Effectiveness and Safety of Auricular Therapy for Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis

Xi Li¹Yan Li^2*Shuang Xu¹Liangzhen Xie²Hongying Kuang²Jialing Liu¹

• ¹Heilongjiang University of Chinese Medicine, Harbin, China, Heilongjiang University of Chinese Medicine, Harbin, China
• ²First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China, Heilongjiang University of Chinese Medicine, Harbin, China

Background: Auricular therapy (AT) has attracted increasing interest as a potential intervention for polycystic ovary syndrome (PCOS). This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of AT in PCOS based on evidence from randomized controlled trials (RCTs). Methods: Eight electronic databases were searched from inception to December 22, 2024. Two reviewers independently conducted study selection, data extraction, and risk-of-bias assessment using the Cochrane tool. Random-effects meta-analyses were performed using mean differences (MDs). The study was registered with the Open Science Framework (OSF; DOI: 10.17605/OSF.IO/VBPSM). Results: Eighteen RCTs involving 1,231 women with PCOS were included. Evidence was insufficient to support AT as a stand-alone intervention. However, adjunctive AT was associated with improvements in selected outcomes, depending on the co-intervention. Compared with traditional Chinese medicine (TCM) formula alone, AT plus TCM formula reduced body mass index (BMI) (MD –0.82, 95% CI –1.60 to –0.03), Self-rating Anxiety Scale (SAS) scores (MD –3.81, 95% CI –6.26 to –1.36), and Self-rating Depression Scale (SDS) scores (MD –4.22, 95% CI –7.74 to –0.69). No significant effects were observed for hormonal or metabolic parameters. Compared with metformin alone, AT plus metformin was associated with reductions in BMI (MD –0.77, 95% CI –1.23 to –0.31), waist–hip ratio (WHR) (MD –0.03, 95% CI –0.05 to –0.02), and luteinizing hormone (LH) levels (MD –0.81, 95% CI –1.05 to –0.57). Compared with acupuncture alone, AT plus acupuncture reduced BMI (MD –3.21, 95% CI –5.09 to –1.33), LH levels (MD –0.80, 95% CI –1.16 to –0.43), LH/FSH ratio (MD –1.39, 95% CI –1.76 to –1.02), and HOMA-IR (MD –0.10, 95% CI –0.16 to –0.05). Evidence for effects on fasting insulin was insufficient. Conclusions: Adjunctive AT may be associated with improvements in anthropometric, hormonal, and psychological outcomes in PCOS, with effects varying by co-intervention. No serious adverse events were reported, although underreporting cannot be excluded. Given substantial heterogeneity, high risk of bias, and small sample sizes, these findings should be interpreted cautiously, and high-quality RCTs are required.