Effect of acupuncture on menopausal hot flushes and serum hormone levels: a systematic review and meta-analysis.

Objective: To evaluate the efficacy/effectiveness and safety of acupuncture for the treatment of hot flushes and its impact on serum hormone levels in menopausal women.

Methods: A total of 10 databases were searched from their inception to August 2018. Reference lists of reviews and included articles were also hand-searched. Randomized controlled trials (RCTs) comparing the effect of acupuncture versus sham acupuncture, or acupuncture versus hormone therapy (HT), as treatment for menopausal hot flushes were included. Outcomes included hot flush frequency, hot flush severity and serum hormone levels of estradiol (E2), luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Meta-analyses were performed using Review Manager 5.3 software.

Results: Thirteen RCTs including 1784 patients were selected, seven of which were available for meta-analysis. Compared with sham acupuncture, acupuncture significantly decreased hot flush frequency (mean difference (MD) -0.84, 95% confidence interval (CI) [-1.64, -0.05], I² = 54%) from baseline to the end of study, but did not impact end scores of hot flush frequency (MD 0.19, 95% CI [-0.61, 0.99], I² = 0%) or severity (MD 0.02, 95% CI [-0.13, 0.17], I² = 0%). No differences were found between acupuncture and HT in serum levels of E₂ (MD 6.56, 95% CI [-3.77, 16.89], I² = 76%), FSH (MD 1.06, 95% CI [-1.44, 3.56], I² = 0%) or LH (MD -3.36, 95% CI [-13.37, 6.65], I² = 89%).

Conclusion: Acupuncture may not decrease hot flush frequency, but yet appears to have similar effects on serum hormone levels as HT, that is, increased E2 and decreased FSH and LH. Considering that no firm conclusions could be drawn due to the low quality and limited number of included trials included, further high-quality RCTs need to be conducted.