Acupuncture for Perimenopause

Acupuncture, a traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body, has been explored as a potential complementary therapy for perimenopause. This period of transition leading up to menopause is characterized by a wide range of often debilitating symptoms, prompting investigation into alternative treatments for symptom management. Several randomized controlled trials (RCTs) have therefore been conducted to assess the efficacy of acupuncture in alleviating perimenopausal symptoms.

Protocols Studied in Research

[1] Real and sham acupuncture for comorbid perimenopausal depression and insomnia. (Cited by: 8) (pmid: 36815166)

• Protocol: A patient-assessor-blinded, randomized, sham-controlled trial involving 70 women with perimenopausal depression and insomnia. Participants received 17 acupuncture sessions over 8 weeks.
• Outcome: Acupuncture showed significant short-term improvement in sleep quality but not depression. No significant long-term benefits were observed at 16 weeks. The treatment was safe and well-tolerated.

[2] 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. Greene Climacteric Scale (GCS), SDS, and SAS were used for assessment.
• Outcome: All three treatments improved mood disorder symptoms, but the combined acupuncture and CHM group showed superior and more sustained improvement in depression scores compared to the other groups. No serious adverse effects were observed.

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

• Protocol: A randomized, placebo-controlled trial with 76 peri-menopausal women with insomnia. Participants received 10 acupuncture sessions (or placebo acupuncture) over 3 weeks targeting specific acupoints. Sleep quality was assessed using PSQI, ISI, and PSG.
• Outcome: Acupuncture significantly improved sleep quality (PSQI, ISI, PSG) in women with PMI compared to placebo acupuncture, demonstrating short-term efficacy.

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

• Protocol: A pragmatic, randomized controlled trial of 209 women (45-60 years old) experiencing frequent VMS. Participants received up to 20 acupuncture treatments over 6 months or served as a waitlist control.
• 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.

[5] Acupuncture for perimenopausal early-wake insomnia. (Cited by: 0) (pmid: 35712942)

• Protocol: A randomized controlled trial comparing acupuncture to oryzanol tablets in 60 perimenopausal women with early-wake insomnia. Acupuncture was administered bi-daily for 4 weeks; oryzanol was taken orally three times daily for 4 weeks. Sleep parameters were assessed using actigraphy and PSQI.
• Outcome: Acupuncture significantly improved sleep parameters (effective sleep time, sleep quality, wake-up times and frequency) compared to oryzanol, demonstrating a higher effective rate (88.9% vs 38.5%). Acupuncture was found to be effective in treating perimenopausal early-wake insomnia.

[6] Electroacupuncture (EA) for mild-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-moderate depression. Outcomes included HAMD-17, MENQOL, and serum sexual hormones.
• 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.

[7] 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 assessed.
• Outcome: Acupuncture significantly reduced hot flash scores and improved menopause-related symptoms compared to usual care alone, with effects sustained at 8 weeks.

[8] Traditional acupuncture (TA) and sham acupuncture (SA) for menopausal vasomotor symptoms (VMS). (Cited by: 18) (pmid: 21968279)

• Protocol: A pilot, randomized, single-blind, placebo-controlled trial comparing TA, SA, and a waiting control (WC) in 33 perimenopausal/postmenopausal women with frequent VMS. Treatments (TA and SA) were administered three times weekly for 12 weeks.
• Outcome: Both TA and SA improved VMS frequency, severity, 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.

[9] Bushen Anshen acupuncture for perimenopausal insomnia (PMI) with kidney-yin deficiency. (Cited by: 0) (pmid: 37313556)

• Protocol: A randomized controlled trial with 70 women (35 per group) with PMI and kidney-yin deficiency. The observation group received Bushen Anshen acupuncture; the control group received sham acupuncture. Treatment involved 10 sessions over 2 weeks. PSQI and PSG assessed sleep quality.
• Outcome: Bushen Anshen acupuncture significantly improved both subjective (PSQI) and objective (PSG) sleep quality in women with PMI and kidney-yin deficiency compared to sham acupuncture.

