---
title: "Amenorrhoea"
url: "https://acuiq.com/wiki/evidence/amenorrhoea"
updated: 2026-10-20
last_verified: 2026-10-20
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-20"
reading_minutes: 11
sources: 20
---

# Amenorrhoea

_What systematic reviews of premature ovarian insufficiency and diminished ovarian reserve, two sham-controlled trials, smaller studies of secondary amenorrhoea and three guideline documents report on acupuncture for absent periods._

Amenorrhoea is the absence of menstrual periods. A [2026 review in American Family Physician](https://pubmed.ncbi.nlm.nih.gov/42607239/) 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](/wiki/evidence/polycystic-ovary-syndrome). 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](https://doi.org/10.1093/hropen/hoae065) 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](https://doi.org/10.1080/13697137.2025.2530441) 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](https://doi.org/10.3389/fendo.2025.1604563) 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](https://doi.org/10.1016/j.ctim.2025.103141) 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](https://doi.org/10.3389/fendo.2024.1361573) 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](https://doi.org/10.1155/2015/842180) 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](https://doi.org/10.3389/fmed.2024.1471243) 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](https://doi.org/10.3389/fmed.2025.1551033) 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](https://doi.org/10.3389/fendo.2023.1136121) 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](https://doi.org/10.2147/IJWH.S580821) 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`](/points/gv20) (Baihui), [`CV04`](/points/cv04) (Guanyuan), [`XC01`](/points/xc01) (Zigong), [`SP06`](/points/sp06) (Sanyinjiao), [`LV03`](/points/lv03) (Taichong), [`BL23`](/points/bl23) (Shenshu), [`BL33`](/points/bl33) (Zhongliao) and [`KD03`](/points/kd03) (Taixi). [Sham acupuncture](/wiki/research/sham-acupuncture) describes the kinds of control in use.

A [2026 single-blind multicentre trial](https://doi.org/10.2174/0113862073473958260916111037) 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](https://doi.org/10.13703/j.0255-2930.20200627-k0001) 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](https://pubmed.ncbi.nlm.nih.gov/24673050/) by Li and colleagues randomised 65 women with POI to cyclical medroxyprogesterone alone or with catgut embedding at [`PC06`](/points/pc06) (Neiguan), [`ST36`](/points/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](https://doi.org/10.1155/2013/657234) 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](https://pubmed.ncbi.nlm.nih.gov/7233907/) 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](https://doi.org/10.1136/acupmed.2011.010081) 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](https://pubmed.ncbi.nlm.nih.gov/15119172/) 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](https://doi.org/10.1210/jc.2017-00131), 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](https://doi.org/10.1093/hropen/hoae065) 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](https://doi.org/10.1016/j.fertnstert.2024.02.001) on the evaluation of amenorrhoea, which replaced its 2008 document, covers diagnosis rather than treatment. [Clinical guidelines](/wiki/evidence/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](/wiki/research/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](/symptoms/absent-periods), [oligomenorrhoea](/symptoms/oligomenorrhea), [premature ovarian insufficiency](/symptoms/premature-ovarian-insufficiency) and [diminished ovarian reserve](/symptoms/diminished-ovarian-reserve) pages list the protocols individual studies prescribed, each with its citation. [IVF](/wiki/evidence/ivf) covers acupuncture alongside assisted reproduction, [Hot flushes](/wiki/evidence/hot-flushes) the menopausal symptoms that POI shares, and [Abnormal uterine bleeding](/wiki/evidence/abnormal-uterine-bleeding) the other menstrual disorders.

