---
title: "Polycystic ovary syndrome"
url: "https://acuiq.com/wiki/evidence/polycystic-ovary-syndrome"
updated: 2026-10-10
last_verified: 2026-10-10
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-10"
reading_minutes: 9
sources: 12
---

# Polycystic ovary syndrome

_What the Cochrane review, later reviews, sham-controlled and drug-controlled trials, and the 2023 international guideline report on acupuncture for ovulation, live birth, periods and insulin resistance in PCOS._

Polycystic ovary syndrome (PCOS) is a hormonal condition marked, as the [Cochrane review](https://doi.org/10.1002/14651858.CD007689.pub5) below describes it, by infrequent or absent periods, infertility and hirsutism, excess body hair driven by androgens. Some trials enrol only women who also have insulin resistance, in which the body needs more insulin than usual to keep blood sugar steady. Trials of acupuncture for PCOS measure one of four things: whether ovulation happens, whether a pregnancy ends in a live birth, how regular periods become, and metabolic markers such as insulin resistance. A trial can succeed on one and fail on another, so this page keeps them apart, and it keeps apart the control each trial used: sham acupuncture, a procedure made to resemble it ([Sham acupuncture](/wiki/research/sham-acupuncture) describes the kinds); a drug; exercise or a meeting with a therapist; or no treatment. Acupuncture during IVF is covered on its own page, [IVF](/wiki/evidence/ivf).

## The Cochrane review

The [Cochrane review](https://doi.org/10.1002/14651858.CD007689.pub5) by Zhang, Lim, Cheng and Lim, published in October 2025, is the fourth update of a review first published in 2011. Its searches of most databases ran to December 2024, though its search of one Chinese database, CBM, stopped in November 2015. It included 9 randomised trials with 1,606 women who ovulated rarely or not at all, one more trial than the 2019 version. Three trials compared acupuncture with sham, one low-frequency electroacupuncture with exercise or no treatment, one acupuncture with relaxation, one with clomiphene, a drug that induces ovulation, and three with Diane-35, an oral contraceptive containing an anti-androgen.

| Outcome | Trials (women) | Result | Certainty (GRADE) |
| --- | --- | --- | --- |
| Live birth | 1 (1,000) | Little or no difference (risk ratio 0.97) | Low |
| Multiple pregnancy | 1 (1,000) | Little or no difference | Low |
| Ovulations per woman during treatment | 2 (1,010) | Little or no difference | Low |
| Clinical pregnancy | 3 (1,117) | Little or no difference (risk ratio 1.07) | Low |
| Miscarriage | 1 (926) | Little or no difference | Low |
| Days between periods at 12 weeks | 1 (141) | Fewer with acupuncture | Very low |
| Adverse events | 3 (1,230) | More with acupuncture (risk ratio 1.16) | Moderate |

GRADE is the scale reviews use to say how far a result can be trusted; low means the true effect may be substantially different. The authors rated every comparison with an active treatment or with no treatment very low in certainty, and none of those trials reported live birth. Adverse events recorded in acupuncture groups included vaginal bleeding, weight gain, fatigue, dizziness, nausea and bruising under the skin. The authors concluded that they found no clear difference between acupuncture and sham on any fertility outcome or on restoring regular periods, that acupuncture is probably associated with more adverse events, and that the effectiveness of acupuncture for PCOS remains uncertain because the trials are few and report different outcomes.

## Later reviews

An [overview of 11 systematic reviews](https://doi.org/10.1016/j.joim.2022.12.002) by Yang and colleagues at Chengdu University of Traditional Chinese Medicine, published in 2023, rated the methods of 9 of them extremely low and 2 low on AMSTAR 2, a checklist for judging how a review was done. Of the 64 results the reviews reported, the overview judged 2 high in certainty and 20 very low. The reviews reported better pregnancy and ovulation rates when acupuncture was added to drugs, and better menstrual recovery against no treatment, and the overview concluded that the efficacy and safety of acupuncture for PCOS remain uncertain.

Two network meta-analyses published in 2026 pooled trials comparing many acupuncture-related methods with drugs or placebo, most of them from China. [Li and colleagues](https://doi.org/10.1186/s12906-026-05295-5) gathered 59 trials with 5,937 participants, searched to October 2023, and found lower testosterone with acupuncture than with drugs and lower scores on the Ferriman-Gallwey scale, a count of excess body hair, with electroacupuncture than with placebo; drugs ranked first for insulin resistance. [Du and colleagues](https://doi.org/10.3389/fendo.2026.1748814) gathered 53 trials with 4,406 participants, searched to September 2025, and reported lower insulin resistance with acupoint injection and with acupuncture plus moxibustion. Both ranked methods by the probability of coming first, and both called the trials limited; Du’s team noted that adverse events were reported in few of them. Neither abstract gives a GRADE rating.

