Electroacupuncture for the treatment of perimenopausal syndrome: a systematic review and meta-analysis of randomized controlled trials

Objective: To assess the efficacy, comparative effectiveness and safety of electroacupuncture (EA) in the treatment of perimenopausal syndrome (PMS). Methods: Nine databases were searched until June 2019. Only relevant randomized controlled trials (RCTs) of EA for PMS were included. Results: Twelve trials involving 746 women were included. EA and hormone therapy (HT) did not significantly differ in terms of effective rate (risk ratio (RR) = 0.98, 95% confidence interval (CI) = 0.93 to 1.04), Kupperman index (KI) (mean difference (MD) = −0.25, 95% CI = −0.76 to 0.26) and serum levels of follicle-stimulating hormone (FSH) (MD = −3.80, 95% CI = −11.59 to 3.98) or luteinizing hormone (LH) (MD = −2.51, 95% CI = −10.72 to 5.70). Serum estradiol (E 2 ) levels were significantly lower in EA versus HT groups (MD = −60.58, 95% CI = −71.93 to −49.23). Compared with sham EA, EA had a significantly greater effect on reductions in KI (MD = −4.71, 95% CI = −6.57 to −2.86) and hot flushes score/24 h (MD = −2.43, 95% CI = −2.93 to −1.93). There were no significant differences between EA and manual acupuncture (MA) in terms of effective rate (RR = 1.14, 95% CI = 0.98 to 1.33) or serum FSH (MD = −2.87, 95% CI = −29.65 to 23.91), LH (MD = 2.73, 95% CI = −9.65 to 15.11) or E 2 (MD = 26.80, 95% CI = −12.06 to 65.65). However, it seemed that EA had a better effect than MA on KI (MD = −2.44, 95% CI = −4.80 to −0.08). Subgroup analyses indicated that EA may have more of a benefit in the pre-menopausal state (hot flushes score/24 h: MD = −1.66, 95% CI = −3.49 to 0.17) compared to post-menopause (p > 0.05). Conclusion: The effect of EA appeared broadly similar to HT and MA in the treatment of PMS, although EA-associated reductions in KI were superior to MA and sham EA, suggesting effects beyond placebo. The evidence base is limited by a small number of eligible studies, risk of bias and clinical/statistical heterogeneity, limiting our ability to draw firm conclusions. As such, additional larger scale, high-quality RCTs are needed.