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Meta-Analysis
. 2013 Jul 30;2013(7):CD007410.
doi: 10.1002/14651858.CD007410.pub2.

Acupuncture for menopausal hot flushes

Sylvie Dodin  1 , Claudine Blanchet, Isabelle Marc, Edzard Ernst, Taixiang Wu, Caroline Vaillancourt, Joalee Paquette, Elizabeth Maunsell
Affiliations
Meta-Analysis

Acupuncture for menopausal hot flushes

Sylvie Dodin et al. Cochrane Database Syst Rev. .

Abstract

Background: Hot flushes are the most common menopausal vasomotor symptom. Hormone therapy (HT) has frequently been recommended for relief of hot flushes, but concerns about the health risks of HT have encouraged women to seek alternative treatments. It has been suggested that acupuncture may reduce hot flush frequency and severity.

Objectives: To determine whether acupuncture is effective and safe for reducing hot flushes and improving the quality of life of menopausal women with vasomotor symptoms.

Search methods: We searched the following databases in January 2013: the Cochrane Menstrual Disorders and Subfertility Group Specialised Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, PsycINFO, Chinese Biomedical Literature Database (CBM), Chinese Medical Current Content (CMCC), China National Knowledge Infrastructure (CNKI), VIP database, Dissertation Abstracts International, Current Controlled Trials, Clinicaltrials.gov, National Center for Complementary and Alternative Medicine (NCCAM), BIOSIS, AMED, Acubriefs, and Acubase.

Selection criteria: Randomized controlled trials comparing any type of acupuncture to no treatment/control or other treatments for reducing menopausal hot flushes and improving the quality of life of symptomatic perimenopausal/postmenopausal women were eligible for inclusion.

Data collection and analysis: Sixteen studies, with 1155 women, were eligible for inclusion. Three review authors independently assessed trial eligibility and quality, and extracted data. We pooled data where appropriate and calculated mean differences (MDs) and standardized mean differences (SMDs) with 95% confidence intervals (CI). We evaluated the overall quality of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.

Main results: Eight studies compared acupuncture versus sham acupuncture. No significant difference was found between the groups for hot flush frequency (MD -1.13 flushes per day, 95% CI -2.55 to 0.29, 8 RCTs, 414 women, I(2) = 70%, low-quality evidence) but flushes were significantly less severe in the acupuncture group, with a small effect size (SMD -0.45, 95% CI -0.84 to -0.05, 6 RCTs, 297 women, I(2) = 62%, very-low-quality evidence). There was substantial heterogeneity for both these outcomes. In a post hoc sensitivity analysis excluding studies of women with breast cancer, heterogeneity was reduced to 0% for hot flush frequency and 34% for hot flush severity and there was no significant difference between the groups for either outcome.Three studies compared acupuncture versus HT. Acupuncture was associated with significantly more frequent hot flushes than HT (MD 3.18 flushes per day, 95% CI 2.06 to 4.29, 3 RCTs, 114 women, I(2) = 0%, low-quality evidence). There was no significant difference between the groups for hot flush severity (SMD 0.53, 95% CI -0.14 to 1.20, 2 RCTs, 84 women, I(2) = 57%, low-quality evidence).One study compared electroacupuncture versus relaxation. There was no significant difference between the groups for either hot flush frequency (MD -0.40 flushes per day, 95% CI -2.18 to 1.38, 1 RCT, 38 women, very-low-quality evidence) or hot flush severity (MD 0.20, 95% CI -0.85 to 1.25, 1 RCT, 38 women, very-low-quality evidence).Four studies compared acupuncture versus waiting list or no intervention. Traditional acupuncture was significantly more effective in reducing hot flush frequency from baseline (SMD -0.50, 95% CI -0.69 to -0.31, 3 RCTs, 463 women, I(2) = 0%, low-quality evidence), and was also significantly more effective in reducing hot flush severity (SMD -0.54, 95% CI -0.73 to -0.35, 3 RCTs, 463 women, I(2) = 0%, low-quality evidence). The effect size was moderate in both cases.For quality of life measures, acupuncture was significantly less effective than HT, but traditional acupuncture was significantly more effective than no intervention. There was no significant difference between acupuncture and other comparators for quality of life. Data on adverse effects were lacking.

Authors' conclusions: We found insufficient evidence to determine whether acupuncture is effective for controlling menopausal vasomotor symptoms. When we compared acupuncture with sham acupuncture, there was no evidence of a significant difference in their effect on menopausal vasomotor symptoms. When we compared acupuncture with no treatment there appeared to be a benefit from acupuncture, but acupuncture appeared to be less effective than HT. These findings should be treated with great caution as the evidence was low or very low quality and the studies comparing acupuncture versus no treatment or HT were not controlled with sham acupuncture or placebo HT. Data on adverse effects were lacking.

