The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial

This randomized controlled study investigated the efficacy of acupuncture in treating menopausal symptoms and its impact on reproductive hormones. The research was conducted at Ankara Training and Research Hospital, Turkey, between October and December 2009, and enrolled 53 postmenopausal women who were alternately assigned to receive real acupuncture or sham acupuncture. The study context arose from the need for alternatives to hormone replacement therapy (HRT), the risks of which were highlighted by the Women's Health Initiative and Million Women Study, which identified associations with cardiovascular disease and cancer. The methodology used the Menopause Rating Scale (MRS) as the primary outcome, assessing somatic, psychological, and urogenital symptoms.

Serum estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels were measured as secondary outcomes. The acupuncture group received treatment with traditional Chinese medicine by a licensed acupuncturist with 6 years of experience, using sterile disposable needles at points ST-36, LI-4, KI-3, LR-3 (bilaterally), EX-HN3, and CV-3, with elicitation of de qi and 20-minute retention without electrical stimulation. The sham group used needles developed by Streitberger and Kleinhenz, which do not penetrate the skin. The results demonstrated significant superiority of real acupuncture.

After treatment, MRS total scores and the somatic and psychological subscales were significantly lower in the acupuncture group compared with the sham group (all p = 0.001). Hot flash severity, the most prominent menopausal symptom, was significantly reduced (p = 0.001). Regarding hormones, the acupuncture group showed significantly lower LH levels (p = 0.046) and significantly higher estradiol levels (p = 0.045) than the sham group after treatment, although there was no difference in FSH levels. The clinical implications suggest that acupuncture may be considered an effective alternative therapy for menopausal symptoms, particularly for women with contraindications to HRT.

The proposed mechanism of action involves activation of the hypothalamus and pituitary through acupuncture stimulation, resulting in alterations in neurotransmitter and neurohormone secretion. The authors suggest that increased central beta-endorphin activity may stabilize thermoregulation and reduce hot flashes. However, the hormonal changes observed were considered too small to fully explain the symptomatic improvements, suggesting that other factors may be involved. The study has important limitations, including the small sample size (statistical power of 0.71), lack of post-treatment follow-up to assess durability of effects, and baseline differences between groups in some variables.

In addition, the duration of treatment may not have been sufficient to reflect the full effect of acupuncture. Despite these limitations, the results are consistent with previous studies that demonstrated efficacy of acupuncture for vasomotor symptoms of menopause, contributing to the body of evidence that supports this therapeutic modality as a valid non-hormonal alternative.