Not long ago, most of the research on acupuncture for menopausal symptoms came from small, short studies. Over the past decade, larger and longer trials have appeared, along with careful reviews of the whole field. Together they give a more useful picture than a simple yes or no, and anyone considering acupuncture for the menopause deserves to see it, including the parts that are less encouraging.
How Chinese medicine sees the menopause
Chinese medicine treats the menopause as a natural transition. The Yellow Emperor’s Classic, the founding text of Chinese medicine, describes a woman’s life in cycles of seven years, with menstruation coming to an end at around forty-nine. In this view, the body’s essence, or Jing, turns away from reproduction as a woman moves into a new stage of life.
When the transition is difficult, practitioners usually look first at the Kidney, which stores that essence, and then at the Heart and Liver. Hot flushes and night sweats often fit a pattern called Kidney Yin deficiency, in which the body’s cooling, moistening side runs low and heat rises. Broken sleep and anxiety often involve the Heart, and irritability and swings in mood often involve the Liver. Every woman’s pattern is different, so treatment differs too.
Hot flushes and night sweats: what the trials found
The Acupuncture in Menopause (AIM) study, published in the journal Menopause in 2016, set out to test acupuncture in real-world conditions. It recruited 209 women aged 45 to 60 who were having at least four hot flushes or night sweats a day. Half had up to 20 acupuncture treatments over six months; the other half waited for six months before starting. Experienced acupuncturists gave the treatment in ordinary clinics, with a plan tailored to each woman using a Chinese medicine diagnosis, so the trial tested acupuncture much as you would actually receive it. At six months, the frequency of hot flushes and night sweats had fallen by 36.7% in the acupuncture group and risen by 6% in the waiting group. The benefit lasted for at least six months after treatment stopped. Women in the acupuncture group began to improve after three treatments, and the biggest effect came after a median of eight.
A follow-up analysis of the same trial, published in 2017, looked at how individual women responded, and the answer varied a great deal. About one woman in nine saw her hot flushes fall by around 85%. The largest group, close to half, saw a reduction of around 47%. Just over a third saw only a small change, around 10% on average, and a few got worse. The researchers found some factors linked to a better response, such as the number of treatments in the first eight weeks, but concluded that predicting who will respond remains difficult.
A Danish trial, the ACOM study, published in BMJ Open in 2019, tested a simpler approach. GPs trained in acupuncture gave 70 women with moderate to severe symptoms either five weekly sessions of standardised Western medical acupuncture or no acupuncture. After six weeks, the acupuncture group reported larger improvements in hot flushes, night sweats, sleep problems, emotional symptoms and skin and hair symptoms. The authors pointed out that the study was short and that they could not rule out a placebo effect.
Researchers have also tested acupuncture in women who have had breast cancer, many of whom cannot take HRT. In the AcCliMaT trial, published in the Journal of Clinical Oncology in 2016, 190 women received either a self-care booklet alone or the booklet plus ten acupuncture sessions. The acupuncture group had lower hot flush scores at the end of treatment and three and six months later, along with better quality of life. If this applies to you, involve your oncology team before starting any new treatment.
The sham acupuncture question
In drug trials, researchers compare a medicine against a dummy pill. The closest equivalent in acupuncture research is sham acupuncture: needles placed away from the traditional points, or blunt needles that press on the skin without piercing it. None of the trials above used a sham control, and that matters.
When a Cochrane review in 2013 brought together 16 trials with 1,155 women, it found no significant difference between real and sham acupuncture for hot flushes. Compared with no treatment, acupuncture appeared to help. Compared with hormone therapy, it appeared less effective. The reviewers judged most of the evidence low or very low in quality and urged great caution.
There are two ways to read this. The benefit may come mainly from the experience of treatment: the time, the attention, the expectation of feeling better. Or sham needling may itself have effects, which would make it a poor dummy. Researchers still disagree about which explanation is right, and it may be some of both.
The North American Menopause Society takes a cautious line. In its 2023 position statement on non-hormone treatments, it did not recommend acupuncture for hot flushes. The same list of treatments it did not recommend included exercise, yoga and relaxation techniques, which gives a sense of how high it set the bar. Its recommended options included cognitive behavioural therapy, clinical hypnosis and several prescription medicines.
Sleep, mood and vaginal changes
Sleep and mood have less research of their own, and most of what exists comes from trials designed around hot flushes. In the ACOM study, sleep problems and emotional symptoms improved along with the flushes. In the AIM study, improvements in several quality of life measures lasted beyond the end of treatment. It is hard to say how much of that came from fewer night sweats and how much from acupuncture’s effect on sleep or mood directly.
For vaginal dryness and discomfort, I am not aware of any good-quality acupuncture trials. Your GP can talk you through the treatments available, and these symptoms are worth raising rather than putting up with.
Where acupuncture fits
Your GP or a menopause clinic is the right place to discuss hormone therapy and the other medical options. Acupuncture may still have a place alongside that care:
- for women who cannot take HRT, or who prefer not to
- for women on HRT who still struggle with sleep, mood or energy
- for women in perimenopause who want support while they work out what suits them
The trials used anywhere from five weekly sessions to around twenty over six months. In my clinic I treat the whole person rather than the hot flush alone, which in Five-Element terms means looking for the element at the root of how this transition is affecting you. Please keep your GP informed about any treatment you are having, and see them promptly about bleeding after the menopause or any symptom that worries you.
The research on acupuncture for menopause is more encouraging than it was ten years ago, and also more complicated. Knowing both sides puts you in a better position to decide whether it is worth trying, and to talk it through with your GP.