### Sources

1. Klein DA, Sylvester JE, Paradise SL, Amenorrhea: a practical approach to diagnosis and management, American Family Physician 2026 — https://pubmed.ncbi.nlm.nih.gov/42607239/
2. ESHRE, ASRM, CRE-WHiRL and IMS Guideline Group on POI, Panay N, Anderson RA, et al., Evidence-based guideline: premature ovarian insufficiency, Human Reproduction Open 2024 — https://doi.org/10.1093/hropen/hoae065
3. Maunder A, Vermeulen N, Vincent AJ, Panay N, Ee C, Complementary therapies for women with premature ovarian insufficiency: a systematic literature review to inform the 2024 update of the ESHRE/ASRM/IMS/CRE-WHiRL guidelines on premature ovarian insufficiency, Climacteric 2026 — https://doi.org/10.1080/13697137.2025.2530441
4. Du Z, Ye G, Wei J, Li S, Zhao S, Wang J, Acupoint stimulation methods for premature ovarian insufficiency: a systematic review and network meta-analysis of randomized controlled trials, Frontiers in Endocrinology 2025 — https://doi.org/10.3389/fendo.2025.1604563
5. Yi Y, Ma F, Jiao Y, Zhang R, Yi Y, Ma Y, Comparative efficacy of acupuncture therapies in premature ovarian failure: a systematic review and network meta-analysis, Complementary Therapies in Medicine 2025 — https://doi.org/10.1016/j.ctim.2025.103141
6. Cao H, Li H, Lin G, et al., The clinical value of acupuncture for women with premature ovarian insufficiency: a systematic review and meta-analysis of randomized controlled trials, Frontiers in Endocrinology 2024 — https://doi.org/10.3389/fendo.2024.1361573
7. Jo J, Lee YJ, Lee H, Effectiveness of acupuncture for primary ovarian insufficiency: a systematic review and meta-analysis, Evidence-Based Complementary and Alternative Medicine 2015 — https://doi.org/10.1155/2015/842180
8. Bai T, Deng X, Bi J, Ni L, Li Z, Zhuo X, The effects of acupuncture on patients with premature ovarian insufficiency and polycystic ovary syndrome: an umbrella review of systematic reviews and meta-analyses, Frontiers in Medicine 2024 — https://doi.org/10.3389/fmed.2024.1471243
9. Sun H, Fang J, Shao X, Commentary: The effects of acupuncture on patients with premature ovarian insufficiency and polycystic ovary syndrome, Frontiers in Medicine 2025 — https://doi.org/10.3389/fmed.2025.1551033
10. Lin G, Liu X, Cong C, Chen S, Xu L, Clinical efficacy of acupuncture for diminished ovarian reserve: a systematic review and meta-analysis of randomized controlled trials, Frontiers in Endocrinology 2023 — https://doi.org/10.3389/fendo.2023.1136121
11. Wang X, Du P, Yang L, et al., Effect of acupuncture for diminished ovarian reserve: a randomized sham-controlled trial, International Journal of Women's Health 2026 — https://doi.org/10.2147/IJWH.S580821
12. Zhang Y, Sun W, Lao J, et al., Efficacy and safety of acupoint catgut embedding combined with hormone replacement therapy versus sham acupoint embedding combined with hormone replacement therapy for diminished ovarian reserve: a single-blind randomized controlled trial, Combinatorial Chemistry and High Throughput Screening 2026 — https://doi.org/10.2174/0113862073473958260916111037
13. Wang LL, Xiang YG, Tan L, et al., Acupuncture-moxibustion treatment by stages based on the theory of transformation of yin and yang for premature ovarian insufficiency, Zhongguo Zhen Jiu 2021 (in Chinese) — https://doi.org/10.13703/j.0255-2930.20200627-k0001
14. Li WD, Xu HQ, Tang JQ, Qiu HS, Premature ovarian failure treated with acupoint catgut implantation and artificial periodic therapy: a randomized controlled trial, Zhongguo Zhen Jiu 2014 (in Chinese) — https://pubmed.ncbi.nlm.nih.gov/24673050/
15. Zhou K, Jiang J, Wu J, Liu Z, Electroacupuncture modulates reproductive hormone levels in patients with primary ovarian insufficiency: results from a prospective observational study, Evidence-Based Complementary and Alternative Medicine 2013 — https://doi.org/10.1155/2013/657234
16. Kubista E, Boschitsch E, Spona J, Effect of ear-acupuncture on the LH-concentration in serum in patients with secondary amenorrhea, Wiener Medizinische Wochenschrift 1981 (in German) — https://pubmed.ncbi.nlm.nih.gov/7233907/
17. Donoyama N, Hotoge S, Ohkoshi N, Acupuncture might have contributed to improving amenorrhoea in a top athlete, Acupuncture in Medicine 2011 — https://doi.org/10.1136/acupmed.2011.010081
18. Han Y, Treatment of secondary amenorrhea with abdomen acupuncture, Journal of Traditional Chinese Medicine 2004 — https://pubmed.ncbi.nlm.nih.gov/15119172/
19. Gordon CM, Ackerman KE, Berga SL, et al., Functional hypothalamic amenorrhea: an Endocrine Society clinical practice guideline, Journal of Clinical Endocrinology and Metabolism 2017 — https://doi.org/10.1210/jc.2017-00131
20. Practice Committee of the American Society for Reproductive Medicine, Current evaluation of amenorrhea: a committee opinion, Fertility and Sterility 2024 — https://doi.org/10.1016/j.fertnstert.2024.02.001