Acupuncture for Menopause

Acupuncture, a traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body, has been explored in several clinical trials and randomized controlled trials (RCTs) as a potential treatment for menopausal symptoms. These studies aim to investigate whether acupuncture can effectively alleviate common menopausal complaints, offering a complementary or alternative therapy to conventional treatments. The growing body of research seeks to determine the efficacy and safety of acupuncture in managing the diverse challenges experienced by women during menopause.

Protocols Studied in Research

[1] Acupuncture combined with Chinese herbal medicine (CHM) for menopausal mood disorder. (Cited by: 0) (pmid: 36921619)

• Protocol: A randomized controlled trial with 95 menopausal women assigned to three groups: combined acupuncture and CHM, acupuncture with CHM placebo, and CHM with sham acupuncture. Treatment lasted 8 weeks with a 4-week follow-up.
• Outcome: All three treatments improved mood disorder symptoms, but the combined acupuncture and CHM group showed superior and more sustained reduction in depression symptoms compared to the other groups. No significant safety concerns were reported.

[2] Electroacupuncture for menopausal symptoms during menopause transition. (Cited by: 3) (pmid: 30125529)

• Protocol: A prospective, multicenter, randomized, participant-blinded trial in China involving 360 women with mild menopausal symptoms. Participants received either electroacupuncture or sham electroacupuncture for 8 weeks, with 24 weeks of follow-up.
• Outcome: While electroacupuncture showed a statistically significant but clinically insignificant reduction in Menopause Rating Scale scores, it did demonstrate a clinically significant improvement in quality of life (Menopause-Specific Quality of Life Questionnaire). The effect on hormone levels was minimal.

[3] Acupuncture for vasomotor symptoms (VMS) in perimenopausal and postmenopausal women. (Cited by: 17) (pmid: 27023860)

• Protocol: A randomized controlled trial (RCT) of 209 women (45-60 years old) experiencing frequent VMS. Participants received up to 20 acupuncture treatments over 6 months or were waitlisted.
• Outcome: Acupuncture significantly reduced VMS frequency and improved quality of life compared to the control group. Benefits persisted for at least 6 months post-treatment.

[4] Acupuncture (integrated with diet and self-massage) for hot flushes and other menopausal symptoms. (Cited by: 5) (pmid: 24827469)

• Protocol: A randomized trial of 100 women with frequent hot flushes compared acupuncture plus diet/self-massage to diet/self-massage alone. Acupuncture was administered twice weekly for 6 weeks.
• Outcome: Acupuncture significantly reduced hot flushes and other menopausal symptoms (sleep disorders, chest tightness, irritability, bone pain, depression) compared to the control group.

[5] Acupuncture combined with Ningshen mixture for climacteric insomnia. (Cited by: 0) (pmid: 38669364)

• Protocol: A randomized controlled trial (RCT) of 82 climacteric insomnia patients. One group received conventional Western medicine, the other acupuncture plus Ningshen mixture. Neurotransmitter levels, TCM syndrome scores, and PSQI were assessed.
• Outcome: Acupuncture combined with Ningshen mixture showed significantly better curative effects, improved neurotransmitter levels (5-HT, beta-endorphin), reduced PSQI and TCM syndrome scores, and lower recurrence rates compared to conventional Western medicine, with no serious adverse effects.

[6] Acupuncture for peri-menopausal insomnia (PMI). (Cited by: 37) (pmid: 29029258)

• Protocol: A randomized, placebo-controlled trial (n=76) of 10 acupuncture sessions (or placebo acupuncture) over 3 weeks in peri-menopausal women with insomnia. Acupuncture targeted specific acupoints.
• Outcome: Acupuncture significantly improved sleep quality (PSQI, ISI) and sleep efficiency (PSG) compared to placebo acupuncture, demonstrating short-term efficacy for PMI treatment.

