Amenorrhoea is the absence of menstrual periods. A 2026 review in American Family Physician by Klein and colleagues defines primary amenorrhoea as the lifelong absence of periods, which warrants evaluation by age 15 or three years after breast development begins, and secondary amenorrhoea as the stopping of previously regular periods for 3 months or of irregular periods for 6 months. This page covers the acupuncture literature on the causes other than polycystic ovary syndrome, which has its own page. Cochrane has published no review of acupuncture for amenorrhoea, premature ovarian insufficiency or functional hypothalamic amenorrhoea; a PubMed search in October 2026 found Cochrane acupuncture reviews only for neighbouring conditions such as polycystic ovary syndrome and period pain. The systematic reviews that do exist mostly concern premature ovarian insufficiency, and their trials measure hormone levels more often than returning periods.
Reviews in premature ovarian insufficiency
Premature ovarian insufficiency (POI) is loss of ovarian function before age 40. The 2024 international guideline on POI diagnoses it from disordered cycles, either amenorrhoea or irregular periods, for at least 4 months together with a follicle-stimulating hormone (FSH) level above 25 IU/l, and puts its prevalence at 3.5% in recent studies. A rising FSH is the pituitary's response to failing ovaries, which is why most trials report FSH and estradiol (E2), the main ovarian oestrogen, as outcomes.
A review by Maunder and colleagues at Western Sydney University was written to inform that guideline and published in Climacteric in 2026. It searched four databases to January 2024 for trials and reviews of any complementary therapy in POI and found nine studies that met its criteria. The authors reported that Chinese herbal medicine and acupuncture may ease menopausal symptoms and regulate gonadotropins, the pituitary hormones FSH and luteinising hormone (LH), in POI, called the evidence very limited, and concluded that it does not support complementary medicines as replacements for hormone therapy.
Two network meta-analyses, which rank several treatments against each other through shared comparators, gathered larger sets of mostly Chinese trials:
- Du and colleagues at Dongzhimen Hospital, Beijing, in 2025, pooled 51 randomised trials with 3,754 patients, searched to November 2024, comparing acupoint stimulation of several kinds with herbal medicine, hormone replacement therapy or placebo. None of the 51 trials described allocation concealment and 98% did not mention blinding. The authors reported that combinations of methods, especially those including moxibustion, improved ovarian function most, measured partly by antral follicle count, the number of small follicles seen on ultrasound.
- Yi and colleagues at Shandong University of Traditional Chinese Medicine, in 2025, pooled 37 trials with 2,419 patients, searched to April 2024. They rated confidence in the evidence from moderate to very low, low overall, and named insufficient allocation concealment, lack of blinding and small samples as the main weaknesses.
A 2024 meta-analysis by Cao and colleagues at Longhua Hospital, Shanghai, pooled 13 trials with 775 patients comparing acupuncture, alone or added to herbs or hormone replacement, with hormone replacement, herbs or both without acupuncture. It reported lower FSH and higher E2 and anti-Müllerian hormone (AMH), a marker of the remaining egg supply, in the acupuncture groups; the FSH result came from trials that disagreed widely (I² 92%, where higher values mean more inconsistency).
The one review that made the return of periods a main outcome is older. Jo and colleagues at Kyung Hee University in Seoul searched twelve databases to July 2014 and included 8 trials with 620 participants, all from China and published in Chinese; none used a sham control, and in three the acupuncture was added to hormone replacement therapy. More women resumed menstruation with acupuncture than in the control groups (risk ratio 1.25), counting a single period after treatment as resumption. The authors rated the certainty of that result low on GRADE, the standard scale for how far a result can be trusted, citing small numbers, unblinded participants and likely publication bias.
An umbrella review by Bai and colleagues in 2024 combined 18 meta-analyses on POI with 20 on polycystic ovary syndrome and reported better hormone levels in POI with acupuncture-related therapies. A 2025 commentary by Sun and colleagues at Zhejiang Chinese Medical University pointed out that the two conditions differ in their underlying biology, depleted follicles in one and excess follicles in the other, and that pooling them may add heterogeneity.
Diminished ovarian reserve
Diminished ovarian reserve is a smaller egg supply than age would predict, short of the threshold for POI. A 2023 meta-analysis by Lin and colleagues, also at Longhua Hospital, pooled 13 trials with 787 patients and reported lower FSH and a higher antral follicle count with acupuncture than with controls, with substantial heterogeneity between studies.
