement. There were no significant between-group differences in reproductive hormone levels, except for the FSH/LH ratio. The study was well conducted with good treatment adherence and a low dropout rate. Blinding was effective, with participants in both groups equally unable to distinguish between real and sham treatment.

Limitations include relatively mild baseline symptoms, an ethnically homogeneous (Chinese) population, and the use of the MRS as the primary outcome rather than hot flash frequency. The study concludes that 8 weeks of electroacupuncture does not appear to relieve menopausal symptoms in a clinically significant manner in women during the menopausal transition, although it may improve quality of life.