---
title: "Menopausal symptoms"
url: "https://acuiq.com/wiki/evidence/menopausal-symptoms"
updated: 2026-11-09
last_verified: 2026-11-09
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
subtitle: "What reviews and trials report on acupuncture and electroacupuncture for menopausal symptoms as a whole, for perimenopausal syndrome, and for sleep and mood around the menopause, and what NICE and NAMS say."
basis: "Modern research"
audience: "Anyone"
published: "2026-11-09"
reading_minutes: 10
sources: 21
---

# Menopausal symptoms

Trials of acupuncture around the menopause measure either a single symptom, most often hot flushes, or the menopausal transition as a whole: hot flushes and sweats together with poor sleep, low mood, anxiety, joint pain and the rest. This page reports the second kind, the reviews and trials that scored all of those symptoms at once, and those that studied sleep and mood in women around the menopause. Hot flushes and night sweats have their own page, [Hot flushes](/wiki/evidence/hot-flushes).

## How the trials measure menopausal symptoms

Three scales recur. The Kupperman index, or Blatt-Kupperman index, sums weighted ratings of symptoms such as hot flushes, insomnia, nervousness and joint pain into one score; a [1998 critique in Maturitas](https://doi.org/10.1016/s0378-5122(98)00024-3) noted that it was derived from clinical experience in New York in the 1950s, mixes self-report with physician ratings, weights items without statistical justification and omits vaginal dryness and loss of libido, and recommended newer scales in its place. The Menopause Rating Scale (MRS) is filled in by the woman herself, as Li and colleagues' [2018 meta-analysis](https://doi.org/10.1159/000479630) notes. The Menopause-Specific Quality of Life questionnaire (MENQOL) scores quality of life as the menopause affects it. Many Chinese trials also report an effective rate, the share of women the trial counted as improved.

## What is perimenopausal syndrome?

Perimenopausal syndrome is the name most Chinese trials give to the symptoms of the menopausal transition taken together. A [2026 network meta-analysis](https://doi.org/10.3389/fneur.2025.1696085) by Yang and colleagues describes it as the hot flushes, sweating, sleep disturbance, joint and muscle pain, fatigue, vaginal dryness and other symptoms that follow declining ovarian function. The trials it pooled diagnosed it by the Chinese Medical Association's criteria, the WHO's criteria for menopause, or a Kupperman index of 15 or more, and some also enrolled women by a traditional Chinese medicine pattern such as liver-kidney yin deficiency. Its search treated "menopausal syndrome" as the same condition.

## Is there a Cochrane review?

Not of menopausal symptoms as a whole. The one Cochrane review of acupuncture in the menopause, a [2013 review of 16 trials](https://doi.org/10.1002/14651858.CD007410.pub2) by Dodin and colleagues, studied hot flushes alone; [Hot flushes](/wiki/evidence/hot-flushes) reports it. The reviews below appeared in other journals.

## Reviews of overall symptom scores

| Review | Trials and women | Comparison | What it reported |
| --- | --- | --- | --- |
| [Befus and colleagues, 2018](https://doi.org/10.1089/acm.2016.0408), an umbrella review from Duke and Wake Forest | 3 earlier reviews and 4 newer trials | No acupuncture; sham | Better health-related quality of life than no acupuncture (standardised mean difference 0.93, 3 trials); smaller or non-significant differences against sham. Benefit may be due in part or in whole to non-specific effects. |
| [Li and colleagues, 2018](https://doi.org/10.1159/000479630) | 6 trials published 2010 to 2016 | Sham | Lower MRS total and subscale scores with acupuncture at the end of treatment and at follow-up; evidence graded very low. |
| [Zhong and colleagues, 2022](https://doi.org/10.1177/09645284211055742), Tongji Hospital, Wuhan | 12 trials, 746 women | Hormone therapy; sham electroacupuncture; manual acupuncture | No significant difference from hormone therapy on the Kupperman index. Against sham, Kupperman index 4.7 points lower. Small number of studies, risk of bias and heterogeneity limited the conclusions. |
| [He and colleagues, 2021](https://doi.org/10.1142/S0192415X21500853), Macau University of Science and Technology | 15 trials, 1,376 women | Hormone therapy | Kupperman index 2.6 points lower with acupuncture and fewer side effects (risk ratio 0.14). Included only trials against hormone therapy. |
| [Yang and colleagues, 2026](https://doi.org/10.3389/fneur.2025.1696085), a network meta-analysis | 49 trials, 4,579 women, 48 trials from China | Drugs, sham, usual care and acupuncture methods against each other | Ranked electroacupuncture combined with Western medicine first on the Kupperman index and moxibustion first on effective rate. Funnel plots suggested publication bias or small-study effects. |

Most of the trials in these reviews compared acupuncture with hormone therapy or other drugs rather than with a sham, a comparison in which the women know which treatment they received. The network analysis by Yang and colleagues ranks treatments against one another, a ranking its authors said needs validating in higher-quality trials.