[10] Acupuncture plus auricular acupressure (AA) versus hormone replacement therapy (Climen) for perimenopausal syndrome. (Cited by: 3) (pmid: 24886348)

• Protocol: A 12-week, multi-center, randomized controlled trial in 206 Chinese women with perimenopausal syndrome compared AA (28 sessions over 12 weeks) to Climen (3 cycles). Outcomes measured at multiple time points.
• Outcome: The abstract does not present the results of the trial; it only states that the results, expected in 2015, would clarify acupuncture's effectiveness for perimenopausal syndrome.

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

• Protocol: A randomized, single-blind, sham-controlled trial involving 103 women. Participants received biweekly acupuncture (real or sham) for 5 weeks, followed by a 7-week follow-up. Hot flash frequency was tracked daily.
• Outcome: The study found no significant difference in hot flash reduction between medical acupuncture and sham acupuncture at 6 or 12 weeks. Medical acupuncture was not more effective.

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

• Protocol: A randomized, single-blind, sham-controlled trial. 54 women with moderate to severe hot flushes received either real or sham acupuncture (11 treatments over 7 weeks) following a 4-week run-in period.
• Outcome: Acupuncture showed no statistically significant difference compared to sham acupuncture in reducing overall hot flush scores. However, it showed some benefit in reducing hot flush severity, suggesting further investigation is needed to isolate specific effects from non-specific effects.

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

• Protocol: A randomized controlled trial involving 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 conventional treatment alone, with no significant hormonal changes observed. The therapy was deemed safe and effective.

[14] Jianpi Peiyuan acupoint thread embedding therapy for perimenopausal obesity. (Cited by: 1) (pmid: 36858391)

• Protocol: A randomized controlled trial comparing acupoint thread embedding therapy (observation group) to health education and lifestyle intervention (control group) in 96 perimenopausal obese women. Treatment involved embedding threads at specific acupoints every 2 weeks for 8 weeks.
• Outcome: Acupoint thread embedding therapy significantly reduced BMI, waist/hip circumference, and body mass, and improved perimenopausal symptoms, insomnia, and anxiety compared to the control group. No serious adverse events were reported.

[15] 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 specific 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 FSH and E2 levels. No significant difference was found between the two acupuncture methods.

[16] Moxibustion and manual acupuncture for perimenopausal insomnia (PMI). (Cited by: 1) (pmid: 31155869)

• Protocol: A randomized controlled trial comparing moxibustion and acupuncture in 60 women with PMI. Participants received 20 days of treatment (10 days on, 2 days off, 10 days on) at four acupoints. Sleep quality was assessed using the PSQI.
• Outcome: Moxibustion showed superior efficacy compared to acupuncture in improving sleep quality in women with PMI, potentially by regulating serum hormone levels (FSH, LH, E2). Both treatments were effective, but moxibustion resulted in significantly better outcomes.

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

• Protocol: A randomized controlled trial of 209 perimenopausal and postmenopausal women with frequent VMS. Participants received up to 20 acupuncture treatments over 6 months or were waitlisted. VMS frequency was tracked weekly.
• Outcome: Acupuncture reduced VMS frequency in about half of the treated women, with varying degrees of improvement. Predicting individual response to acupuncture remains difficult.

[18] Acupoint catgut embedding (ACE) for central obesity in perimenopausal women. (Cited by: 0) (pmid: 39496462)

• Protocol: A randomized controlled trial comparing ACE to sham stimulation in 82 perimenopausal women with central obesity. 16s rRNA sequencing was used to analyze gut microbiota changes.
• Outcome: ACE significantly reduced weight and waist circumference, increased gut microbiota diversity, and increased levels of *Klebsiella* and *Kosakonia*. These increases correlated with higher adiponectin levels and were inversely correlated with body weight and waist circumference, suggesting a potential mechanism for ACE's weight loss effects.

