Are acupuncture and related therapies effective in relieving menopause-related symptoms and improving quality of life among women in natural menopause?
Date of publication of the systematic review: February 2015
Design
Systematic review of 12 randomized control trials (RCTs).
Participants
869 women experiencing natural menopause and aged between 40 and 60 years (mean age: 52.87 years).
Intervention
Among included RCTs, various forms of acupuncture and related therapies including manual acupuncture, electroacupuncture and moxibustion were used as intervention. Treatment duration varied from 4 to 12 weeks. The total number of treatment sessions varied between 9 and 36.
Comparator
Comparison: Acupuncture and related therapies versus sham acupuncture or usual care or waiting list without any additional treatment.
Major Outcomes
Outcome 1: Mean effect sizes on hot flash frequency reduction at the end of treatment;
Outcome 2: Mean effect sizes on hot flash severity reduction at the end of treatment;
Outcome 3: Mean effect sizes on changes in psychiatric, somatic, and urogenital aspects of the Menopause Rating Scale at the end of treatment;
Outcome 4: Mean effect sizes on changes in menopause-related quality of life in vasomotor domain at the end of treatment.
Settings
The reviewers did not state whether the studies were conducted in inpatient or outpatient settings.
Comparison    Acupuncture and related therapies versus sham acupuncture or usual care or waiting list
Main Results
Compared to sham acupuncture or usual care or waitlist, acupuncture and related therapies significantly reduced hot flash frequency (g: -0.35, 95% CI: -0.5 to -0.21) and severity (g: -0.44, 95% CI: -0.65 to -0.23) at the end of treatment. It significantly reduced psychiatric (g: -1.56, 95% CI: -2.21 to -0.92), somatic (g: -1.39, 95% CI: -2.04 to -0.75), and urogenital (g: -0.82, 95% CI: -1.46 to -0.19) aspects of the Menopause Rating Scale. Besides, it showed a significant improvement on menopause-related quality of life in the vasomotor domain (g: -0.46, 95% CI: -0.90 to -0.02).
Comparison: Acupuncture and related therapies versus sham acupuncture or usual care or waiting list among women in natural menopause
Outcomes (units) No. of studies (Total number of participants) Mean (SD) / No. of participants Heterogeneity test (I2) Hedges’s g (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 10(785) Not reported /421 Not reported/ 364 Not reported -0.35 (-0.5 to -0.21) <0.0001 High
2 (NA) 8(706) Not reported /379 Not reported /327 Not reported -0.44 ( -0.65 to -0.23) <0.0001 High
3 (NA) 4(299) Not reported /178 Not reported /121 Not reported i) Psychiatric : -1.56 (-2.21 to 0.92)
ii) Somatic: -1.39 (-2.04 to -0.75)
iii) urogenital: -0.82 (-1.46 to -0.19)
<0.0001
<0.0001
0.011
Moderate
Moderate
Moderate
4 (NA) 3(84) Not reported /45 Not reported /39 Not reported -0.46 (-0.90 to -0.02) 0.041 Moderate
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Acupuncture and related therapies versus sham acupuncture or usual care or waiting list
Main Results
Compared to sham acupuncture or usual care or waitlist, acupuncture and related therapies significantly reduced hot flash frequency (g: -0.35, 95% CI: -0.5 to -0.21) and severity (g: -0.44, 95% CI: -0.65 to -0.23) at the end of treatment. It significantly reduced psychiatric (g: -1.56, 95% CI: -2.21 to -0.92), somatic (g: -1.39, 95% CI: -2.04 to -0.75), and urogenital (g: -0.82, 95% CI: -1.46 to -0.19) aspects of the Menopause Rating Scale. Besides, it showed a significant improvement on menopause-related quality of life in the vasomotor domain (g: -0.46, 95% CI: -0.90 to -0.02).
Comparison: Acupuncture and related therapies versus sham acupuncture or usual care or waiting list among women in natural menopause
Outcomes (units) 1 (NA) 2 (NA) 3 (NA) 4 (NA)
No. of studies (Total number of participants) 10(785) 8(706) 4(299) 3(84)
Mean (SD) / No. of participants Intervention Not reported /421 Not reported /379 Not reported /178 Not reported /45
Comparator Not reported/ 364 Not reported /327 Not reported /121 Not reported /39
Hedges’s g (95% CI) -0.35 (-0.5 to -0.21) -0.44 ( -0.65 to -0.23) i) Psychiatric : -1.56 (-2.21 to 0.92)
ii) Somatic: -1.39 (-2.04 to -0.75)
iii) urogenital: -0.82 (-1.46 to -0.19)
-0.46 (-0.90 to -0.02)
p value <0.0001 <0.0001 <0.0001
<0.0001
0.011
0.041
Overall quality of evidence* High High Moderate
Moderate
Moderate
Moderate
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Conclusion
Benefits
This study demonstrated significant effect of acupuncture on reducing hot flash frequency and severity, relieving menopause-related symptoms and improving the vasomotor subscale score on quality of life among women in natural menopause. For outcomes 1 and 2, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect. For outcomes 3 to 4, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
Adverse effects were reported in three included studies, such as common cold, muscle pain, joint pain, headache, nausea, bleeding and discomfort. However, the association between these adverse events and acupuncture and related therapies were not examined. The other five included studies reported no adverse effect and four studies did not report adverse effects.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/25003620
The synopsis is based on the following article:
Chiu HY, Pan CH, Shyu YK, Han BC, Tsai PS. Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials. Menopause. 2015 Feb 1;22(2):234-44.


* 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.