Uterine fibroids, also called leiomyomas, are benign growths in the muscle of the uterus. The 2013 Cochrane review of herbal preparations calls them the most common non-cancerous growth in women of childbearing age and links them with heavy menstrual bleeding and reduced fertility. The literature on acupuncture for fibroids is small: the one Cochrane review found no trial it could include, and the trials pooled since then all come from China and compare acupuncture with a Chinese herbal formula or a drug, never with sham acupuncture. Chinese herbal medicine, Guizhi Fuling formula above all, has the larger literature. This page reports the acupuncture reviews first and the herbal reviews separately, because a result for one says nothing about the other.
The Cochrane review
The Cochrane review by Zhang, Peng, Clarke and Liu, published in January 2010, searched English and Chinese databases to May 2009 for randomised trials comparing needle acupuncture with sham, no treatment, Chinese or Western medicine. It counted moxibustion as acupuncture only when needles were also used. Of 106 reports it retrieved, 95 described trials with no control group and 5 did not say whether allocation was random. Six were randomised; one of them, Yu 2005, came closest to inclusion, and the authors excluded it after its author could not say how the sequence was generated or concealed. That trial gave 62 women warm needling, a needle heated by burning moxa on its handle, at XC01 (Zigong), and compared it with Gongliuqing capsule, a Chinese herbal product. A second report, Deng 2008, combined acupuncture with herbal medicines and so could not show what acupuncture alone did.
With no trial included, the review has no pooled result and no GRADE rating; GRADE is the scale reviews use to say how far a result can be trusted, from high to very low. The authors concluded that the effectiveness of acupuncture for fibroids remains uncertain and called for well-designed trials with long follow-up. The record was last edited in December 2011, to reword how the interventions were described, with no change to its conclusions. It has not been updated or withdrawn.
Later reviews
A 2023 meta-analysis in Frontiers in Medicine by Ren and colleagues at Guang'anmen Hospital in Beijing searched six databases to May 2023 and included 11 randomised trials with 735 women. All 11 were published in Chinese. Seven used manual acupuncture, two electroacupuncture, one warm needling and one catgut embedding, in which absorbable suture is left under the skin at a point (Thread embedding describes it). Nine control groups took a fixed Chinese herbal formula, two of them Guizhi Fuling capsule; one took a formula chosen by pattern diagnosis, and one took mifepristone, an anti-progesterone drug. In four trials the acupuncture group also took the herbal formula, so the comparison was acupuncture added to herbs against herbs alone.
Pooled across all 11 trials, the review found smaller fibroids in the acupuncture groups, but heterogeneity was 91% on the I² scale, which means the trials disagreed with each other far more than chance explains. It found lower symptom scores in four trials with 245 women, again with high heterogeneity, and oestrogen levels did not differ. Because every trial compared acupuncture with a pill, the authors rated all 11 at high risk of bias for blinding. They reported no serious adverse reactions, and the review gives no GRADE rating.
A 2024 meta-analysis in Frontiers in Oncology by Chen and colleagues at Yunnan University of Traditional Chinese Medicine asked the add-on question directly. It included 9 trials from China with 640 women, each comparing acupuncture plus Chinese herbs with the same herbs alone, for 2 to 6 months. The review found a higher overall response rate with the combination (risk ratio 1.20) and smaller fibroids. The authors rated the evidence low for response rate and very low for fibroid size, and said few trials reported adverse effects.
A 2025 narrative review by Hooshyarazar and colleagues at Mashhad University of Medical Sciences in Iran collected 24 published acupuncture prescriptions for fibroids from English-language sources. The points chosen most often were CV04 (Guanyuan), SP06 (Sanyinjiao), Zigong and CV03 (Zhongji). The review reports what practitioners prescribed, not whether it helped, and its authors note the lack of adequate clinical trials.
