Menopausal problems and acupuncture.

Hot flushes are common and distressing in postmenopausal women. Treatment with oestrogens carries significant health risks. The current hypothesis for their mechanism involves a narrowing of the thermoneutral zone, which may be counteracted by interventions that increase oestrogen, endorphin or serotonin levels, or decrease noradrenalin levels. Acupuncture has several mechanisms with the potential to reduce hot flush frequency and severity. This article reviews the current clinical trial literature. Sixteen studies are included in the review. Three studies comparing acupuncture with no specific therapy show that acupuncture treatment leads to a reduction of around 50% in hot flush frequency. There were seven comparisons between acupuncture and other therapy: three showed acupuncture to have a significantly smaller effect on frequency than oestrogen therapy, two found a similar effect to relaxation, one found a significantly greater effect than the food supplement oryzanol, and one was unclear. Out of seven studies that compared acupuncture with some other form of needle penetration, whether superficial or deep and whether on or off acupuncture points, five showed no effect, one showed an effect on frequency, and another on severity but not frequency. These studies provide little support for a point specific effect of acupuncture in this condition. Two studies compared acupuncture with non-penetrating, blunt needles: one was significantly positive for flush severity but not frequency, and the other showed no effect. In conclusion, the results from all studies are in agreement with the hypothesis that acupuncture needling relieves hot flushes. There are few data however supporting the hypothesis that the effect of acupuncture is point specific. Future research should investigate whether there is a biological effect of needling on hot flushes or not, whether tailored treatment is superior to standardised treatment, and ways of delivering treatment that causes least discomfort and least cost.