## Trials that scored overall symptoms

The largest sham-controlled trial is a [2018 multicentre trial](https://doi.org/10.1016/j.ajog.2018.08.019) in mainland China, by Liu and colleagues, published in the American Journal of Obstetrics and Gynecology. It gave 360 women in the menopause transition 24 sessions of electroacupuncture at traditional points, or sham electroacupuncture at non-points, over 8 weeks. The MRS total fell by 6.3 points with electroacupuncture and 4.5 with sham, a difference of 1.8 points, below the 5-point minimal clinically important difference, the smallest change patients notice. The MENQOL total improved more with electroacupuncture by 5.7 to 8.4 points over 32 weeks, above that scale's 4-point threshold. The authors concluded that electroacupuncture did not seem to relieve menopausal symptoms but appeared to improve quality of life, and noted that the women's symptoms were mild at the start.

The [2019 ACOM trial](https://doi.org/10.1136/bmjopen-2018-023637), by Lund and colleagues in nine Danish general practices, gave 36 women with moderate to severe symptoms five weekly sessions of Western medical acupuncture at fixed points (CV3, CV4, LR8, SP6 and SP9) and offered the other 34 the same treatment after six weeks. At six weeks the acupuncture group scored lower than the waiting group on hot flushes, sweats, menopause-related sleeping problems, emotional symptoms, physical symptoms, and skin and hair symptoms. A [2020 follow-up analysis](https://doi.org/10.1177/0964528420920280) of the same trial reported that the effect on flushes, sweats and sleep lasted up to 21 weeks after treatment, and found a small improvement in hot flushes in women who were still waiting for treatment. The trial had no sham arm.

The [2016 Acupuncture in Menopause trial](https://doi.org/10.1097/GME.0000000000000597) by Avis and colleagues in North Carolina, which also compared acupuncture with a waiting list, measured sleep quality, depressive symptoms, anxiety and quality of life as secondary outcomes alongside hot flushes, and reported lasting improvements in many of these.

## Sleep around the menopause

A [2016 meta-analysis](https://doi.org/10.1097/AOG.0000000000001268) in Obstetrics and Gynecology, by Chiu and colleagues at Taipei Medical University, pooled 31 trials with 2,433 women around or after the menopause and reported lower odds of sleep disturbance with acupuncture (odds ratio 0.21). A [2025 review](https://doi.org/10.1371/journal.pone.0318562) in PLOS ONE, by Zhang and colleagues in Nanjing, analysed 28 trials with 2,063 women with menopausal insomnia and kept the comparisons apart:

- Against sham, 6 trials with 428 women: Pittsburgh Sleep Quality Index (PSQI, scored 0 to 21) 2.7 points lower with acupuncture, with very high heterogeneity.
- Against sleeping tablets or hormone therapy, 16 trials with 1,203 women: PSQI 2.4 points lower with acupuncture, with no clear difference in trials that lasted more than 8 weeks.
- Acupuncture added to those drugs, 5 trials with 367 women: PSQI 3.8 points lower than the drugs alone.

It rated the certainty of the evidence moderate to very low. Among the sham-controlled trials, a [2017 trial](https://doi.org/10.1093/sleep/zsx153) in the journal Sleep randomised 76 women in Shanghai to 10 sessions of acupuncture or a retractable Streitberger placebo needle; PSQI scores fell by 8.0 and 1.3 points. A [2020 Shanghai trial](https://doi.org/10.2147/NSS.S282315) of 84 women reported a PSQI 2.4 points lower than with a non-penetrating sham after 8 weeks, a difference that held to week 20. In a [2026 non-inferiority trial](https://doi.org/10.1016/j.ctcp.2026.102071) by Yu and colleagues, 160 women with perimenopausal insomnia received electroacupuncture or cognitive behavioural therapy for insomnia (CBT-I); the Insomnia Severity Index fell by 6.8 points with electroacupuncture and 9.2 with CBT-I, a gap inside the margin the trial had set in advance for calling electroacupuncture no worse. [Insomnia](/wiki/evidence/insomnia) reports the reviews of acupuncture for insomnia in general.

