Acupuncture for Perimenopausal Insomnia: A systematic review and meta-analysis

Ruqin Yang¹Shumin Zhang¹Xin Tang¹Qifu Li²Gaoyangzi Huang¹Ya Huang¹Yuanzheng Deng¹Hongyang Wang¹Ziwen Chen²Taipin Guo^1*FanRong Liang^2*

• ¹Yunnan University of Chinese Medicine, Kunming, China
• ²Chengdu University of Traditional Chinese Medicine, Chengdu, China

Objective: Perimenopausal insomnia (PMI) significantly compromises the quality of life and the physical and mental well-being of perimenopausal women. Although many randomized controlled trials (RCTs) indicate that acupuncture alleviates PMI symptoms, comprehensive evidence on its efficacy and safety is lacking. We conducted a meta-analysis to systematically evaluate the therapeutic efficacy and safety of acupuncture for PMI, aiming to provide robust, evidence-based guidance for clinical practice. Methods: 12 trials were included in the study, involving 499 participants in the acupuncture group and 495 in the control group, and provided data for the meta-analysis. Quality assessment was performed using the Cochrane Risk of Bias tool (ROB). RevMan version 5.4 and Stata 18.0 software were used for meta-analysis and sensitivity analysis. Results: A total of 10 studies were included, with the random-effects model showing that acupuncture significantly improved sleep quality compared to the drug control group, as evidenced by a reduction in PSQI scores [mean difference (MD) = -2.26, 95% confidence interval (CI) (-4.23 to -0.29), P < 0.00001]. Subgroup analyses revealed that acupuncture outperformed estazolam (MD = -2.89, P < 0.00001). However, it did not outperform alprazolam (MD = -2.30, P = 0.27) or diazepam (MD = -6.55, P < 0.00001). Compared to sham acupuncture, acupuncture resulted in a significantly greater reduction in PSQI scores (MD = -4.85, P = 0.0001). Acupuncture also led to reductions in LH (MD = -6.55, P < 0.00001) and FSH (MD = -12.12, P = 0.002), and an increase in E2 levels (MD = 11.96, P < 0.00001). One study reported a significant improvement in ISI scores (MD = -3.64, P = 0.0003). Adverse event data were reported in only 4 of the 12 studies. Conclusion: Current evidence of low to moderate quality suggests that acupuncture may offer potential benefits and demonstrate good safety for PMI. However, these findings require further validation through large-scale, multicenter, double-blind RCTs using standardized protocols.