Written by Karen Pilkington, Edzard Ernst and the CAM-Cancer Consortium.
Updated July 21, 2015

Acupuncture for hot flushes

Does it work?

Systematic reviews

Two systematic reviews including six 10 and one 11 acupuncture trial(s) were published in 2009 and 2010 respectively. The first focused on acupuncture for hot flushes in breast cancer patients and a special effort was made to include the Asian literature.10  The second covered a range of non-hormonal treatments for the same indication.11 Both reviews concluded that the evidence to suggest that acupuncture alleviates hot flushes in breast cancer patients is not convincing. This was due mainly to the poor quality of the existing studies.

A recent Cochrane review includes trials published up to 2013 of acupuncture in women with hot flushes related to the natural menopause or menopause due to surgical removal of ovaries, radiation, or chemotherapy.12 Sixteen trials were included of which 5 were in women with a history of cancer. Overall, there was no significant difference between the acupuncture and sham acupuncture for hot flush frequency (MD -1.13 flushes per day, 95% CI -2.55 to 0.29, 8 RCTs, low-quality evidence) but flushes were significantly less severe in the acupuncture group. However, the effect was small, the results of individual trials were extremely variable and the evidence was judged to be of very low quality (SMD -0.45, 95% CI -0.84 to -0.05, 6 RCTs). When compared to no treatment, acupuncture appeared to be more beneficial but it was less effective than hormone therapy and the evidence was low or very low quality.

A further systematic review attempted to assess how long the effects of acupuncture might persist in cancer patients.13 The authors carried out searches in 2011 and 2012 and identified 17 studies, 7 of which scored at least 3 on the Jadad quality score and 6 of which were included in the analysis. Four of these studies are included in the Cochrane review, one was in men with prostate cancer and one trial is described under Clinical trials.14 The analysis, which was in the form of pre-post comparison indicated that effects were maintained at least 3 months after the end of acupuncture treatment but, as the authors point out, these are preliminary findings.

Clinical trials

A subsequent RCT with two parallel groups and a total of 50 patients compared 12 weeks of acupuncture treatment to 12 weeks of oral venlafaxine therapy.15 The findings of this study indicated that acupuncture is “equivalent” to drug treatment in reducing hot flushes. One should, however, note that this trial was not designed as an equivalence study and that the design of the study failed to fully control for placebo-effects. Therefore firm conclusions cannot be drawn from these data.

A second RCT also focused on vasomotor symptoms including hot flushes and compared acupuncture with non-penetrating stimulation at non-acupuncture points.14 Seventy-four breast cancer patients treated with adjuvant tamoxifen suffering from hot flushes and sweating were treated. Both groups reported improvement in the severity and frequency of symptoms but no statistical difference was found between the groups. This may be due, at least in part, to the similarity between the treatments as the ‘sham’ points chosen were only 1cm from the ‘true’ points and, in both cases, the points were stimulated (superficially in the case of the controls).

Another study published since the Cochrane review also tested acupuncture against a similar sham procedure.16 A range of patient reported outcomes including hot flushes were measured at 4, 8 and 12 weeks after randomisation to the two groups.  About three-quarters of the 47 women included had suffered hot flushes at baseline. No significant difference was detected between groups after treatment. Some apparent differences in the responses of different ethnic groups were highlighted as worth further investigation.

The most recent study is a follow-up of one of the RCTs included in the Cochrane review.17 Eighty patients had 2 years previously been randomized to a course of acupuncture or sham acupuncture for hot flushes. Sixty-one women completed and returned questionnaires which assessed health related quality of life. Scores at the end of treatment and after 3 months showed a statistically significant difference between the groups but this difference became non-significant based on scores after 2 years. 

As patients’ expectations are known to strongly influence the effect on hot flushes,18,19 caution seems indicated when interpreting results, particularly in those studies in which there is no control or no blinding.

Citation Karen Pilkington, Edzard Ernst, CAM-Cancer Consortium. Acupuncture for hot flushes [online document]. http://ws.cam-cancer.org/The-Summaries/Mind-body-interventions/Acupuncture-for-hot-flushes. July 21, 2015.

