by Lewis Chang, PhD
Hormone therapy may be the most effective treatment for reducing vasomotor symptoms. But for many symptomatic perimenopausal and postmenopausal women, the risk of hormone therapy outweighs the benefit. One of the non-pharmacological options that many women consider is acupuncture. However, there has not been a systematic review of randomized clinical trials (RCTs) assessing acupuncture’s effectiveness in the past few years.
Researchers from the Center of Integrative Medicine at Wake Forest School of Medicine (Winston-Salem, NC) and Duke University Medical Center (Durham, NC) conducted an updated review by assessing clinical evidence from previously published reviews, adding findings from newly published RCTs . Because a variety of assessment tools were used in these trials, the investigators relied on standardized mean differences (SMDs), a statistical model that allowed them to combine outcome data from different trials. SMDs of 0.2, 0.5, and ≥0.8 would be considered small, moderate, and large treatment effects, respectively.
Nineteen relevant RCTs involving nearly 2000 participants were identified and included in the updated analysis. Duration of acupuncture treatments in these RCTs ranged from 4 to 12 weeks. The investigators found that, compared with no acupuncture, acupuncture was associated with a statistically significant decrease in vasomotor symptom frequency (mean SMD -0.66) and severity (mean SMD -0.49). In trials where safety of acupuncture was assessed, the investigators found that all reported adverse events were graded mild.
In RCTs of acupuncture, there is constant debate on what constitutes an appropriate control group. Some researchers argued for a sham procedure; others suggested using no acupuncture as sham procedures may not be physiologically inert. When the study investigators analyzed trials that utilized a sham procedure as the control group, they found that the effect of acupuncture was smaller and not statistically significant.
The study authors also acknowledged two important limitations in their systematic review. First, they only included studies published in English language, which might have excluded important evidence. Second, some relevant variables that commonly affected perimenopausal and postmenopausal women were not evaluated, such as sleep quality and psychological symptoms.
The study results were published in the Journal of Alternative and Complementary Medicine (January 2018).
Why is this Clinically Relevant?
 Befus D., Coeytaux R.R., Goldstein K.M., et al., Management of Menopause Symptoms with Acupuncture: An Umbrella Systematic Review and Meta-Analysis. J Altern Complement Med, 2018. doi: 10.1089/acm.2016.0408.