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Conflict of interest statement

None.

Figures

1
1
Study flow diagram.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
4
4
Forest plot of comparison: 1 Acupuncture versus sham acupuncture, outcome: 1.1 Hot flush frequency (number/day).
5
5
Forest plot of comparison: 1 Acupuncture versus sham acupuncture, outcome: 1.2 Hot flush severity.
6
6
Forest plot of comparison: 2 Acupuncture versus hormone therapy, outcome: 2.1 Hot flush frequency (number/day).
7
7
Forest plot of comparison: 2 Acupuncture versus hormone therapy, outcome: 2.2 Hot flush severity.
1.1
1.1. Analysis
Comparison 1 Acupuncture versus sham acupuncture, Outcome 1 Hot flush frequency (number/day).
1.2
1.2. Analysis
Comparison 1 Acupuncture versus sham acupuncture, Outcome 2 Hot flush severity.
1.3
1.3. Analysis
Comparison 1 Acupuncture versus sham acupuncture, Outcome 3 Hot flush frequency in trials less than 12 weeks.
1.4
1.4. Analysis
Comparison 1 Acupuncture versus sham acupuncture, Outcome 4 Hot flush frequency in trials of 12 weeks and more.
1.5
1.5. Analysis
Comparison 1 Acupuncture versus sham acupuncture, Outcome 5 Hot flush frequency in cancer trials.
1.6
1.6. Analysis
Comparison 1 Acupuncture versus sham acupuncture, Outcome 6 Hot flush severity in cancer trials.
1.7
1.7. Analysis
Comparison 1 Acupuncture versus sham acupuncture, Outcome 7 Hot flush severity in trials less than 12 weeks.
1.8
1.8. Analysis
Comparison 1 Acupuncture versus sham acupuncture, Outcome 8 Hot flush severity in trials of 12 weeks and more.
1.9
1.9. Analysis
Comparison 1 Acupuncture versus sham acupuncture, Outcome 9 Quality of life.
1.10
1.10. Analysis
Comparison 1 Acupuncture versus sham acupuncture, Outcome 10 Quality of life in trials less than 12 weeks.
1.11
1.11. Analysis
Comparison 1 Acupuncture versus sham acupuncture, Outcome 11 Quality of life in trials of 12 weeks and more.
2.1
2.1. Analysis
Comparison 2 Acupuncture versus hormone therapy, Outcome 1 Hot flush frequency (number/day).
2.2
2.2. Analysis
Comparison 2 Acupuncture versus hormone therapy, Outcome 2 Hot flush severity.
2.3
2.3. Analysis
Comparison 2 Acupuncture versus hormone therapy, Outcome 3 Hot flush severity in cancer trials.
2.4
2.4. Analysis
Comparison 2 Acupuncture versus hormone therapy, Outcome 4 Quality of life.
3.1
3.1. Analysis
Comparison 3 Electroacupuncture versus relaxation, Outcome 1 Hot flush frequency (number/day).
3.2
3.2. Analysis
Comparison 3 Electroacupuncture versus relaxation, Outcome 2 Hot flush frequency in cancer trials.
3.3
3.3. Analysis
Comparison 3 Electroacupuncture versus relaxation, Outcome 3 Hot flush severity.
3.4
3.4. Analysis
Comparison 3 Electroacupuncture versus relaxation, Outcome 4 Quality of life.
4.1
4.1. Analysis
Comparison 4 Acupuncture versus waiting list or no intervention, Outcome 1 Change in frequency of hot flushes from baseline to end of study.
4.2
4.2. Analysis
Comparison 4 Acupuncture versus waiting list or no intervention, Outcome 2 Hot flush frequency.
4.3
4.3. Analysis
Comparison 4 Acupuncture versus waiting list or no intervention, Outcome 3 Change in hot flush severity from baseline to end of study.
4.4
4.4. Analysis
Comparison 4 Acupuncture versus waiting list or no intervention, Outcome 4 Hot flush severity (end score).
4.5
4.5. Analysis
Comparison 4 Acupuncture versus waiting list or no intervention, Outcome 5 Quality of life ‐ change from baseline to end of study.
4.6
4.6. Analysis
Comparison 4 Acupuncture versus waiting list or no intervention, Outcome 6 Quality of life (end score).
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