[7] Traditional acupuncture (TA) and sham acupuncture (SA) for vasomotor symptoms (VMS) in perimenopausal and postmenopausal women. (Cited by: 18) (pmid: 21968279)

• Protocol: A pilot, randomized, single-blind, placebo-controlled trial comparing TA, SA, and a waiting control (WC) group. 33 women with frequent VMS received 12 weeks of acupuncture (3 treatments/week) or no treatment.
• Outcome: Both TA and SA improved VMS and quality of life compared to WC. TA showed a potential impact on the hypothalamic-pituitary-adrenal axis, warranting further investigation in a larger trial.

[8] Laser acupuncture (LA) plus calcium/vitamin D/fluoride supplementation for osteoporosis in postmenopausal women. (Cited by: 1) (pmid: 36944142)

• Protocol: A randomized controlled trial comparing LA plus supplementation to supplementation alone in 68 osteoporotic postmenopausal women. LA was administered 3 times weekly for 20 minutes/session for 12 weeks.
• Outcome: Both groups showed significant improvement in forearm bone mineral density (BMD) and pain scores. However, the combination of LA and supplementation resulted in significantly greater improvements in both BMD and pain reduction compared to supplementation alone.

[9] Acupuncture for menopausal symptoms in postmenopausal women. (Cited by: 14) (pmid: 21383392)

• Protocol: A sham-controlled clinical trial randomly assigned 53 postmenopausal women to receive either true acupuncture or sham acupuncture. Menopausal symptoms and hormone levels (estradiol, FSH, LH) were assessed before and after treatment.
• Outcome: Acupuncture significantly reduced menopausal symptoms (total MRS score, somatic and psychological subscales, hot flushes) compared to sham acupuncture. Acupuncture also resulted in higher estradiol and lower LH levels compared to sham.

[10] Chinese medicine acupuncture versus sham acupuncture for menopausal hot flashes. (Cited by: 24) (pmid: 26784863)

• Protocol: A stratified, blinded, randomized, sham-controlled trial of 327 women (≥40 years) with moderate to severe hot flashes and a Chinese medicine diagnosis of kidney yin deficiency. Participants received 10 acupuncture treatments over 8 weeks.
• Outcome: The study found no significant difference in hot flash scores between the acupuncture and sham acupuncture groups at the end of treatment. Acupuncture was not superior to sham acupuncture for this condition.

[11] Acupuncture plus usual care for hot flashes and menopause-related symptoms in perimenopausal and postmenopausal women. (Cited by: 28) (pmid: 19907348)

• Protocol: A multicenter, randomized controlled trial compared acupuncture plus usual care (12 sessions over 4 weeks) to usual care alone in women with frequent hot flashes. Hot flash scores and Menopause Rating Scale scores were measured.
• Outcome: Acupuncture significantly reduced hot flash scores and improved menopause-related symptoms compared to usual care alone, with effects sustained at 8 weeks.

[12] *Urtica dioica* (nettle) and acupuncture for menopausal hot flashes. (Cited by: 6) (pmid: 31126551)

• Protocol: A randomized, double-blind, placebo-controlled trial of 72 postmenopausal women with frequent hot flashes. Participants received *Urtica dioica*, acupuncture, both, or placebo/sham acupuncture for 7 weeks, followed by a 4-week follow-up.
• Outcome: *Urtica dioica* significantly reduced hot flash severity and improved quality of life compared to placebo, similar to acupuncture. Combining *Urtica dioica* and acupuncture offered no additional benefit.

[13] Traditional Chinese Medicine (TCM) acupuncture and Chinese herbal medicine (CHM) for hot flushes and quality of life in postmenopausal women. (Cited by: 10) (pmid: 23676632)

• Protocol: A four-arm randomized controlled pilot trial with 40 postmenopausal women experiencing frequent hot flushes. Participants received either TCM acupuncture, sham acupuncture, verum CHM, or placebo CHM for 12 weeks.
• Outcome: TCM acupuncture significantly reduced hot flush frequency, severity, and overall menopausal symptoms compared to sham acupuncture and verum CHM. Verum CHM showed no significant benefit over placebo.

