🪡 Exploring Acupuncture as a Supportive Option in Menopause & Perimenopause

Menopause is a natural phase in a woman’s life, but for many it brings significant discomfort and impacts quality of life. Symptoms such as hot flashes (vasomotor symptoms or VMS), night sweats, sleep disturbances, mood swings and physical changes are common. While hormone therapy remains a standard treatment, some women seek non‑hormonal alternatives. Among these alternatives is acupuncture. In this blog I’ll summarise what we know (and don’t know) about the use of acupuncture in menopause, featuring key studies including those by Avis et al., Lund et al. and Zhao et al. and provide a balanced perspective of benefits, limitations and practical considerations.

What is acupuncture and how might it help in menopause?

Acupuncture is a component of Traditional Chinese Medicine (TCM) but is often used in a “western medical acupuncture” mode in research: fine needles are inserted into specific points (acupoints) in the body, the theory being to regulate bodily systems (e.g., nervous, endocrine) and restore balance. In the context of menopause, the hypothesis is that acupuncture might modulate the autonomic nervous system, influence neuro‑endocrine pathways, improve sleep, reduce the frequency or intensity of hot flashes and thereby improve overall quality of life.

Although exactly how acupuncture works remains unclear, the clinical question is: does it help women going through menopause and if so to what extent?

Summary of Evidence

• Acupuncture can reduce the frequency and severity of hot flashes, with effects typically noticeable after 3–5 sessions.

• Maximum symptom relief often occurs after 6–10 sessions, with some studies using up to 20 sessions.

• Benefits have been shown to persist for several months after treatment ends, though not indefinitely.

• Acupuncture can also improve sleep quality, particularly in women experiencing menopause-related insomnia.

• Mood improvements (e.g. anxiety, irritability) have been observed, often linked to better sleep and symptom relief.

• Individualised acupuncture protocols (tailored to the person) may offer greater benefit than rigid, standardised approaches.

• The onset of benefit is gradual, with some women experiencing steady improvement over several weeks.

• Acupuncture is generally considered safe, with very few and mild side effects (e.g. bruising, fatigue).

• It may be particularly helpful for women who cannot or choose not to use hormone therapy.

• While not a cure-all, acupuncture can be a valuable part of a broader menopause management plan, especially when combined with lifestyle support and medical guidance.

Using the results of studies* for real‑life decision‑making

*scroll down for the studies and their findings

When acupuncture may be a useful adjunct

• If you cannot or prefer not to use hormone therapy (e.g. due to personal preference, contraindications, risk concerns).

• If your main bothersome symptoms are hot flashes, night sweats, sleep disturbance, mood/physical symptoms and you’d like a non‐pharmacological adjunct.

• If you are willing to commit to a course of treatments (for example weekly or every 1–2 weeks) and accept moderate improvement rather than complete resolution.

Things to consider

• Acupuncture may reduce symptom frequency/severity but is unlikely to eliminate all symptoms and effects may be gradual over weeks (for example, the AIM study found effect after ~3 treatments and maximal around 8 treatments)

• Discuss with your medical doctor (especially if you are also using hormone replacement therapy, other treatments or have specific health conditions) to integrate safely.

• If your symptoms are very severe (e.g., very frequent hot flashes/night sweats impacting daily functioning), you may still need to consider HRT or other evidence‑based treatments; acupuncture might serve as part of a broader strategy.

• Individual variability: Some women respond better than others. For example, the AIM study sub‐analysis found that 59% had at least a 40% reduction in VMS after 8 weeks in the acupuncture arm, but 41% had minimal reduction in that time.

• Having realistic expectations and using acupuncture as part of a broader treatment strategy (including lifestyle, sleep/weight/exercise, and discussing HRTwhen appropriate) is wise.

Final thoughts

If you’re experiencing menopausal symptoms and exploring your options, acupuncture may present a valuable tool in your toolbox, especially if you’re seeking non‐drug approaches or complementary treatments. The research, especially the Avis et al. and Zhao studies, shows promise, though it’s not without caveats. Ultimately, careful shared decision‑making between you, your medical provider and your acupuncturist will yield the best outcome.

Summary of the studies

Here’s a breakdown of what the research shows, including strengths and caveats.

Key study – Avis et al. (“AIM” trial)

The AIM (“Acupuncture in Menopause”) study led by Nancy E. Avis et al. provides one of the more robust pieces of evidence in this area.

• 209 perimenopausal/postmenopausal women aged 45‑60 experiencing ≥4 vasomotor symptoms per day were recruited.

• They were randomised to receive up to 20 acupuncture treatments in the first 6 months (acupuncture group) or the second 6 months (wait‑list control) within a 12‑month trial.

• Primary outcome: mean daily frequency of VMS; secondary outcomes: VMS interference, sleep quality, depressive symptoms, somatic/other symptoms, anxiety, quality of life.

• Results: At 6 months, the acupuncture group saw a 36.7% decline in VMS frequency vs a 6.0% increase in the control group

• At 12 months, the acupuncture group maintained a 29.4% reduction from baseline suggesting sustained effect.

• The study found that clinically meaningful improvements appeared after about 3 treatments and maximum benefit was reached around a median of 8 treatments.