[19] Auricular point seed burying combined with fire dragon pot moxibustion for perimenopausal insomnia. (Cited by: 1) (pmid: 35508300)

• Protocol: A randomized controlled trial (RCT) of 70 perimenopausal women with insomnia. The control group received auricular seed burying; the observation group received this plus fire dragon pot moxibustion. Treatment lasted 10 weeks. PSQI, SAS, and SDS scores were measured.
• Outcome: Combining auricular seed burying with fire dragon pot moxibustion significantly improved sleep quality (PSQI), reduced anxiety (SAS) and depression (SDS) scores, and increased total sleep time compared to seed burying alone in perimenopausal women with insomnia.

[20] Electroacupuncture and medication for Perimenopausal Syndrome (PMS). (Cited by: 2) (pmid: 29071914)

• Protocol: A randomized controlled trial comparing electroacupuncture at specific points (EX-CA 1, ST 25, SP 6, CV 4) with estradiol valerate and medroxyprogesterone acetate in 58 PMS patients over 8 weeks.
• Outcome: Both interventions effectively reduced PMS symptoms and improved hormone levels. Acupuncture showed superior long-term efficacy compared to medication based on Menopause Rating Scale scores.

[21] Acupoint catgut embedding and Kuntai capsule for perimenopausal syndrome. (Cited by: 1) (pmid: 25543423)

• Protocol: A controlled clinical trial comparing acupoint catgut embedding (at specific acupoints) versus Kuntai capsule (oral administration) in 33 perimenopausal women. Treatment lasted 60 days. Kupperman Index (KI) was used to assess outcomes.
• Outcome: Both interventions reduced KI scores, but acupoint catgut embedding showed significantly better short-term (10-day) efficacy in reducing KI scores and improving total effective rate. Differences were not significant after 30 and 60 days.

[22] He's fire needle therapy combined with walnut-shell moxibustion for perimenopausal dry eye disease. (Cited by: 0) (pmid: 39681489)

• Protocol: A randomized controlled trial (RCT) of 60 perimenopausal women with dry eye disease. The observation group received fire needle therapy and walnut-shell moxibustion; the control group received hyaluronic acid eye drops. Treatment lasted 4 weeks.
• Outcome: The combined fire needle and moxibustion therapy showed significantly better improvement in dry eye symptoms (tear secretion, tear film break-up time, symptom scores) compared to hyaluronic acid eye drops.

[23] Combined electroacupuncture, acupoint injection, and fire-needle therapy for menopausal syndrome. (Cited by: 1) (pmid: 29888582)

• Protocol: A randomized controlled trial comparing combined therapy (electroacupuncture, acupoint injection, fire-needle) to electroacupuncture alone in 100 menopausal women. Treatments were administered daily for 10 days, with a 3-month follow-up. The Kupperman index measured symptom severity.
• Outcome: The combined therapy group showed significantly greater improvement in menopausal symptoms (Kupperman score) compared to the electroacupuncture-only group both immediately post-treatment and at 3-month follow-up. The combined therapy had a higher total effective rate.

[24] Acupuncture combined with wheat-grain moxibustion for perimenopausal depression with kidney deficiency and liver depression. (Cited by: 1) (pmid: 33909356)

• Protocol: A randomized controlled trial comparing acupuncture/moxibustion to fluoxetine in 60 perimenopausal women with depression. Acupuncture and moxibustion were applied to specific acupoints; fluoxetine was administered orally. Treatment lasted 8 weeks, with follow-ups at 1, 3, and 6 months.
• Outcome: Acupuncture combined with moxibustion showed significantly greater reduction in depression scores and a higher effective rate compared to fluoxetine, suggesting a more sustained therapeutic effect.

[25] "Yinqi Guiyuan needles therapy" combined with moxibustion at Yongquan (KI 1) for perimenopausal insomnia with heart-kidney imbalance. (Cited by: 0) (pmid: 30672215)

• Protocol: A randomized controlled trial comparing acupuncture plus moxibustion to diazepam and oryzanol in 100 perimenopausal women with insomnia and heart-kidney imbalance. Treatment lasted 20 days (two 10-day courses). Pittsburgh Sleep Quality Index (PSQI) assessed sleep quality.
• Outcome: Acupuncture plus moxibustion significantly improved sleep quality (lower PSQI scores) and had a higher effective rate than medication, with no significant adverse effects.

