Stimulated by Wang et al 2025.[1]
EA – electroacupuncture
MA – manual acupuncture
JIM – the Journal of Integrative Medicine
IF – impact factor
JICM – the Journal of Integrative and Complementary Medicine
JACM – the Journal of Alternative and Complementary Medicine
HF – hot flashes or flushes
PCOS – polycystic ovarian syndrome
POI – primary ovarian insufficiency
POF – primary ovarian failure
MRS – menopause rating scale
MENQoL – menopause-specific quality of life questionnaire
PSQI – Pittsburgh sleep quality index
TCMSSS – traditional Chinese medicine syndrome score scale
LH – luteinising hormone
FSH – follicle stimulating hormone– key to acronyms
It has been almost exactly a year since hot flushes featured in the title of this blog, see Hot flushes 2024. At that time, I remarked that whilst we have been talking about acupuncture for hot flushes (HF) for decades, we still lack evidence of efficacy. Perhaps using EA rather than MA will change that?
This paper published in JIM (IF 4.0), not to be confused with JICM (formerly known as JACM, see Acupuncture and fracture risk in OA), is a sham controlled trial of EA in early natural menopause performed in Shanghai. The main focus was on severity of HF as measured by the HF score, which was calculated from a 7-day symptom diary. The latter combines both frequency and severity of HF by indicating whether or not an episode of HF was mild, moderate, severe, or very severe. The number of mild hot flushes over 7 days was multiplied by 1, moderate by 2, severe by 3, and very severe by 4. The total of these added together and divided by 7 gave the average HF score per day.
The population studied were women between 40 and 60 years old who had an HF score of 6 or more for the previous 7 days consecutively. There were a variety of exclusions related to breast cancer treatment, PCOS, POI, POF, and more.
Acupuncture or sham was applied 3 times a week for 6 weeks. The sham was a non-penetrating variety that was applied to the same acupuncture points used in the verum group. EA was simulated with leads connected and a flashing light on the device but zero intensity.
In the acupuncture group, MA was applied at BL23 bilaterally in the prone position, but the needles were not retained, and then the patient rolled over. EA was applied between SP6 and KI7 at 2Hz, and MA was applied at LI4, CV4, and KI3. Supplementary points were allowed for comorbid symptoms including GV20, HT7, BL18, and LR3.
The primary outcome was the HF score at 6 weeks. Secondary outcomes included MRS, MENQoL, PSQI, TCMSSS, as well as blood oestrogen, LH, and FSH levels.
The HF score dropped from a median of 14.36 in the EA group to 11.50 at 6 weeks (difference of 2.86). In the sham group the median dropped from 12.58 to 11.22 (difference of 1.36). I am unsure whether this difference would have been significant but there was no difference in the absolute HF score at 6 weeks nor any other time point.
The within-group changes were highly statistically significant, but the size of the reduction is nowhere near the MCID for the HF score (4 to 6 points per day, which is the equivalent of 2 fewer moderate to severe hot flushes).
Interestingly, the vasomotor subscale of MENQoL did demonstrate a significant difference between groups and that was maintained at week 10 and week 18. Differences were also seen in the psychological subscale at week 6 and week 10 but not week 18, and in the PSQI at all time points from week 6 onwards.
So, clearly the EA plus MA protocol had some benefits in terms of quality of life and sleep but did not show much difference in terms of HF score reduction, which is a composite of frequency and severity.
In case you hadn’t noticed, this is another technically negative (or more correctly neutral) RCT for acupuncture coming out of China. That in itself is not a bad thing, but it still leaves us with the efficacy question over acupuncture for hot flushes.
References
1 Wang H-X, Yu X-T, Hu J, et al. Electroacupuncture for hot flashes in early menopause: A randomized sham-controlled trial. J Integr Med. 2025;S2095-4964(25)00110-4. doi: 10.1016/j.joim.2025.07.008
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