A study outside China
The trials in both meta-analyses were run in China. The one study from elsewhere found for this page is a 2019 feasibility study in Medical Acupuncture by Cruz, Carrington and Hong at the Atlantic Institute of Oriental Medicine in Fort Lauderdale, Florida, which gave 9 women a 7-point protocol from Tung's acupuncture twice a week for 6 or 12 weeks, with no control group. All 9 completed it without adverse events, and symptom questionnaire scores fell; the ultrasound measurements of fibroid size could not be interpreted because of technical problems. The authors present it as evidence that a larger controlled trial could be run, not as a test of effect.
Herbal medicine
The herbal literature is larger and comes mostly from China. It answers a different question, since it tests what a formula does, and none of it is evidence about needling.
| Review | Trials (women) | Main comparison | What it found | Certainty |
|---|---|---|---|---|
| Liu 2013, Cochrane | 21 (2,222) | Several herbal preparations against placebo, drugs or no treatment | No trial reported fibroid symptoms. Guizhi Fuling formula plus mifepristone shrank fibroids more than mifepristone alone (7 trials). No serious adverse effects in the 13 trials that reported them. | Most trials at unclear or high risk of bias |
| Chen 2014, BMC Complementary and Alternative Medicine | 38 (3,816) | Guizhi Fuling formula, alone or with mifepristone | Smaller fibroids with the formula plus mifepristone than with mifepristone alone; less period pain with the formula alone or combined. No serious adverse events. | Methodological quality generally poor |
| Lei 2023, BMC Complementary Medicine and Therapies | 28 (2,813) | Guizhi Fuling capsule plus low-dose mifepristone against mifepristone alone | Smaller fibroids and uterus, lower menstrual flow and lower sex-hormone levels with the combination; adverse reactions not significantly more frequent. | Very low to moderate (GRADE) |
The Cochrane authors concluded that the evidence neither supports nor refutes herbal preparations for fibroids. Chen and colleagues wrote that the trials' high risk of bias prevented a firm conclusion, and Lei and colleagues called for a rigorous, large trial to confirm theirs.
What guidelines say
NICE guideline NG88 on heavy menstrual bleeding, published in March 2018 and last updated in July 2026, covers fibroids of 3 cm or more. For those it lists tranexamic acid, anti-inflammatory painkillers, hormonal treatments, uterine artery embolisation, myomectomy and hysterectomy, and it points to NICE appraisals of two GnRH antagonist drugs. Its recommendations do not mention acupuncture or herbal medicine.
ACOG Practice Bulletin 228, the American College of Obstetricians and Gynecologists' guidance on symptomatic fibroids, was published in June 2021 and reaffirmed in 2025. Its stated scope is medical, procedural and surgical management; its full text is open only to members and could not be read for this page.
The Society of Obstetricians and Gynaecologists of Canada published Guideline No. 461 in June 2025, replacing its earlier guideline and grading each statement with GRADE. Its 24 recommendations cover imaging, hormonal and non-hormonal drugs, surgery, embolisation, radiofrequency ablation and focused ultrasound, and none mentions acupuncture or herbal medicine. Clinical guidelines compares other bodies' positions on acupuncture.
What the reviews could not settle
No sham-controlled trial of acupuncture for fibroids has been published, so no review can separate the effect of needling from the effect of an unblinded treatment and the attention that comes with it. The trials compared acupuncture with herbal formulas whose own benefit the herbal reviews could not confirm, or added acupuncture to them. Most trials measured fibroid volume on ultrasound and an overall response rate; few measured heavy bleeding or pain, the symptoms the Cochrane review set as its primary outcomes, and the herbal Cochrane review found no trial that reported them. Every pooled trial came from China, all of Ren's were published in Chinese, and Where the trials come from discusses what that means for a body of evidence. Period pain covers the trials in dysmenorrhoea, and Polycystic ovary syndrome the trials in another hormonal condition.
AcuiQ's uterine fibroids and menorrhagia pages list the protocols individual studies prescribed, each with its citation.