[14] Electroacupuncture (EA) for mild-to-moderate depression in perimenopausal women. (Cited by: 17) (pmid: 30003102)

• Protocol: A multicenter, randomized, controlled trial compared 36 sessions of EA to escitalopram in 242 perimenopausal women with mild-to-moderate depression. Outcomes included HAMD-17, MENQOL, and serum hormone levels.
• Outcome: Both EA and escitalopram improved depression symptoms (HAMD-17) and quality of life (MENQOL) at 24-week follow-up, with no significant difference between groups. EA was deemed safe and effective.

[15] Therapeutic acupuncture (TA) for hot flashes (HFs) in breast cancer patients. (Cited by: 0) (pmid: 37851349)

• Protocol: A randomized, single-blind trial compared TA to sham acupuncture (SA) in 54 breast cancer patients experiencing >10 HFs/week. Participants recorded HF frequency and severity using diaries and the MenQoL scale.
• Outcome: TA significantly reduced hot flash severity (p=0.0064) compared to SA, with a sustained effect at one-month follow-up. Larger studies are needed.

[16] Acupuncture and phytoestrogens versus hormone therapy (estrogen plus progestin) for menopausal symptoms (hot flushes). (Cited by: 3) (pmid: 31142156)

• Protocol: A 3-month randomized controlled trial of 75 postmenopausal women with hot flushes comparing conjugated estrogens/medroxyprogesterone acetate, weekly acupuncture, and soy isoflavones. Outcomes were assessed using Greene's climacteric scale and Menopause Quality of Life (MenQoL) questionnaire.
• Outcome: Acupuncture and, to a lesser extent, phytoestrogens significantly reduced menopausal symptoms, comparable to hormone therapy. Acupuncture's benefits on quality of life were more sustained after treatment cessation.

[17] Acupuncture for vasomotor symptoms during menopausal transition. (Cited by: 0) (pmid: 32898024)

• Protocol: A crossover, single-blind, sham-controlled trial with 100 women. Participants received either real or sham acupuncture for 24 weeks, then crossed over to the other treatment for another 24 weeks. The Kupperman-Blatt Menopausal Index was used to assess symptoms.
• Outcome: Acupuncture significantly reduced hot flashes and other menopausal symptoms compared to sham acupuncture. The effect was more pronounced in the group that received acupuncture in the second half of the study.

[18] Manual acupuncture (MA) and electroacupuncture (EA) for menopausal syndrome. (Cited by: 3) (pmid: 29231609)

• Protocol: A randomized controlled trial comparing MA and EA in 50 menopausal women. Participants received treatments at four acupoints for eight weeks, three times a week. MA used regular needling; EA used disperse-dense wave stimulation.
• Outcome: Both MA and EA significantly reduced menopausal symptoms (MRS, MENQOL, SAS, SDS scores), improved quality of life, and showed no significant differences between the two interventions. Hormonal changes were not significantly different between groups.

[19] Acupuncture plus auricular acupressure (AA) for perimenopausal syndrome. (Cited by: 3) (pmid: 24886348)

• Protocol: A randomized controlled trial (RCT) comparing AA to hormone replacement therapy (Climen) in 206 women. AA involved 28 acupuncture sessions over 12 weeks, plus auricular acupressure. Climen was a 3-cycle hormone regimen.
• Outcome: The abstract describes the study protocol and states that results, determining acupuncture's effectiveness for perimenopausal syndrome, would be available in 2015, but doesn't provide the results themselves.

[20] Gua sha therapy for perimenopausal syndrome. (Cited by: 8) (pmid: 27760084)

• Protocol: A randomized controlled trial of 80 women with perimenopausal syndrome. The intervention group received 15-minute Gua sha sessions weekly for 8 weeks in addition to conventional treatment; the control group received conventional treatment only.
• Outcome: Gua sha therapy significantly reduced perimenopausal symptoms and improved quality of life compared to the control group, with no significant hormonal changes observed. The therapy is suggested as a safe and effective non-drug treatment option.

[21] Medical acupuncture for hot flashes in menopausal women. (Cited by: 34) (pmid: 17019380)

• Protocol: A randomized, single-blind, sham-controlled trial with 103 women experiencing hot flashes received either medical or sham acupuncture biweekly for 5 weeks, followed by a 7-week follow-up. Daily hot flash questionnaires were used to track outcomes.
• Outcome: The study found no significant difference in hot flash reduction between medical and sham acupuncture groups at 6 or 12 weeks post-treatment. Medical acupuncture was not more effective than sham acupuncture.