• The AIM trial also showed improvements in sleep quality, somatic and memory symptoms, and anxiety in the acupuncture group relative to control.

NCCIH, PubMed

Why this matters:
This trial offers relatively strong pragmatic evidence that acupuncture can reduce menopausal vasomotor symptoms and improve related quality‑of‑life outcomes, with effects that persist beyond the end of treatment.

Supporting study- Lund et al. and meta‑analysis

• The study by Kamma Sundgaard Lund et al. (“ACOM” trial) in 2019 (standardised acupuncture vs delayed control, 70 women) found significant reductions in hot flashes (and other menopausal symptoms) at week 6, and in a post‑hoc follow‑up the benefit sustained up to ~21 weeks post‑treatment.

• A 2015 meta‐analysis (12 RCTs, 869 participants) found that acupuncture significantly reduced hot flash frequency and severity . PubMed+1

Evidence from Zhao et al. – insomnia/sleep focus

The “Zhao” studies are about sleep/insomnia during the menopausal transition (or perimenopause):

• A 2021 systematic review: “Comparative Utility of Acupuncture and Western Medication in the Management of Perimenopausal Insomnia” (Fei‑Yi Zhao et al.) found that acupuncture significantly reduced global scores of the Pittsburgh Sleep Quality Index (PSQI) [MD = –2.38, 95% CI (–3.38, –1.37), p < 0.01] and the Kupperman Index [MD = –5.95, 95% CI (–10.68, –1.21), p = 0.01] compared with hypnotics. PubMed

• A 2024 meta‐analysis found that acupuncture may significantly improve sleep quality in menopausal women: six trials with 344 participants showed an MD = –3.47 (95% CI –5.06 to –1.88) for acupuncture vs control. PubMed+1

• In the meta‐analysis context, the authors cited a study by “Zhao and others” which showed that in a trial with 17 sessions over 8 weeks in post‑menopausal women, the intervention group had significantly better sleep and lower anxiety than the placebo group — though at the 16‑week follow‑up the difference was not statistically significant. PMC

Why this matters:

• These studies add an important dimension: beyond hot flashes/vasomotor symptoms, sleep disturbance is a major menopausal complaint. The fact that acupuncture shows some effectiveness here strengthens the case for its broader supportive role.

• This is mostly an insomnia or sleep‑quality related study, not necessarily targeted at hot flashes- one shouldn’t conflate the findings as if they guarantee hot‑flash relief.

Positive findings overall

• The meta‐analysis and trials indicate that acupuncture can significantly reduce both the frequency and severity of hot flashes in menopausal women. PubMed+1

• Improvements have also been seen in sleep quality, somatic symptoms, memory, anxiety, and general menopausal symptom burden (according to the AIM trial and the Zhao sleep‑insomnia studies).

• The fact that the AIM trial found sustained benefit up to at least 6 months post‑treatment is encouraging.

Limitations & conflicting findings

• The Cochrane review (2013) found no significant difference between acupuncture and sham acupuncture for hot flush frequency (MD –1.13 flushes/day; 95% CI –2.55 to 0.29) and only a small difference in severity (SMD –0.45; 95% CI –0.84 to –0.05). PubMed

• One systematic review notes that many of the studies are at risk of bias (e.g. control groups aware they were not receiving acupuncture) and that the true specific effect of acupuncture versus non‑specific effects (placebo, practitioner attention) remains unclear. NCBI

• Differences in protocols: number of sessions, points used, duration, population (perimenopause vs postmenopause; natural vs induced), and outcome measures are heterogeneous.

• The magnitude of benefit, while statistically significant, may be modest in some cases — for some women it may not reduce symptoms to a negligible level, but an appreciable reduction nonetheless.

• Regarding the Zhao sleep/insomnia studies: While improvements are shown, heterogeneity is high (I² values >90%) and follow‑up durations are often short; long‑term maintenance data are limited. PubMed

What the results mean

• Benefit size: In many trials, reductions in hot flashes/severity are moderate- not complete elimination. For example, the AIM study saw ~37% reduction at 6 months, dropping to ~29% at 12 months.

• Duration of effect: Some level of sustainability is evident (e.g. up to ~21 weeks or 6 months post‑treatment in some trials), but long‑term data (12+ months) remain limited.

• Comparison to hormone therapy (HT): Acupuncture is not shown to match HT in efficacy for many women. The Cochrane review noted that acupuncture seemed less effective than HT but more effective than no treatment. PubMed+1

• Placebo/attention effect issue: Because many trials used wait‑list or no‑treatment controls rather than sham acupuncture, it’s challenging to isolate how much of the benefit is from the needle insertion per se vs other non‑specific effects (expectation, practitioner contact, self‑monitoring). The authors of the AIM trial themselves note this. NCCIH

• Heterogeneity: The varied methodologies mean that clinical translation (i.e., “How many sessions? Which points? What is realistic benefit for me?”) is less precise.

• Safety: Generally, acupuncture appears safe in the studies cited, with minimal adverse events reported (for example, in the AIM trial: two women reported pain during treatment and one numbness) NCCIH