Traditional Chinese acupuncture is no more effective than a sham version of the procedure at relieving menopausal hot flashes, according to an Australian study published online this week in the Annals of Internal Medicine.
Women in this study reported improvements in the number and intensity of their hot flashes whether they received the real or the fake treatment — a strong indication that the placebo effect was at work with both.
The study also found “no evidence of an advantage of acupuncture over sham acupuncture on quality of life, anxiety, or depression,” write the study’s authors.
And before anybody jumps on this study for being conducted by conventional physicians who are antagonistic to nonconventional medical treatments, I’ll point out that the lead author is Dr. Carolyn Ee, a family physician at the University of Melbourne who is trained in — and uses — Chinese medicine, including acupuncture, with her patients.
A common experience
As background information in the study points out, about 75 percent of women experience hot flashes as they transition through menopause, and the flashes tend to continue for an average of five years. For most women, hot flashes are more of an annoyance than a problem, but for some, they can be debilitating, particularly when they occur at night (“night sweats”) and interfere with sleep.
Because conventional drugs used to relieve severe hot flashes — most notably, hormone replacement medications — are associated with serious adverse effects, including an increased risk of blood clots and cancer, many women turn to alternative therapies, including acupuncture. There’s no good, solid evidence, however, that any of these therapies actually work.
Past studies on the effectiveness of acupuncture have suggested it might relieve hot flashes, but those studies have been riddled with methodology problems, and were not able to come to any definitive conclusions.
To try to resolve the issue, Ee and her colleagues designed a randomized controlled trial, considered the gold standard in medical research. They recruited 327 women who were either postmenopausal (more than 12 months past their final menstrual period) or transitioning toward menopause. All the women reported having at least seven moderate-intensity hot flashes daily — symptoms that apparently would be part of a “kidney yin deficiency” diagnosis in Chinese medicine, according to the study.
The women were randomly assigned to receive 10 treatments for eight weeks of either a standardized acupuncture protocol for treating kidney yin deficiency or a sham treatment. The sham treatment used a blunt-needle device that gives the visual and physical impression of being inserted into the skin. The sham “insertions” were done only on sites on the body that are not used in real acupuncture.
The study used 15 different Chinese acupuncture clinics across Australia, and the clinicians had a minimum of five years of clinical experience. Everybody except the acupuncture therapists were blinded as to whether the treatment was real.
The women kept daily diaries of their hot flashes, and ranked each one as either mild, moderate, severe or very severe. They also filled out questionnaires that measured other outcomes, such as quality of life, depression and anxiety. This data was collected up to six months after the treatments had ended.
Sixteen percent of the women in the acupuncture group and 13 percent of those in the sham group dropped out of the study before it was completed.
An analysis of the data collected from the women who remained revealed that both groups reported about a 40 percent improvement in the number and intensity of their hot flashes when their “treatment” ended — benefits that continued through the six-month follow-up period of the study.
The data also did not reveal any advantage of acupuncture for outcomes related to quality of life, anxiety and depression.
These findings suggest that the placebo effect was at work. In other words, just the belief that they were receiving help for their hot flashes led the the women perceive their symptoms as being less troublesome.
Cannot be recommended
Ee and her colleagues conclude that acupuncture cannot be recommended to women for the treatment of hot flashes.
“This was a large and rigorous study and we are confident there is no additional benefit from inserting needles compared with stimulation from pressuring the blunt needles without skin penetration for hot flushes,” Ee said in a released statement.
“If women want to consider having acupuncture for hot flushes,” she added, “they should know that although previous studies show it is better than doing nothing, our study demonstrates that needling does not appear to make a difference.”
FMI: You’ll find an abstract for the study on the Annals of Internal Medicine website, but the full study is behind a paywall.