[22] Needle acupuncture for menopausal vasomotor symptoms (hot flushes and night sweats). (Cited by: 6) (pmid: 24925094)

• Protocol: A randomized, sham-controlled trial of 360 menopausal women with frequent hot flushes. Participants received either true or sham acupuncture (10 treatments over 8 weeks). Blinding was used.
• Outcome: The abstract does not present results; it describes a study protocol designed to assess the efficacy and safety of acupuncture for managing menopausal vasomotor symptoms. Results are pending.

[23] Acupuncture for hot flushes in perimenopausal and postmenopausal women. (Cited by: 18) (pmid: 21653660)

• Protocol: A randomized, single-blind, sham-controlled trial comparing real and sham acupuncture over 7 weeks in 54 women experiencing moderate to severe hot flushes. A 4-week run-in period preceded treatment.
• Outcome: Acupuncture showed no statistically significant difference compared to sham acupuncture in reducing overall hot flush scores. However, a possible benefit on hot flush severity was observed, warranting further investigation into specific acupuncture points and non-specific effects.

[24] Acupuncture treatment for menopausal vasomotor symptoms (VMS). (Cited by: 7) (pmid: 27676631)

• Protocol: A randomized controlled trial of 209 perimenopausal and postmenopausal women (aged 45-60) with frequent VMS. Participants received up to 20 acupuncture treatments over 6 months or were assigned to a waitlist control group. VMS frequency was tracked weekly.
• Outcome: Acupuncture resulted in four distinct response trajectories. While ~50% of the acupuncture group experienced a reduction in VMS frequency (ranging from 9.6% to 85%), predicting individual response to acupuncture remains difficult. The control group showed a smaller, overall decrease in VMS.

[25] TCM acupuncture and sham acupuncture for vasomotor symptoms in post-menopausal women. (Cited by: 12) (pmid: 20430288)

• Protocol: A randomized, single-blind trial compared 12 weeks of TCM acupuncture (n=27) versus sham acupuncture (n=24) in post-menopausal women. Hot flashes were tracked daily, and psychological measures were assessed at baseline and multiple follow-ups.
• Outcome: Both true and sham acupuncture significantly reduced vasomotor symptoms. No difference was found between the two groups, suggesting sham acupuncture may have therapeutic effects, thus limiting its usefulness as a placebo control.

[26] Acupuncture (Traditional Chinese Medicine and sham) for menopausal hot flashes. (Cited by: 29) (pmid: 18528313)

• Protocol: A randomized, controlled pilot study of 56 peri- and postmenopausal women with frequent hot flashes. Participants were assigned to usual care, sham acupuncture, or Traditional Chinese Medicine acupuncture (twice weekly for 8 weeks).
• Outcome: All groups showed a significant decrease in hot flash frequency, but acupuncture groups showed a significantly greater reduction than the usual care group. The study suggests a strong placebo effect or a genuine effect of both acupuncture types.

[27] Brief, standardized acupuncture for moderate to severe menopausal symptoms. (Cited by: 2) (pmid: 32517477)

• Protocol: A post-hoc analysis of a randomized controlled trial (RCT) with 70 women receiving weekly acupuncture (CV3, CV4, LR8, SP6, SP9) for five weeks, either immediately or after a 6-week delay. Menopausal symptoms were assessed using the MenoScores Questionnaire for 26 weeks.
• Outcome: Acupuncture's positive effects on menopausal symptoms (hot flushes, sweats, sleep problems) persisted for up to 21 weeks post-treatment. A small pre-treatment effect was also observed for hot flushes.

[28] Acupuncture for insomnia in postmenopausal women. (Cited by: 12) (pmid: 22943846)

• Protocol: A randomized, double-blind, placebo-controlled trial of 18 postmenopausal women with insomnia. Participants received 10 sessions of either real or sham acupuncture over 5 weeks. Sleep quality, depression, and quality of life were assessed before and after treatment.
• Outcome: Acupuncture significantly improved self-reported sleep quality and psychological quality of life compared to sham acupuncture. Acupuncture also resulted in a higher percentage of deep sleep (N3+4) as measured by polysomnography.