A 2026 trial at the China Academy of Chinese Medical Sciences in Beijing randomised 120 women aged 18 to 40 to acupuncture with electrical stimulation or to sham, three 20-minute sessions a week for 12 weeks. The sham needled the same points to 1 to 3 mm with a current too weak to make the muscles twitch. At 12 weeks the antral follicle count had risen more with acupuncture, by a median of 2 follicles against none; by week 24 the difference was no longer significant. AMH, FSH, E2 and menstrual cycle length did not differ between the groups, and both groups improved from baseline. The points included GV20 (Baihui), CV04 (Guanyuan), XC01 (Zigong), SP06 (Sanyinjiao), LV03 (Taichong), BL23 (Shenshu), BL33 (Zhongliao) and KD03 (Taixi). Sham acupuncture describes the kinds of control in use.
A 2026 single-blind multicentre trial led from Shanghai Municipal Hospital of Traditional Chinese Medicine gave all participants hormone replacement therapy and added either acupoint catgut embedding, in which absorbable thread is placed under the skin at points, or a sham embedding. It reported higher AMH and antral follicle counts in the embedding group after 3 and 6 months; the abstract does not give the number of participants.
Trials that counted returning periods
A 2021 trial at the Second Affiliated Hospital of Zhengzhou University randomised 66 women with POI to acupuncture and moxibustion timed to the phases of the cycle or to Femoston, an estradiol and dydrogesterone hormone preparation, for three cycles. Among the women who had amenorrhoea, the share whose periods returned did not differ significantly between the groups. A 2014 trial by Li and colleagues randomised 65 women with POI to cyclical medroxyprogesterone alone or with catgut embedding at PC06 (Neiguan), ST36 (Zusanli), Guanyuan and Sanyinjiao for six months, and reported better symptom scores in the combined group at follow-up. Neither trial had a sham group. A 2013 case series at Guang An Men Hospital in Beijing treated 11 women with POI with electroacupuncture for three months; 10 had a period during treatment, and two, including the one who had not, reported no periods during follow-up.
Functional hypothalamic and other secondary amenorrhoea
Functional hypothalamic amenorrhoea is a form of chronic anovulation, the absence of ovulation, with no identifiable organic cause and often associated with stress, weight loss or excessive exercise, as the Endocrine Society guideline below describes it. No randomised trial of acupuncture for it was found in PubMed. A 1981 study by Kubista and colleagues gave ear acupuncture to 13 women aged 17 to 26 with intermittent or secondary amenorrhoea, 6 of them a placebo version, and reported a fall in LH during needling. A 2011 case report by Donoyama and colleagues at Tsukuba University of Technology describes a 26-year-old endurance athlete with athletic amenorrhoea whose amenorrhoea continued after a course of hormones alone, apart from one bleed, and after months of acupuncture alone, and whose periods returned after the two were combined; she had 46 acupuncture sessions in all. A 2004 report by Han in Nanjing on abdominal acupuncture for secondary amenorrhoea has no abstract in its record.
What guidelines say
The Endocrine Society's 2017 guideline on functional hypothalamic amenorrhea, cosponsored by the American Society for Reproductive Medicine (ASRM), the European Society of Endocrinology and the Pediatric Endocrine Society, is the society's current guideline on the condition; Europe PMC listed no update by October 2026. Its summary calls the condition a diagnosis of exclusion and calls for a multidisciplinary approach including medical, dietary and mental health support, and names bone loss and infertility among its complications.
The 2024 POI guideline of the European Society of Human Reproduction and Embryology (ESHRE), developed with ASRM, the International Menopause Society and the Australian research centre CRE-WHiRL, replaced the 2015 version. It recommends that clinicians ask about complementary therapies, that they should not replace hormone therapy (strong recommendation, very low-certainty evidence), and that women be told there is limited evidence for acupuncture for menopausal symptoms in POI and that the evidence does not suggest a benefit from adding it to hormone therapy. ASRM's 2024 committee opinion on the evaluation of amenorrhoea, which replaced its 2008 document, covers diagnosis rather than treatment. Clinical guidelines compares other bodies' positions.
What the reviews could not settle
The reviews pool hormone levels and follicle counts; few trials report whether periods returned, and the one review that pooled it rated the result low certainty. Almost all trials compared acupuncture with no acupuncture or with hormone therapy rather than with sham, so the reviews cannot separate a specific effect from the attention and expectation that come with treatment, and the one sham-controlled trial that reported a menstrual outcome found no difference in cycle length. Most trials come from China, several combine acupuncture with herbs or hormones, and the network meta-analyses rank combinations from trials their authors rated at unclear or high risk of bias; Where the trials come from discusses what a study's country tells a reader. For functional hypothalamic amenorrhoea, where the guideline calls for medical, dietary and mental health support, no randomised trial was found.
AcuiQ's absent periods, oligomenorrhoea, premature ovarian insufficiency and diminished ovarian reserve pages list the protocols individual studies prescribed, each with its citation. IVF covers acupuncture alongside assisted reproduction, Hot flushes the menopausal symptoms that POI shares, and Abnormal uterine bleeding the other menstrual disorders.