References

  1. BAcC (British Acupuncture Council) website. Ten Top Things to Know. Available at: www.acupuncture.org.uk. Accessed 17th April 2015.
  2. Filshie, J., Cummings, M. Western medical acupuncture. In: Ernst, E., White, A.  (Eds). Acupuncture: A Scientific Appraisal. 1999. Butterworth-Heinemann, Oxford. pp 31-59.
  3. White A; Editorial Board of Acupuncture in Medicine. Western medical acupuncture: a definition. Acupunct Med. 2009 27(1):33-5.
  4. White A, Ernst E. Introduction. In: Ernst, E., White, A. (Eds). Acupuncture: A Scientific Appraisal. 1999. Butterworth-Heinemann, Oxford. pp1-10.
  5. Birch S, Kaptchuk T. History, nature and current practice of acupuncture: an East Asian perspective. In: Ernst, E., White, A.  (Eds). Acupuncture: A Scientific Appraisal. 1999. Butterworth-Heinemann, Oxford. pp 11-30.
  6. Ahn AC, Colbert AP, Anderson BJ, Martinsen OG, Hammerschlag R, Cina S, Wayne PM, Langevin HM. Electrical properties of acupuncture points and meridians: a systematic review. Bioelectromagnetics. 2008 29(4):245-56.
  7. Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol 2008; 84(4):355-375.
  8. Molassiotis A, Browall M, Milovics L, Panteli V, Patiraki E, Fernandez-Ortega P. Complementary and alternative medicine use in patients with gynecological cancers in Europe. Int J Gynecol Cancer. 2006 16 Suppl 1:219-24.
  9. Molassiotis A, Fernadez-Ortega P, Pud D, Ozden G, Scott JA, Panteli V, Margulies A, Browall M, Magri M, Selvekerova S, Madsen E, Milovics L, Bruyns I, Gudmundsdottir G, Hummerston S, Ahmad AM, Platin N, Kearney N, Patiraki E. Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol. 2005 16(4):655-63.
  10. Lee MS, Kim KH, Choi SM, Ernst E. Acupuncture for treating hot flashes in breast cancer patients: a systematic review. Breast Cancer Res Treat. 2009 Jun;115(3):497-503.
  11. Rada G, Capurro D, Pantoja T, Corbalán J, Moreno G, Letelier LM, Vera C. Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD004923.
  12. Dodin, S., C. Blanchet, I. Marc, E. Ernst, T. Wu, C. Vaillancourt, J. Paquette and E. Maunsell. Acupuncture for menopausal hot flushes. Cochrane Database Syst Rev 2013 7: CD007410.
  13. Frisk, J. W., M. L. Hammar, M. Ingvar and A. C. Spetz Holm. How long do the effects of acupuncture on hot flashes persist in cancer patients? Support Care Cancer 2014 22(5): 1409-1415.
  14. Liljegren, A., P. Gunnarsson, B. M. Landgren, N. Robeus, H. Johansson and S. Rotstein. Reducing vasomotor symptoms with acupuncture in breast cancer patients treated with adjuvant tamoxifen: a randomized controlled trial. Breast Cancer Res Treat 2012 135(3): 791-798.
  15. Walker EM, Rodriguez AI, Kohn B, Ball RM, Pegg J, Pocock JR, Nunez R, Peterson E, Jakary S, Levine RA. Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. J Clin Oncol. 2010 Feb 1;28(4):634-40.
  16. Bao, T., L. Cai, C. Snyder, K. Betts, K. Tarpinian, J. Gould, S. Jeter, M. Medeiros, S. Chumsri, A. Bardia, M. Tan, H. Singh, K. H. Tkaczuk and V. Stearns. Patient-reported outcomes in women with breast cancer enrolled in a dual-center, double-blind, randomized controlled trial assessing the effect of acupuncture in reducing aromatase inhibitor-induced musculoskeletal symptoms. Cancer 2014 120(3): 381-389.
  17. Hervik, J. and O. Mjaland. Long term follow up of breast cancer patients treated with acupuncture for hot flashes. Springerplus 2014 3: 141.
  18. Otte JL, Carpenter JS, Zhong X, Johnstone PA. Feasibility study of acupuncture for reducing sleep disturbances and hot flashes in postmenopausal breast cancer survivors. Clin Nurse Spec. 2011 Sep-Oct;25(5):228-36.
  19. Mao JJ, Leed R, Bowman MA, Desai K, Bramble M, Armstrong K, Barg F. Acupuncture for hot flashes: decision making by breast cancer survivors. J Am Board Fam Med. 2012 May-Jun;25(3):323-32.
  20. White A, Hayhoe S, Ernst E. Survey of Adverse Events Following Acupuncture Acupunct Med. 1997; 15:67-70.
  21. Witt CM, Pach D, Brinkhaus B, Wruck K, Tag B, Mank S, Willich SN. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed. 2009 Apr;16(2):91-7. doi: 10.1159/000209315. Epub 2009 Apr 9.
  22. White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med. 2004; 22(3):122-123.
  23. Ernst E. Deaths after acupuncture: a systematic review. Int J Risk Safety 2010; 22(3):131-136.
  24. BMAS (British Medical Acupuncture Society). Code of Practice & Complaints Procedure. Version 9 December 2009. Available at: http://www.medical-acupuncture.co.uk/LinkClick.aspx?fileticket=HTz5FvjFjfA%3d&tabid=64. Accessed 21st July 2015.