[29] Individualized acupuncture plus self-care versus self-care alone for hot flashes in postmenopausal women. (Cited by: 29) (pmid: 19423996)

• Protocol: A multicenter, randomized controlled trial compared acupuncture plus self-care to self-care alone in postmenopausal women experiencing ≥7 hot flashes daily. The acupuncture group received 10 sessions.
• Outcome: Acupuncture plus self-care significantly reduced hot flash frequency and intensity, and improved health-related quality of life compared to self-care alone. Changes in calcitonin gene-related peptide levels were not significant.

[30] Acupuncture plus enhanced self-care for hot flashes in women with breast cancer. (Cited by: 49) (pmid: 27022113)

• Protocol: A pragmatic, randomized controlled trial compared acupuncture plus enhanced self-care versus enhanced self-care alone in 190 women with breast cancer. The acupuncture group received 10 acupuncture sessions.
• Outcome: Acupuncture plus enhanced self-care significantly reduced hot flash scores and improved quality of life compared to enhanced self-care alone at the end of treatment and at 3- and 6-month follow-ups.

[31] Electroacupuncture for menopausal transition symptoms. (Cited by: 0) (pmid: 24950841)

• Protocol: A randomized controlled trial (RCT) of 360 women comparing electroacupuncture to sham electroacupuncture over 8 weeks, with 20- and 32-week follow-ups. Outcome measures included hot flashes, quality of life, and hormone levels.
• Outcome: The abstract describes the study protocol; no results or conclusions are presented as this is a study protocol, not a results report.

[32] Acupuncture, phytoestrogens, and hormone therapy for climacteric symptoms and cardiovascular risk factors. (Cited by: 3) (pmid: 32852460)

• Protocol: A prospective, randomized controlled trial comparing three 3-month treatments (acupuncture, phytoestrogens, low-dose hormone therapy) in women with climacteric symptoms. Cardiovascular risk factors were assessed before and after treatment.
• Outcome: Acupuncture and phytoestrogens reduced blood pressure significantly, more so than hormone therapy. Phytoestrogens also lowered LDL cholesterol, while hormone therapy increased triglycerides and insulin resistance.

[33] Laser acupuncture (LA) combined with diet for metabolic syndrome in obese postmenopausal women. (Cited by: 0) (pmid: 39138739)

• Protocol: A randomized controlled trial comparing a diet regimen alone (Group A) versus a diet regimen plus LA (Group B) in 30 postmenopausal women. LA was administered for 30 minutes, three times a week for two months.
• Outcome: Both groups showed significant improvements in metabolic syndrome markers. However, the group receiving LA in addition to the diet showed significantly greater improvements in blood pressure, cholesterol, triglycerides, fasting blood glucose, insulin, and insulin resistance, while HDL levels increased in both groups. LA is suggested as a safe and effective adjunct therapy.

[34] Low-calorie diet with and without laser acupuncture for visceral obesity in postmenopausal women. (Cited by: 12) (pmid: 12580844)

• Protocol: A randomized controlled trial comparing a 6-month low-calorie diet alone versus the same diet combined with laser acupuncture in 74 postmenopausal women with visceral obesity. Body weight, BMI, and waist-to-hip ratio were measured at baseline and 6 months.
• Outcome: Both groups showed significant weight loss, but the combined low-calorie diet and laser acupuncture group experienced significantly greater reductions in body weight, BMI, and waist-to-hip ratio. Laser acupuncture was deemed a beneficial addition to the diet.

[35] Acupuncture and diazepam for menopausal irritability. (Cited by: 4) (pmid: 25022116)

• Protocol: A randomized controlled trial compared acupuncture (warming needling at LI4 and LR3, 2 sessions) to diazepam (2.5mg TID for 23 days) in 60 women with menopausal irritability. Clinical efficacy, Kupperman score, and SRHMS were assessed.
• Outcome: Both acupuncture and diazepam were effective, but acupuncture showed significantly greater improvement in Kupperman and SRHMS scores compared to diazepam.