[26] Auricular intradermal needling combined with erjian (HX(6,7i)) bloodletting for perimenopausal insomnia. (Cited by: 2) (pmid: 29971997)

• Protocol: A randomized controlled trial comparing the intervention (auricular needling and bloodletting) to oral estazolam in 90 perimenopausal women with insomnia. Treatment involved specific auricular points needled and bled alternately every three days.
• Outcome: The combined auricular needling and bloodletting improved sleep quality (PSQI scores) and neurotransmitter levels (5-HT and NE) significantly more than estazolam, with a higher overall effectiveness rate. Estrogen levels were unaffected.

[27] Acupuncture at "thirteen ghost points" plus Kaixin powder vs. Kaixin powder alone for mild perimenopausal depression. (Cited by: 2) (pmid: 32270639)

• Protocol: A randomized controlled trial comparing 60 women with mild perimenopausal depression receiving either Kaixin powder alone or Kaixin powder plus acupuncture. Treatment lasted 12 weeks. Outcomes were measured using HAMD, SDS, and Kupperman scales.
• Outcome: Combined acupuncture and Kaixin powder treatment showed significantly greater improvement in depression symptoms and a higher effective rate compared to Kaixin powder alone. Both treatments showed improvements compared to baseline.

[28] Bushen Huoxue Anshen Fang (TCM) and acupuncture for perimenopausal sleep disorder with kidney deficiency and blood stasis. (Cited by: 1) (pmid: 30989965)

• Protocol: A randomized controlled trial comparing TCM and acupuncture in 67 women. Both interventions were administered for three 30-day courses. Outcomes included PSQI, Kupperman scores, TCM syndrome severity, and hormone levels.
• Outcome: Both TCM and acupuncture showed similar efficacy in improving sleep quality and related symptoms. TCM was superior in improving Kupperman scores, while acupuncture showed better effects on PT and TT coagulation parameters. Both were considered safe and effective.

[29] Moxibustion at BL 23 and Vitamin E supplementation for sub-health perimenopausal women. (Cited by: 1) (pmid: 29231589)

• Protocol: A randomized controlled trial comparing moxibustion at BL 23 (4 courses over 28 days) versus oral Vitamin E (28 days) in 60 perimenopausal women. Quality of life, sex hormones (estradiol, progesterone), AMH, and inhibin B were assessed.
• Outcome: Moxibustion significantly improved quality of life, increased estradiol and progesterone levels (particularly in premenopausal women), and improved AMH levels compared to Vitamin E, suggesting a potential role in improving ovarian reserve and delaying ovarian aging.

[30] Catgut implantation at back-shu acupoints for mild perimenopausal depression with kidney deficiency and liver stagnation syndrome. (Cited by: 1) (pmid: 26255514)

• Protocol: A randomized controlled trial comparing catgut implantation to conventional acupuncture in 45 women. Treatments were administered over 8 weeks, with follow-up at 12 weeks. Outcomes were measured using Kupperman and Hamilton Depression Scales.
• Outcome: Catgut implantation showed significantly greater and more sustained reduction in depression symptoms (particularly sleep disturbance and retardation) compared to acupuncture. The long-term efficacy of catgut implantation was superior.

[31] Combination of Source and Back-Shu acupuncture points for perimenopausal syndrome. (Cited by: 1) (pmid: 19563189)

• Protocol: A randomized controlled trial comparing acupuncture at specific Source and Back-Shu points versus routine acupuncture points in 80 women with perimenopausal syndrome. Kupperman scores and hormone levels were measured.
• Outcome: The combination Source and Back-Shu point acupuncture group showed significantly higher effectiveness (92.5% vs 80%), lower Kupperman scores, and improved hormone levels (E2, FSH, LH) compared to the routine acupuncture group.

