Is manual acupuncture effective in treating menopausal hot flashes?
Date of publication of the randomized controlled trial: February 2016
Design
Randomized controlled trial (RCT).
Participants
327 women older than 40 years in their late menopausal transition or postmenopausal with at least 7 moderate hot flashes daily, meeting criteria for Chinese medicine diagnosis of kidney yin deficiency. (Mean age for manual acupuncture group: 55.2 years, mean age for sham group: 54.8 years).
Intervention
Manual acupuncture was provided twice weekly for 2 weeks and weekly for the remaining 6 weeks. Six acupuncture points were needled until de qi. Needles were retained for 20 minutes with manual manipulation (twirling and rotating) for 20 minutes. The acupuncturists had bachelor’s degrees in Chinese medicine, and with at least 5 years of clinical experience.
Comparator
Comparison: Manual acupuncture versus sham acupuncture.
Major Outcomes
Outcome 1: Hot flashes scores as measured by a validated hot flashes diary at the end of treatment (8 weeks). Hot flashed scores can include 0 but have no upper limit. Lower score indicated the greater improvement of hot flashes.
Settings
This study was performed in an outpatient setting.
Comparison    Manual acupuncture versus sham acupuncture
Main Results
Compared to sham acupuncture, manual acupuncture showed no significant difference in mean hot flashed scores at the end of treatment (mean difference (MD): 0.33, 95% CI: -1.87 to 2.52). Both groups showed approximately 40% improvement at the end of treatment compared to the mean baseline hot flashes scores.
Comparison: Manual acupuncture versus sham acupuncture among postmenopausal women
Outcomes (units) No. of studies (Total no. of participants) Mean score / No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 1 (327) 15.36/ 163 15.04/ 164 Not applicable as there is only 1 study 0.33 (-1.87 to 2.52) 0.77 Low
Keys: MD = mean difference, CI = confidence interval.
Comparison    Manual acupuncture versus sham acupuncture
Main Results
Compared to sham acupuncture, manual acupuncture showed no significant difference in mean hot flashed scores at the end of treatment (mean difference (MD): 0.33, 95% CI: -1.87 to 2.52). Both groups showed approximately 40% improvement at the end of treatment compared to the mean baseline hot flashes scores.
Comparison: Manual acupuncture versus sham acupuncture among postmenopausal women
Outcomes (units) 1 (NA)
No. of studies (Total no. of participants) 1 (327)
Mean score / No. of participants Intervention 15.36/ 163
Comparator 15.04/ 164
MD (95% CI) 0.33 (-1.87 to 2.52)
p value 0.77
Overall quality of evidence* Low
Keys: MD = mean difference, CI = confidence interval.
Conclusion
Benefits
Compared to sham acupuncture, manual acupuncture showed no significant reduction in mean hot flashes scores at the end of treatment. Both groups showed approximately 40% improvement at the end of treatment as compared to mean baseline hot flashes scores. The overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
No serious adverse events were reported. 21 adverse events were reported in manual acupuncture group, while 5 adverse events were reported in sham acupuncture group. Most events were mild, self-limiting, and intrinsic to acupuncture (such as bleeding and pain).
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/26784863
The synopsis is based on the following article:
Ee C, Xue C, Chondros P, Myers SP, French SD, Teede H, et al. Acupuncture for Menopausal Hot FlashesA Randomized TrialAcupuncture for Menopausal Hot Flashes. Annals of internal medicine. 2016 Feb 2;164(3):146-54.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.