Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment).

A Cochrane review ¹ included 8 studies with a total of 528 subjects. In comparison of acupuncture to sham acupuncture no significant difference was found for hot flush frequency (MD -1.13 flushes per day, 95% CI -2.55 to 0.29; 8 RCTs, n=414, I² = 70%, low-quality evidence) but flushes were significantly less severe in the acupuncture group, with a small effect size (SMD -0.45, 95% CI -0.84 to -0.05, 6 RCTs, 297 women, I² = 62%, very-low-quality evidence). In a post hoc sensitivity analysis excluding studies of women with breast cancer, heterogeneity was reduced to 0% for hot flush frequency and 34% for hot flush severity and there was no significant difference between the groups for either outcome. Acupuncture was associated with significantly more frequent hot flushes than hormone therapy (MD 3.18 flushes per day, 95% CI 2.06 to 4.29, 3 RCTs, n=114, I² = 0%, low-quality evidence). There was no significant difference between the groups for hot flush severity (SMD 0.53, 95% CI -0.14 to 1.20, 2 RCTs, 84 women, I² = 57%, low-quality evidence).

A meta-analysis ² included 13 RCTs with a total of 844 breast cancer patients. Acupuncture had no significant effect on the frequency and the severity of hot flush (p = 0.34; p = 0.33), but significantly ameliorated menopause symptoms (p = 0.009).

Another systemativ review ³ including 13 RCTS assessed the maintenance effect of acupuncture on breast cancer-related menopause symptoms (n=943). Acupuncture had no significant long-term maintenance effect on the frequency or severity of hot flushes (p = 0.29; p = 0.34), but had a significant 3-month maintenance effect of ameliorating menopause symptoms at 3 months after treatment ended (p = 0.001). No adverse events were reported.