Acupuncture for menopausal symptoms in Chinese women: a systematic review

This systematic review examines the efficacy of acupuncture in the treatment of menopausal symptoms in Chinese women, representing one of the largest compilations of evidence on this topic. The study is particularly relevant given that only a small percentage of Chinese women use menopausal hormone therapy (MHT), either due to lack of awareness or fear of cancer, making therapeutic alternatives such as acupuncture extremely important. The methodology included analysis of multiple randomized controlled trials and clinical experience from specialized centers, including the Department of Acupuncture-Moxibustion at Tsinghua Chuiyangliu University Hospital, which serves more than 20,000 patients annually, of whom 30% are menopausal women. Results demonstrated significant efficacy of acupuncture for various menopausal symptoms.

For vasomotor symptoms such as hot flashes, acupuncture showed up to a 54% reduction in 24-hour frequency after 12 weeks of treatment, with lasting effects of 6 to 12 months. For neuropsychiatric symptoms, including insomnia and depression, electroacupuncture showed efficacy equivalent to escitalopram, with advantages at long-term follow-up. The success rate reported by the authors was greater than 80% for hot flashes, pain, and neuropsychiatric symptoms. For urinary symptoms, electroacupuncture at lumbosacral points demonstrated a 61% effective rate for stress urinary incontinence, significantly higher than the sham control (18.9%).

The proposed mechanism of action involves regulation of the central nervous system, increasing the activity of β-endorphins to stabilize body temperature regulation, and modulating neurotransmitters such as serotonin, dopamine, and norepinephrine. Acupuncture also demonstrated the ability to promote residual ovarian function and estrogen synthesis, potentially benefiting bone metabolism. The most commonly used acupuncture points include Zusanli (ST-36), Sanyinjiao (SP-6), Shenmen (HT-7), Taichong (LR-3), Taixi (KI-3), Guanyuan (CV-4), and Baihui (GV-20), concentrated on the bladder, ren, du, and spleen meridians. The safety profile was excellent, with rare and mild adverse reactions, such as minor uterine bleeding, needle dizziness, local pain, or fatigue, easily manageable with temporary suspension.

The likelihood of serious complications such as nerve injury or pneumothorax was extremely low when performed by trained professionals. The clinical implications are substantial, especially for women with contraindications to MHT, including hormone-dependent cancer, active thrombosis, myocardial infarction, uncontrolled hypertension, or hepatic dysfunction. Acupuncture emerges as a viable therapeutic option for cancer survivors experiencing iatrogenic menopause after chemo- or radiotherapy.