The effectiveness and efficacy of acupuncture and associated modalities on the vasomotor symptomatology associated with perimenopause or post-menopause : an evidence based literature review

Abstract

Background : Vasomotor symptoms (VMS), generally referring to ‘Hot flushes’ and ‘night sweats’, are the most common and frequent reported episodes of perimenopausal symptom affecting around 75% of menopausal women .The worldwide occurrence of VMS to be as high as 80%, with a range in variety and severity sufficient to affect the quality of life and overall health of women. These symptoms commence one to two years before menopause and may continue from six months to more than 10 years. Objectives: To investigate the degree of effectiveness or efficacy and safety of acupuncture and concomitant modalities in treating vasomotor symptoms in females during spontaneous perimenopause and after the menopause. Methodology: The design method is the literature of randomised controlled trials .A total of 20 databases were systematically searched for the related reports over the past 17 years from date of inception of search (2005-2023) ,for peer-reviewed, full-text journal articles of international studies published in English language. Acupuncture from any tradition was considered, including auricular acupuncture, electroacupuncture, acupressure, and laser acupuncture, moxibustion etc. A total of 118 potentially relevant articles were retrieved for this literature review. 109 studies were excluded since they did not meet the preselection criteria .Eventually, the 9 RCT studies that met the inclusion criteria and provided exclusive information about the use of acupuncture and its modalities for the treatment of Hot flushes were selected and incorporated in this literature review . The total population for

5

these studies were of 849 participants. The RCT’s were analysed for study strength using the STRICTA and CONSORT assessment tools. Additionally, the Cochrane Risk of Bias tool was used to appraise the risk of bias in the included studies . These tools aided in assessing the quality of the methodology of each study and the standard of reporting in each selected RCT’S.

Results: The average CONSORT score for all the studies was 27.6 (74.5%: minimum 43.2% | maximum 89.2%) while the average STRICTA score was 13.4 (78.8%: minimum 64.7% | maximum 94.1%) The average combined STRICTA and CONSORT scores for the nine reviewed studies is 40.9 (75.8%: minimum 50.9% | maximum 90.7%. All but one study has a combined CONSORT and STRICTA percentage score of >65% with an average percentage score of 75.8%. This suggests that the RCT studies can be considered as having an adequate scientific rigorous validity though careful attention could be given to improve validity. However ,different bias parameters for the nine studies reviewed were found. Some studies had a particularly high risk of bias and high risk of uncertain bias score . Conclusion : This literature review explored and subsequently indicated that acupuncture and concomitant modalities is safe, useful and effective or efficacious in managing hotflushes in females during all stages of menopause and that it improves the related quality of life. Regrettably, the robustness of the results was however difficult to determine mostly due to the heterogeneity of the included trials , poor methodology of most trials, low study populations with several reporting and selection bias and various study limitations in all 9 RCT’s. Therefore, definite firm conclusions on both the effectiveness or the efficacy of acupuncture treatment or its modalities and which is the leading protocol to

6

follow , could not be reached. In the interest of evidence-based practice, rigorous large - scale studies adhering to CONSORT and STRICTA guidelines , aiming to reduce Bias and possibly incorporating a standardized protocol are needed ,to confirm findings and elucidate optimal treatment approaches in investigating the role of acupuncture and concomitant modalities, in managing hot flush symptoms during natural female perimenopause and after the menopause.