A [2025 review of safety](https://doi.org/10.1177/19336586251360119) by Nurwati and colleagues in Indonesia included 13 trials, searched to September 2024. No trial recorded a serious or life-threatening adverse event. Bruising at the needle sites was more frequent with acupuncture than with sham or no acupuncture, and miscarriage rates were similar to controls when low-frequency electroacupuncture was given before pregnancy.

## Landmark trials

The [PCOSAct trial](https://doi.org/10.1001/jama.2017.7217), published in JAMA in 2017 by Wu, Stener-Victorin and colleagues, is the trial behind the Cochrane review’s live-birth result. It randomised 1,000 Chinese women with PCOS at 27 hospitals to four groups of 250 in a factorial design, which tests two treatments at once: active or control acupuncture, each combined with clomiphene or a placebo pill. Active acupuncture meant deep needling with manual and low-frequency electrical stimulation twice a week; control acupuncture meant shallow needling with no manual stimulation and a stimulator that delivered no current. Treatment lasted up to 4 ovulation cycles, and 926 women completed the trial.

- Live births were 29.4% with active acupuncture and clomiphene, 28.0% with control acupuncture and clomiphene, 13.9% with active acupuncture and placebo, and 16.8% with control acupuncture and placebo.
- Clomiphene raised the live-birth rate from 15.4% to 28.7%, a difference of 13.3 percentage points; active and control acupuncture gave 21.8% and 22.4%.
- Diarrhoea (5.0% against 1.6%) and bruising (7.4% against 1.8%) were more common with active acupuncture.

The authors concluded that the finding does not support acupuncture as an infertility treatment in these women.

A [2022 trial in Human Reproduction](https://doi.org/10.1093/humrep/deab272) by Wen and colleagues at three hospitals in Guangdong randomised 342 women with PCOS and insulin resistance to acupuncture with a placebo pill, metformin with sham acupuncture, or sham acupuncture with a placebo pill, for 4 months. Insulin resistance fell by 14.7% with acupuncture, 25.0% with metformin and 8.6% with sham. The authors found acupuncture less effective than metformin and not significantly different from sham. Gastrointestinal side effects were more frequent with metformin, and bruising with acupuncture.

Smaller trials in Sweden and the United States came first. A [2011 trial in Virginia](https://doi.org/10.1210/jc.2011-1126) by Pastore and colleagues gave 84 women 12 sessions of true or sham acupuncture over 8 weeks and found similar ovulation rates over 5 months: 0.37 a month with true acupuncture and 0.40 with sham. In Gothenburg, Stener-Victorin’s group randomised 84 women to 16 weeks of low-frequency electroacupuncture, exercise or no treatment, in a [2011 trial](https://doi.org/10.1152/ajpendo.00495.2010) led by Jedel; menstrual frequency in the electroacupuncture group rose from 0.28 to 0.69 periods a month, more than with exercise, and both active groups did better than no treatment. A [2013 trial](https://doi.org/10.1152/ajpendo.00039.2013) by Johansson in the same group randomised 32 women to acupuncture or to meetings with a physical therapist for 10 to 13 weeks, and found more frequent ovulation and lower sex-steroid levels with acupuncture. Neither Swedish trial used a sham control.

Trials adding acupuncture to letrozole, the drug current guidance prefers for inducing ovulation, are newer and smaller. A [2025 trial](https://doi.org/10.1016/j.ctim.2025.103215) by Ding and colleagues randomised 134 infertile women on letrozole to added acupuncture or placebo acupuncture over 3 cycles, and reported higher ovulation and pregnancy rates with acupuncture; it did not report live births in its abstract.

## What guidelines say

The [2023 International Evidence-based Guideline](https://doi.org/10.1210/clinem/dgad463) for the assessment and management of PCOS, led by Teede and colleagues at Monash University and published the same year in four journals, updates the 2018 guideline and carries 77 evidence-based and 54 consensus recommendations. Its published recommendations do not mention acupuncture. They name letrozole the first-line drug for inducing ovulation in infertile women with PCOS who have no other infertility factor, on high-certainty evidence. On complementary therapies, two practice points apply: women taking them are encouraged to tell their healthcare professional, and information given to women should be evidence-based while respecting their preferences, complementary therapies included. The full guideline document, hosted by Monash, could not be opened for this page. [Clinical guidelines](/wiki/evidence/clinical-guidelines) compares other bodies’ positions.