[32] Acupuncture at the five-zangshu points for Perimenopausal Syndrome (PMS). (Cited by: 3) (pmid: 17853753)

• Protocol: A randomized controlled trial (RCT) compared acupuncture at five-zangshu points versus Premarin tablets in 40 women with PMS. Treatment effects were assessed using Kupperman index and hormone levels.
• Outcome: Acupuncture demonstrated a significantly higher total effective rate (90% vs 65%) and greater improvement in Kupperman scores and serum estradiol levels compared to Premarin.

[33] Scraping therapy for perimenopausal syndrome. (Cited by: 1) (pmid: 23301486)

• Protocol: A study of 20 women with perimenopausal syndrome received scraping therapy along the Governor Vessel and Urinary Bladder Meridian, focusing on Back-shu and Ashi points. Symptom improvement was measured using a modified Kupperman score.
• Outcome: Scraping therapy showed a 90% effective rate in alleviating perimenopausal symptoms. Significant improvements were observed across various symptoms, including hot flashes, insomnia, and anxiety, with a statistically significant reduction in the Kupperman score.

Research Interpretation: Summary and Conclusion

Multiple randomized controlled trials (RCTs) investigated acupuncture's efficacy for various perimenopausal symptoms, employing diverse acupuncture techniques (e.g., manual, electroacupuncture, moxibustion, thread embedding) and incorporating different control groups (sham acupuncture, waitlists, conventional treatments, or placebos). While some studies reported significant improvements in sleep quality, hot flashes, vasomotor symptoms (VMS), depression, and quality of life with acupuncture compared to controls or alternative treatments, other studies found no significant differences. Consistent positive findings were observed for acupuncture's impact on sleep disturbances and VMS, with some evidence suggesting superior efficacy compared to certain medications or other interventions. However, the effectiveness varied depending on the specific acupuncture technique, symptom targeted, and patient population. Several studies highlighted the need for further research to optimize acupuncture protocols and identify patient subgroups who might benefit most. Overall, the evidence suggests acupuncture may be a beneficial adjunct therapy for some perimenopausal symptoms, but more large-scale, well-designed RCTs are needed to establish definitive conclusions and clinical guidelines.

Publications

[1] Zhao FY; Zheng Z; Fu QQ; Conduit R; Xu H; Wang HR; Huang YL; Jiang T; Zhang WJ; Kennedy GA (2023). Acupuncture for comorbid depression and insomnia in perimenopause: A feasibility patient-assessor-blinded, randomized, and sham-controlled clinical trial Frontiers in public health 11 :1120567.

[2] 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.

[3] 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).

[4] 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.

[5] Zhu JF; Liu T; Hu F; Sheng JL; Jin YY (2022). [Acupuncture for perimenopausal early-wake insomnia: a randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 42 (6) :608-12.

[6] 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.

[7] 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.

[8] 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.

[9] Yang WJ; Zhao N; Yu XT; Xie C; Li JJ; Zhang CY; Chen YF (2023). [Bushen Anshen acupuncture for perimenopausal insomnia of kidney-yin deficiency: a randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 43 (6) :634-8.

[10] 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.

[11] 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.

[12] 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.

[13] 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.

[14] Wang Y; Yue HY; Chen YQ; Yin X; Xu SF; Mi YQ; Li SS (2023). [Jianpi Peiyuan acupoint thread embedding therapy for perimenopausal obesity: a randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 43 (3) :294-8.

[15] Cao Z; Tang J; Xue Y; Wang Q; Li S; Zhou Y; Zhang W (2017). [Comparison between manual acupuncture and electroacupuncture for hot flashes and sex hormone of perimenopausal syndrome] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 37 (3) :247-252.

[16] Zhang WR; Guo H; Tan SH; Min Y; Yang C (2019). [Moxibustion therapy is superior to manual acupuncture in the treatment of perimenopausal insomnia: a randomized controlled trial] Zhen ci yan jiu = Acupuncture research 44 (5) :358-62.

[17] 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.

