Factors associated with a clinically relevant reduction in menopausal symptoms of a standardized acupuncture approach for women with bothersome menopausal symptoms

This study represents an important post hoc analysis of a randomized controlled trial that investigated which factors may predict the success of acupuncture in treating bothersome menopausal symptoms. The research included 67 Danish women between 40 and 65 years of age who suffered from moderate-to-severe menopausal symptoms, particularly hot flashes assessed by the validated MenoScores (MSQ) questionnaire. The acupuncture protocol was standardized and based on Western medical acupuncture, using specific points: CV-3, CV-4, LR-8, SP-6, and SP-9 (with LR-8, SP-6, and SP-9 applied bilaterally). Treatment consisted of five weekly 10-minute sessions, performed by general practitioners with specific training in acupuncture.

The researchers used a sophisticated statistical approach called dominance analysis to identify which patient characteristics were most associated with a clinically relevant reduction in symptoms. The results were striking: 77.6% of the women experienced a clinically relevant reduction on at least one of the four symptom scales assessed (hot flashes, day and night sweats, general sweat, and menopause-specific sleep problems). Specifically for vasomotor symptoms, 71.6% of participants reported significant improvement. The most surprising finding was that educational level emerged as the factor most consistently associated with treatment success.

Women with vocational/technical education were more likely to experience improvement compared with women with university-level higher education. The researchers speculate that this may be related to different perceptions and expectations about acupuncture, with more educated women possibly holding a more critical stance or lower expectations regarding treatment efficacy. In addition to education, other important factors for success included: no alcohol consumption, having had two or more children, and presence of urinary incontinence. These findings suggest that multiple biological and social factors may influence the response to acupuncture.

The study has several important methodological strengths: it used validated questionnaires, achieved high participant adherence (100% response), employed a standardized protocol that can be easily replicated in different clinical settings, and was well tolerated by participants with only mild adverse effects. The standardized approach is particularly valuable because it allows transferability to different clinical environments, even outside Denmark. From a mechanistic standpoint, the authors explain that Western medical acupuncture is based on stimulation of the nervous system, and the points selected correspond to spinal cord segments (T11 through S3 and S2 through S4) that innervate the ovaries and uterus. In addition, acupuncture has been shown to stimulate beta-endorphins, serotonin, and norepinephrine, substances related to temperature regulation and the generation of hot flashes.