## What the reviews could not settle

The sham-controlled trials of acupuncture alone, PCOSAct among them, found no difference on fertility; the one sham-controlled trial that reported a difference, Ding 2025, added acupuncture to letrozole and reported no live births. The other trials that found a difference compared acupuncture with exercise, a therapist, drugs or nothing. PCOSAct is the only trial that measured live birth, so the Cochrane authors had nothing to pool it with, and all its women were Chinese. Most metabolic results come from trials in China that reviews rated low in methodological quality, and the one large sham-controlled trial of insulin resistance, Wen 2022, found no difference from sham. [Where the trials come from](/wiki/research/where-the-trials-come-from) discusses what the country of a trial tells a reader. No trial has tested acupuncture added to letrozole with live birth as its outcome. [Obesity](/wiki/evidence/obesity) covers the trials of acupuncture for weight, and [Period pain](/wiki/evidence/period-pain) the trials in dysmenorrhoea.

AcuiQ’s [polycystic ovary syndrome](/symptoms/polycystic-ovary-syndrome-pcos) and [anovulation](/symptoms/anovulation) pages list the protocols individual studies prescribed, each with its citation.

### Sources

1. Zhang GS, Lim ECN, Cheng NCL, Lim CED, Acupuncture for polycystic ovary syndrome, Cochrane Database of Systematic Reviews 2025 — https://doi.org/10.1002/14651858.CD007689.pub5
2. Yang H, Xiao ZY, Yin ZH, et al., Efficacy and safety of acupuncture for polycystic ovary syndrome: an overview of systematic reviews, Journal of Integrative Medicine 2023 — https://doi.org/10.1016/j.joim.2022.12.002
3. Li P, Lu Y, Wang Y, Weng A, Liang X, Effects of different acupuncture methods on polycystic ovarian syndrome: a systematic review and network meta-analysis, BMC Complementary Medicine and Therapies 2026 — https://doi.org/10.1186/s12906-026-05295-5
4. Du Z, Yerebake M, Shi A, et al., Efficacy and safety of acupuncture-related therapies in improving insulin resistance, reproductive endocrine outcomes, and ovarian morphology in polycystic ovary syndrome: a systematic review and network meta-analysis, Frontiers in Endocrinology 2026 — https://doi.org/10.3389/fendo.2026.1748814
5. Nurwati I, Tristan CD, Modesty K, et al., Safety of acupuncture in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials, Medical Acupuncture 2025 — https://doi.org/10.1177/19336586251360119
6. Wu XK, Stener-Victorin E, Kuang HY, et al., Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial, JAMA 2017 — https://doi.org/10.1001/jama.2017.7217
7. Wen Q, Hu M, Lai M, et al., Effect of acupuncture and metformin on insulin sensitivity in women with polycystic ovary syndrome and insulin resistance: a three-armed randomized controlled trial, Human Reproduction 2022 — https://doi.org/10.1093/humrep/deab272
8. Pastore LM, Williams CD, Jenkins J, Patrie JT, True and sham acupuncture produced similar frequency of ovulation and improved LH to FSH ratios in women with polycystic ovary syndrome, Journal of Clinical Endocrinology and Metabolism 2011 — https://doi.org/10.1210/jc.2011-1126
9. Jedel E, Labrie F, Odén A, et al., Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial, American Journal of Physiology: Endocrinology and Metabolism 2011 — https://doi.org/10.1152/ajpendo.00495.2010
10. Johansson J, Redman L, Veldhuis PP, et al., Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial, American Journal of Physiology: Endocrinology and Metabolism 2013 — https://doi.org/10.1152/ajpendo.00039.2013
11. Ding M, Zhu X, Huang Y, et al., Acupuncture as an alternative treatment for polycystic ovary syndrome: effects on ovulation rate, pregnancy rate and endometrial receptivity, Complementary Therapies in Medicine 2025 — https://doi.org/10.1016/j.ctim.2025.103215
12. Teede HJ, Tay CT, Laven JJE, et al., Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome, Journal of Clinical Endocrinology and Metabolism 2023 — https://doi.org/10.1210/clinem/dgad463