## Mood around the menopause

A [2021 review](https://doi.org/10.3389/fpsyt.2021.666988) in Frontiers in Psychiatry, by Zhao and colleagues at RMIT University, analysed 25 trials with 2,213 women with perimenopausal depression. Against antidepressants or hormone therapy, acupuncture was followed by lower Hamilton Depression Scale scores (standardised mean difference 0.54), and adding acupuncture to those drugs by lower scores than the drugs alone. Too few trials compared acupuncture with a sham or with hormone therapy alone to analyse.

A [2018 multicentre trial](https://doi.org/10.1155/2018/5351210) at six hospitals in China randomised 242 women with mild to moderate perimenopausal depression to 36 sessions of electroacupuncture or the antidepressant escitalopram. The groups did not differ during treatment; at the week-24 follow-up, depression and MENQOL scores were lower in the electroacupuncture group. A [2023 trial](https://doi.org/10.1080/13697137.2023.2187284) in Climacteric of 95 women in Guangzhou compared acupuncture, Chinese herbal medicine and the two together, each with a placebo of the other; menopausal symptom and anxiety scores did not differ between the three groups after treatment, and depression scores were lower with the combination. [Depression](/wiki/evidence/depression) reports the reviews of acupuncture for depression in general.

## What guidance says

NICE's [menopause guideline (NG23)](https://www.nice.org.uk/guidance/ng23/chapter/Recommendations), first published in November 2015 and last updated on 15 April 2026, is current. It recommends hormone replacement therapy for vasomotor symptoms and suggests considering it for depressive symptoms that begin with other menopausal symptoms, and suggests considering CBT for depressive symptoms and for sleep problems that come with vasomotor symptoms. Its section on complementary therapies discusses unregulated preparations, isoflavones, black cohosh and St John's wort, and does not mention acupuncture. The North American Menopause Society's [2023 nonhormone therapy position statement](https://doi.org/10.1097/GME.0000000000002200) covers vasomotor symptoms only; it lists acupuncture among the treatments it does not recommend for them, on limited or inconsistent evidence (its Level II). Neither body has issued guidance on acupuncture for overall menopausal symptoms, sleep or mood. [Clinical guidelines](/wiki/evidence/clinical-guidelines) compares these positions with other bodies'.

## What the reviews could not settle

The reviews and trials here could not separate the effect of needling from the effect of a course of treatment. Most compared acupuncture with drugs, a waiting list or nothing, without blinding; the largest sham-controlled trial found a difference in overall symptom scores smaller than patients notice, alongside a larger one in quality of life; and the sham-controlled sleep trials were small, used different shams and disagreed on the size of the effect. [Sham acupuncture](/wiki/research/sham-acupuncture) explains why no sham is inert. Of the 49 trials in the largest network analysis, 48 were run in China, and many scored women on the Kupperman index, which the 1998 critique advised replacing. None compared acupuncture with fezolinetant, or with menopause-specific CBT for overall symptoms.

AcuiQ's [perimenopausal syndrome](/symptoms/perimenopausal-syndrome) and [menopause](/symptoms/menopause) pages list the protocols individual studies prescribed, each with its citation; [perimenopausal insomnia](/symptoms/insomnia-perimenopausal) lists those for sleep.