[18] Jin Y; Huang Y; Zhu J; Liao D; Zeng S; Jin X (2024). Acupoint catgut embedding regulates community structure of intestinal flora in central obesity during perimenopause Women & health 64 (10) :857-869.

[19] Feng H; Pan A; Zheng G; Yu W (2022). Clinical study of auricular point seed burying combined with fire dragon pot moxibustion in perimenopausal women with insomnia The journal of obstetrics and gynaecology research 48 (7) :1938-1944.

[20] Liu XR; Zang ZW; Li XL; Ma JH (2016). [Effectiveness of Electroacupuncture of Zigong (EX-CA 1), etc. in Treatment of Perimenopausal Syndrome Women] Zhen ci yan jiu = Acupuncture research 41 (3) :247-50.

[21] Yang CY; Liu L; Ge HX; Zhu ZY (2014). [Acupoint catgut embedding for perimenopausal syndrome: a clinical controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 34 (10) :961-4.

[22] Zeng Q; Hong QY; Yao J; Liu XJ; Liu NG (2024). [Observation on the clinical effect of He's fire needle therapy combined with walnut-shell moxibustion on perimenopausal dry eye disease] Zhen ci yan jiu = Acupuncture research 49 (12) :1303-1309.

[23] Peng YY; Jing HT; Luan L; Tu YY (2018). [Treatment of Menopausal Syndrome by Combined Electroacupuncture, Acupoint-injection and Fire-needle Therapies] Zhen ci yan jiu = Acupuncture research 43 (4) :260-2.

[24] Zhang X; Su SY; Qin MX; Cai HQ; Huang M; Dai Q; Lin A (2021). [Therapeutic effect of acupuncture combined with wheat-grain moxibustion on perimenopausal depression with kidney deficiency and liver depression] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 41 (4) :377-80.

[25] Zhang W; Jin Y (2018). [Clinical observation of "Yinqi Guiyuan needles therapy" combined with moxibustion at Yongquan (KI 1) on perimenopausal insomnia with heart-kidney imbalance] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 38 (12) :1279-82.

[26] Meng F; Gong W; Liao Y; Xu H; Wang X (2018). [Effect of auricular intradermal needling combined with erjian (HX(6,7i)) bloodletting on sleep quality and neuroendocrine level in patients with perimenopausal insomnia] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 38 (6) :575-9.

[27] Gu T; Wang RH; Wu T; Ke ZH; Yang H; Wang D (2020). [Therapeutic effect on mild perimenopausal depression treated with acupuncture at the "thirteen ghost points" and kaixin powder] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 40 (3) :267-71.

[28] Ma K; Chen YX; Dong ML (2019). [Clinical efficacy of Bushen Huoxue Anshen therapy in treating perimenopausal sleep disorder with kidney deficiency and blood stasis] Zhongguo Zhong yao za zhi = Zhongguo zhongyao zazhi = China journal of Chinese materia medica 44 (6) :1069-1074.

[29] Shen J; Shen M; Li Z; Zhang R; Li X; Ai B (2017). [Effects of moxibustion at Shenshu (BL 23) on level of sex hormones and AMH in sub-health peri-menopausal women] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 37 (4) :381-385.

[30] Sun Z; Jin Y; Xiang H; Liu F (2015). [Clinical observation on mild perimenopausal depression of kidney deficiency and liver stagnation syndrome treated with acupoint catgut implantation] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 35 (5) :443-6.

[31] Shang YJ; Zhang Y; Kong LL; Wang YY; Wang DS; Liu J (2009). [Clinical observation on combination of source point and Back-Shu Point for treatment of perimenopausal syndrome] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 29 (6) :444-8.

[32] Jin H; Liu TT; Wang R (2007). [Clinical observation on acupuncture at the five-zangshu for treatment of perimenopausal syndrome] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 27 (8) :572-4.

[33] Jiang RR; Xu GH; An HL; Li J; Chen H; Hou YJ (2012). [Observation on the therapeutic effect of scraping therapy on perimenopausal syndrome] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 32 (12) :1121-3.