[36] Manual acupuncture and electroacupuncture for perimenopausal syndrome symptoms (hot flashes, hormone levels). (Cited by: 5) (pmid: 29231429)

• Protocol: A randomized controlled trial comparing manual acupuncture and electroacupuncture in 50 perimenopausal women. Treatments (at four acupoints) were administered twice weekly for 8 weeks. Outcomes were assessed using questionnaires and hormone level measurements at multiple time points.
• Outcome: Both manual acupuncture and electroacupuncture significantly improved hot flashes, menopausal rating scale scores, quality of life, and serum follicle-stimulating hormone and estradiol levels. No significant difference was found between the two acupuncture techniques.

[37] Moxibustion for menopausal hot flashes. (Cited by: 11) (pmid: 19293729)

• Protocol: A randomized clinical trial assigned 51 perimenopausal and postmenopausal women to moxibustion (two different protocols) or a waiting list control group. Moxibustion involved 14 sessions over 4 weeks at acupuncture points.
• Outcome: Moxibustion significantly reduced the frequency and severity of hot flashes compared to the control group. One moxibustion protocol also improved quality of life scores. Larger studies with placebo controls are recommended.

[38] Acupuncture for hot flashes in breast cancer survivors. (Cited by: 2) (pmid: 32217888)

• Protocol: A randomized controlled trial (RCT) analyzed data from 108 breast cancer survivors receiving acupuncture (electro or sham) or pharmacological treatment (gabapentin or placebo). Genetic analysis of six SNPs across five genes was performed.
• Outcome: Six specific genotypes were associated with a significantly higher likelihood of responding to acupuncture for hot flash reduction (70.3% vs 37.5%), but not to pharmacological treatment. This suggests potential for personalized acupuncture treatment.

[39] Traditional Chinese Medicine (TCM) acupuncture plus self-care for hot flushes in postmenopausal women. (Cited by: 3) (pmid: 17324253)

• Protocol: A multi-center, randomized controlled trial (RCT) comparing TCM acupuncture plus self-care to self-care alone in 286 postmenopausal women experiencing ≥7 hot flushes daily. Participants received 10 acupuncture sessions over 12 weeks.
• Outcome: The abstract describes the study protocol; no results or conclusions are presented as it's a protocol for an *ongoing* trial.

[40] Acupuncture for menopausal discomfort (hot flashes and sleep disturbances) in breast cancer patients. (Cited by: 42) (pmid: 22906948)

• Protocol: A prospective, double-blinded, randomized controlled trial comparing acupuncture, sham acupuncture, and no treatment in 94 breast cancer patients. Acupuncture sessions were administered.
• Outcome: Acupuncture significantly relieved hot flashes and sleep disturbances compared to sham acupuncture and no treatment, with effects lasting at least 12 weeks post-treatment. No side effects were reported.

Research Interpretation: Summary and Conclusion

Multiple randomized controlled trials (RCTs) investigated acupuncture's efficacy for various menopausal symptoms, employing diverse protocols including manual and electroacupuncture, often combined with other therapies (e.g., herbal medicine, self-care). While many studies demonstrated statistically and clinically significant reductions in hot flashes, vasomotor symptoms, and improved quality of life compared to controls (sham acupuncture, waitlists, or standard care), some studies found no significant difference between true and sham acupuncture, highlighting the potential for placebo effects. Consistent benefits were observed across studies for mood disorders and sleep quality, although the specific acupuncture techniques and combinations varied widely. Individual responses to acupuncture were heterogeneous, emphasizing the need for further research to identify predictors of treatment success and optimize treatment protocols. The overall evidence suggests acupuncture may offer a valuable adjunctive therapy for menopausal symptoms, but further investigation is warranted to clarify its mechanisms of action and establish clinical guidelines.

Publications

[1] Wang J; Liao Y; You Y; Liang W; Wan L; Yang H; Liu J; Li Y; Wang X; Nie G (2023). Acupuncture and Chinese herbal medicine for menopausal mood disorder: a randomized controlled trial Climacteric : the journal of the International Menopause Society 26 (4) :392-400.

