Hot flushes are the commonest vasomotor symptom of the menopause, the group of symptoms that also includes night sweats. In women treated for breast cancer they can also follow surgery, chemotherapy or hormone-blocking treatment, according to the Society for Integrative Oncology. The 2013 Cochrane review of acupuncture for menopausal hot flushes, by Sylvie Dodin and colleagues at Université Laval, pooled 16 trials with 1,155 women. Against a sham, it found no significant difference in how often flushes came; against no treatment, it found fewer and milder flushes; and against hormone therapy, it found more. It rated all of that evidence low or very low in certainty. Trials since then have kept the same split between sham and no-treatment comparisons, and guideline bodies have read it differently for women with and without breast cancer.
The Cochrane review
The review searched to January 2013 for randomised trials in women around or after the menopause with hot flushes, comparing any form of acupuncture with a sham, with no treatment or with another treatment. Several results are standardised mean differences, which express the gap between groups in standard deviations so that trials using different scales can be pooled; the review called 0.5 a moderate effect.
| Comparison | Trials and women | What the review found | Certainty |
|---|---|---|---|
| Acupuncture against sham | 8 trials, 414 women (frequency); 6 trials, 297 women (severity) | No significant difference in the number of flushes a day. Flushes less severe with acupuncture, by a small amount (standardised mean difference 0.45). With the one trial in women with cancer removed, neither difference remained. | Low (frequency); very low (severity) |
| Acupuncture against hormone therapy | 3 trials, 114 women | About 3 more flushes a day with acupuncture than with hormone therapy. | Low |
| Electroacupuncture against relaxation | 1 trial, 38 women | No significant difference. | Very low |
| Traditional acupuncture against waiting list or no treatment | 3 trials, 463 women | Fewer flushes and milder flushes, each a moderate effect (standardised mean differences 0.50 and 0.54). | Low |
The authors concluded that there was insufficient evidence to say whether acupuncture controls menopausal hot flushes, and warned that the no-treatment and hormone-therapy comparisons had no sham or placebo control. Data on adverse effects were lacking. The review has not been updated since 2013.
Trials in women without cancer
Four of the larger trials in women without cancer compared acupuncture with different controls.
- The 2009 ACUFLASH trial in Norway gave 134 women ten sessions of individualised acupuncture plus self-care advice and 133 women the advice alone. After 12 weeks, flushes had fallen by 5.8 a day with acupuncture and 3.7 a day without it.
- A 2016 Australian trial in the Annals of Internal Medicine, by Ee and colleagues, randomised 327 women with at least seven moderate flushes a day to ten sessions of Chinese medicine acupuncture or a non-penetrating sham over eight weeks. Hot flush scores at the end of treatment were 15.36 and 15.04, a difference that was not statistically significant.
- The 2016 Acupuncture in Menopause trial in North Carolina, by Avis and colleagues, gave 209 women up to 20 sessions in the first six months or the second. At six months flushes had fallen by 36.7% in the acupuncture group and risen by 6.0% in the waiting group, and most of the fall held six months after treatment ended.
- A 2018 trial at multiple centres in China, by Liu and colleagues, gave 360 women in the menopause transition 24 sessions of electroacupuncture or sham electroacupuncture at non-acupoints. Both symptom scores and hot flush scores improved more with electroacupuncture, but by less than the minimal clinically important difference, the smallest change patients notice; quality-of-life scores improved by more than that threshold.
A 2026 systematic review by Maunder and colleagues, written to inform the International Menopause Society’s recommendations, covered 158 studies of complementary therapies published from 2022 to 2024. It described the evidence for acupuncture as promising but mostly of low or very low certainty.
Trials after breast cancer
The Cochrane review’s sensitivity analysis suggested that results may differ in women with cancer. A 2015 review by Garcia and colleagues found eight trials of acupuncture for hot flushes in cancer patients, all in women with breast cancer, none at low risk of bias, and judged the evidence insufficient to support or refute a benefit.
Two trials appeared that year and the next in the Journal of Clinical Oncology. The 2016 AcCliMaT trial by Lesi and colleagues at hospitals in Emilia-Romagna, Italy, randomised 190 women with breast cancer to ten sessions of acupuncture plus enhanced self-care, or self-care alone, for 12 weeks. Hot flush scores, frequency multiplied by severity, were lower with acupuncture at the end of treatment and at three and six months afterwards. The trial had no sham arm. A 2015 trial by Mao and colleagues at the University of Pennsylvania randomised 120 breast cancer survivors to electroacupuncture, sham acupuncture, the drug gabapentin or a placebo pill for eight weeks. Hot flush scores fell most with electroacupuncture, then sham acupuncture, gabapentin and the placebo pill; the sham needles produced a larger placebo effect than the placebo pill. Treatment-related adverse events were reported by 39.3% on gabapentin, 20.0% on the placebo pill, 16.7% with electroacupuncture and 3.1% with sham acupuncture.
What guidance says
NICE’s menopause guideline (NG23), first published in 2015 and last updated in April 2026, recommends hormone replacement therapy for vasomotor symptoms, with menopause-specific cognitive behavioural therapy and the drug fezolinetant as options. Its section on complementary therapies discusses isoflavones and black cohosh and makes no recommendation on acupuncture. The North American Menopause Society’s 2023 nonhormone therapy position statement lists acupuncture among the treatments it does not recommend for vasomotor symptoms, on limited or inconsistent evidence (its Level II).
For women with breast cancer, the Society for Integrative Oncology’s 2017 guideline on integrative therapies during and after treatment states that acupuncture can be considered for improving hot flashes, graded C. ASCO, the American Society of Clinical Oncology, endorsed that guideline in 2018. Clinical guidelines compares these positions with other bodies’ positions on acupuncture.
What the reviews could not settle
Acupuncture beat waiting lists and self-care alone, and in most trials did not beat a sham by a margin patients would notice. The trials therefore leave open whether the needling or the course of treatment accounts for the change. The Mao trial shows how large the response to a sham procedure can be in this condition. Sham acupuncture explains why no sham is inert. The sources also could not settle whether women with breast cancer respond differently, since the cancer trials are smaller and most lack a sham, and none of the trials here compared acupuncture directly with fezolinetant or with menopause-specific CBT.
AcuiQ’s hot flashes page lists the protocols individual studies prescribed, each with its citation; the hot flushes, menopause and perimenopausal syndrome pages hold related studies.