Safety of Acupuncture in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

Introduction: Acupuncture has emerged as an effective adjunctive therapy for polycystic ovary syndrome (PCOS) with concern on the higher rate of adverse events (AE). In addition, timing of intervention, specific acupoints, and stimulation strength are concerning, as high-stimulation electroacupuncture (EA) may increase miscarriage risk. This review aims to systematically evaluate the safety profile of acupuncture in PCOS.

Materials and methods: PubMed, ScienceDirect, and Scopus were searched prior to September 8, 2024. This study included randomized controlled trials (RCTs) comparing acupuncture with "control" (sham/no acupuncture) or active drugs. Study quality was assessed using RoB 2.0. Meta-analyses were conducted with R Studio.

Results: From 1,041 articles, 13 RCTs were included. There was no significant serious or life-threatening AE occurred in all trials. In acupuncture versus control groups, mild to moderate AEs were similar overall, except bruising, which was significantly more frequent at needle insertion sites with acupuncture (OR = 3.34; 95% CI: 1.76-6,37; p < 0.01). In acupuncture versus active drugs, there were no significantly higher mild to moderate AEs in the acupuncture group. Miscarriage rates were comparable with acupuncture versus controls or ovulation-induction drugs, particularly with low-frequency (2 Hz) EA applied prepregnancy. Collectively, the findings support acupuncture's safety profile, including no significant increase in miscarriage risk when administered prior to pregnancy.

Conclusions: Acupuncture has emerged as a safe option for complementary therapy in PCOS. Further research is needed to refine acupuncture protocols, which further position it as a preferred adjunctive treatment in PCOS.