### Sources

1. Dodin S, Blanchet C, Marc I, et al., Acupuncture for menopausal hot flushes, Cochrane Database of Systematic Reviews 2013 — https://doi.org/10.1002/14651858.CD007410.pub2
2. Alder E, The Blatt-Kupperman menopausal index: a critique, Maturitas 1998 — https://doi.org/10.1016/s0378-5122(98)00024-3
3. Yang X, Zhu F, Zhong Y, et al., Comparative effectiveness of different acupuncture therapies for perimenopausal syndrome: a systematic review and network meta-analysis, Frontiers in Neurology 2026 — https://doi.org/10.3389/fneur.2025.1696085
4. Befus D, Coeytaux RR, Goldstein KM, et al., Management of menopause symptoms with acupuncture: an umbrella systematic review and meta-analysis, Journal of Alternative and Complementary Medicine 2018 — https://doi.org/10.1089/acm.2016.0408
5. Li W, Luo Y, Fu W, Lei R, Acupuncture may improve quality of life in menopausal women: a meta-analysis of randomized controlled trials, Complementary Medicine Research 2018 — https://doi.org/10.1159/000479630
6. Zhong Z, Dong H, Wang H, et al., Electroacupuncture for the treatment of perimenopausal syndrome: a systematic review and meta-analysis of randomized controlled trials, Acupuncture in Medicine 2022 — https://doi.org/10.1177/09645284211055742
7. He QD, Zhong ZH, Liu MN, et al., Efficacy and safety of acupuncture vs. hormone therapy for menopausal syndrome: a systematic review and meta-analysis, American Journal of Chinese Medicine 2021 — https://doi.org/10.1142/S0192415X21500853
8. Liu Z, Ai Y, Wang W, et al., Acupuncture for symptoms in menopause transition: a randomized controlled trial, American Journal of Obstetrics and Gynecology 2018 — https://doi.org/10.1016/j.ajog.2018.08.019
9. Lund KS, Siersma V, Brodersen J, Waldorff FB, Efficacy of a standardised acupuncture approach for women with bothersome menopausal symptoms: a pragmatic randomised study in primary care (the ACOM study), BMJ Open 2019 — https://doi.org/10.1136/bmjopen-2018-023637
10. Lund KS, Siersma V, Bang CW, et al., Sustained effects of a brief and standardised acupuncture approach on menopausal symptoms: post hoc analysis of the ACOM randomised controlled trial, Acupuncture in Medicine 2020 — https://doi.org/10.1177/0964528420920280
11. Avis NE, Coeytaux RR, Isom S, Prevette K, Morgan T, Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial, Menopause 2016 — https://doi.org/10.1097/GME.0000000000000597
12. Chiu HY, Hsieh YJ, Tsai PS, Acupuncture to reduce sleep disturbances in perimenopausal and postmenopausal women: a systematic review and meta-analysis, Obstetrics and Gynecology 2016 — https://doi.org/10.1097/AOG.0000000000001268
13. Zhang X, Liu C, Qin S, et al., Acupuncture as an independent or adjuvant therapy to standard management for menopausal insomnia: a systematic review and meta-analysis, PLOS ONE 2025 — https://doi.org/10.1371/journal.pone.0318562
14. Fu C, Zhao N, Liu Z, et al., Acupuncture improves peri-menopausal insomnia: a randomized controlled trial, Sleep 2017 — https://doi.org/10.1093/sleep/zsx153
15. Li S, Wang Z, Wu H, et al., Electroacupuncture versus sham acupuncture for perimenopausal insomnia: a randomized controlled clinical trial, Nature and Science of Sleep 2020 — https://doi.org/10.2147/NSS.S282315
16. Yu XT, Wang HX, Hu J, et al., Effect of electroacupuncture versus cognitive behavioral therapy for perimenopausal insomnia: a non-inferiority, randomized controlled trial, Complementary Therapies in Clinical Practice 2026 — https://doi.org/10.1016/j.ctcp.2026.102071
17. Zhao FY, Fu QQ, Kennedy GA, et al., Acupuncture as an independent or adjuvant management to standard care for perimenopausal depression: a systematic review and meta-analysis, Frontiers in Psychiatry 2021 — https://doi.org/10.3389/fpsyt.2021.666988
18. Li S, Li ZF, Wu Q, et al., A multicenter, randomized, controlled trial of electroacupuncture for perimenopause women with mild-moderate depression, BioMed Research International 2018 — https://doi.org/10.1155/2018/5351210
19. Wang J, Liao Y, You Y, et al., Acupuncture and Chinese herbal medicine for menopausal mood disorder: a randomized controlled trial, Climacteric 2023 — https://doi.org/10.1080/13697137.2023.2187284
20. National Institute for Health and Care Excellence, Menopause: identification and management (NG23), recommendations, last updated April 2026 — https://www.nice.org.uk/guidance/ng23/chapter/Recommendations
21. The North American Menopause Society, The 2023 nonhormone therapy position statement of The North American Menopause Society, Menopause 2023 — https://doi.org/10.1097/GME.0000000000002200