[2] Liu Z; Ai Y; Wang W; Zhou K; He L; Dong G; Fang J; Fu W; Su T; Wang J; Wang R; Yang J; Yue Z; Zang Z; Zhang W; Zhou Z; Xu H; Wang Y; Liu Y; Zhou J; Yang L; Yan S; Wu J; Liu J; Liu B (2018). Acupuncture for symptoms in menopause transition: a randomized controlled trial American journal of obstetrics and gynecology 219 (4) :373.e1-373.e10.

[3] Avis NE; Coeytaux RR; Isom S; Prevette K; Morgan T (2016). Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial Menopause (New York, N.Y.) 23 (6) :626-37.

[4] Baccetti S; Da Fre M; Becorpi A; Faedda M; Guerrera A; Monechi MV; Munizzi RM; Parazzini F (2014). Acupuncture and traditional Chinese medicine for hot flushes in menopause: a randomized trial Journal of alternative and complementary medicine (New York, N.Y.) 20 (7) :550-7.

[5] Cai Y; Zhang X; Li J; Yang W (2024). Effect of acupuncture combined with Ningshen mixture on climacteric insomnia: A randomized controlled trial Medicine 103 (17) :e37930.

[6] Fu C; Zhao N; Liu Z; Yuan LH; Xie C; Yang WJ; Yu XT; Yu H; Chen YF (2017). Acupuncture Improves Peri-menopausal Insomnia: A Randomized Controlled Trial Sleep 40 (11).

[7] Painovich JM; Shufelt CL; Azziz R; Yang Y; Goodarzi MO; Braunstein GD; Karlan BY; Stewart PM; Merz CN (2012). A pilot randomized, single-blind, placebo-controlled trial of traditional acupuncture for vasomotor symptoms and mechanistic pathways of menopause Menopause (New York, N.Y.) 19 (1) :54-61.

[8] Hassan ES; Maged AM; Kotb A; Fouad M; El-Nassery N; Kamal WM (2023). Effect of laser acupuncture on pain and density of bone in osteoporotic postmenopausal women: a randomized controlled trial Menopause (New York, N.Y.) 30 (5) :545-550.

[9] Sunay D; Ozdiken M; Arslan H; Seven A; Aral Y (2011). The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial Acupuncture in medicine : journal of the British Medical Acupuncture Society 29 (1) :27-31.

[10] Ee C; Xue C; Chondros P; Myers SP; French SD; Teede H; Pirotta M (2016). Acupuncture for Menopausal Hot Flashes: A Randomized Trial Annals of internal medicine 164 (3) :146-54.

[11] Kim KH; Kang KW; Kim DI; Kim HJ; Yoon HM; Lee JM; Jeong JC; Lee MS; Jung HJ; Choi SM (2010). Effects of acupuncture on hot flashes in perimenopausal and postmenopausal women--a multicenter randomized clinical trial Menopause (New York, N.Y.) 17 (2) :269-80.

[12] Kargozar R; Salari R; Jarahi L; Yousefi M; Pourhoseini SA; Sahebkar-Khorasani M; Azizi H (2019). Urtica dioica in comparison with placebo and acupuncture: A new possibility for menopausal hot flashes: A randomized clinical trial Complementary therapies in medicine 44 :166-173.

[13] Nedeljkovic M; Tian L; Ji P; Deglon-Fischer A; Stute P; Ocon E; Birkhauser M; Ausfeld-Hafter B (2014). Effects of acupuncture and Chinese herbal medicine (Zhi Mu 14) on hot flushes and quality of life in postmenopausal women: results of a four-arm randomized controlled pilot trial Menopause (New York, N.Y.) 21 (1) :15-24.

[14] Li S; Li ZF; Wu Q; Guo XC; Xu ZH; Li XB; Chen R; Zhou DY; Wang C; Duan Q; Sun J; Luo D; Li MY; Wang JL; Xie H; Xuan LH; Su SY; Huang DM; Liu ZS; Fu WB (2018). A Multicenter, Randomized, Controlled Trial of Electroacupuncture for Perimenopause Women with Mild-Moderate Depression BioMed research international 2018 :5351210.

[15] Serra D; Fleishman SB; White C; Leung TM; Chadha M (2023). Acupuncture Reduces Severity of Hot Flashes in Breast Cancer: A Randomized Single-Blind Trial Holistic nursing practice 37 (6) :330-336.

[16] Palma F; Fontanesi F; Facchinetti F; Cagnacci A (2019). Acupuncture or phy(F)itoestrogens vs. (E)strogen plus progestin on menopausal symptoms. A randomized study Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology 35 (11) :995-998.

[17] Soares JM Jr; Branco-de-Luca AC; da Fonseca AM; Carvalho-Lopes CM; Arruda-Veiga EC; Roa CL; Bagnoli VR; Baracat EC (2020). Acupuncture ameliorated vasomotor symptoms during menopausal transition: single-blind, placebo-controlled, randomized trial to test treatment efficacy Menopause (New York, N.Y.) 28 (1) :80-85.

[18] Wen C; Liu Y; Pan X; Mao Z; Zhou L; Zhang H (2017). [Manual acupuncture versus electroacupuncture for menopausal syndrome:a randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 37 (5) :491-495.

[19] Li Y; Zheng H; Zheng Q; Zhao L; Qin E; Wang Y; Zeng Q; Zheng H; Zhao Y; Sun W; Zhang X; Liu Z; Liu B (2014). Use acupuncture to relieve perimenopausal syndrome: study protocol of a randomized controlled trial Trials 15 :198.

[20] Meng F; Duan PB; Zhu J; Lou QQ; Fang ZH; An HL; Liu LY; Hu Y; Hu Q (2017). Effect of Gua sha therapy on perimenopausal syndrome: a randomized controlled trial Menopause (New York, N.Y.) 24 (3) :299-307.

[21] Vincent A; Barton DL; Mandrekar JN; Cha SS; Zais T; Wahner-Roedler DL; Keppler MA; Kreitzer MJ; Loprinzi C (2007). Acupuncture for hot flashes: a randomized, sham-controlled clinical study Menopause (New York, N.Y.) 14 (1) :45-52.

[22] Pirotta M; Ee C; Teede H; Chondros P; French S; Myers S; Xue C (2014). Acupuncture for menopausal vasomotor symptoms: study protocol for a randomised controlled trial Trials 15 :224.

[23] Kim DI; Jeong JC; Kim KH; Rho JJ; Choi MS; Yoon SH; Choi SM; Kang KW; Ahn HY; Lee MS (2011). Acupuncture for hot flushes in perimenopausal and postmenopausal women: a randomised, sham-controlled trial Acupuncture in medicine : journal of the British Medical Acupuncture Society 29 (4) :249-56.

[24] Avis NE; Coeytaux RR; Levine B; Isom S; Morgan T (2017). Trajectories of response to acupuncture for menopausal vasomotor symptoms: the Acupuncture in Menopause study Menopause (New York, N.Y.) 24 (2) :171-179.

[25] Venzke L; Calvert JF Jr; Gilbertson B (2010). A randomized trial of acupuncture for vasomotor symptoms in post-menopausal women Complementary therapies in medicine 18 (2) :59-66.

[26] Avis NE; Legault C; Coeytaux RR; Pian-Smith M; Shifren JL; Chen W; Valaskatgis P (2008). A randomized, controlled pilot study of acupuncture treatment for menopausal hot flashes Menopause (New York, N.Y.) 15 (6) :1070-8.

[27] Lund KS; Siersma V; Bang CW; Brodersen J; Waldorff FB (2020). Sustained effects of a brief and standardised acupuncture approach on menopausal symptoms: post hoc analysis of the ACOM randomised controlled trial Acupuncture in medicine : journal of the British Medical Acupuncture Society 38 (6) :396-406.

[28] Hachul H; Garcia TK; Maciel AL; Yagihara F; Tufik S; Bittencourt L (2013). Acupuncture improves sleep in postmenopause in a randomized, double-blind, placebo-controlled study Climacteric : the journal of the International Menopause Society 16 (1) :36-40.

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