Acupuncture for Hot Flashes

Hot flashes, a common and often debilitating symptom of menopause, have prompted exploration of various treatment options. Acupuncture, a traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body, has been investigated in a number of clinical trials and randomized controlled trials (RCTs) as a potential intervention for managing hot flashes. These studies aim to determine the effectiveness and safety of acupuncture in alleviating the severity and frequency of this menopausal symptom.

Protocols Studied in Research

[1] Chinese medicine acupuncture versus sham acupuncture for menopausal hot flashes. (Cited by: 24) (pmid: 26784863)

• Protocol: A randomized, sham-controlled trial of 327 Australian women (40+) experiencing moderate to severe hot flashes. Participants received 10 acupuncture treatments or sham acupuncture over 8 weeks.
• Outcome: The study found no significant difference in hot flash severity between the acupuncture and sham acupuncture groups. Chinese medicine acupuncture was not superior to sham acupuncture for treating menopausal hot flashes.

[2] Therapeutic acupuncture (TA) for hot flashes (HFs) in breast cancer patients. (Cited by: 0) (pmid: 37851349)

• Protocol: A randomized, single-blind trial comparing TA to sham acupuncture (SA) in 54 breast cancer patients experiencing >10 HFs/week. Participants recorded HFs in diaries and completed the MenQoL scale at baseline, post-treatment, and 1-month follow-up.
• Outcome: TA significantly reduced HF severity (p=.0064) compared to SA, with a sustained effect at 1-month follow-up. Larger studies are needed to confirm these findings.

[3] Acupuncture for hot flashes in breast cancer patients on tamoxifen. (Cited by: 0) (pmid: 36787483)

• Protocol: A randomized, single-blind, no-treatment-controlled trial in Korea. 30 patients with moderate-severe hot flashes received either acupuncture (3x/week for 4 weeks) or no treatment.
• Outcome: Acupuncture significantly reduced hot flash severity and improved quality of life compared to the control group; these effects persisted 4 weeks post-treatment. No adverse events were reported.

[4] Acupuncture for hot flashes in women with hormone receptor-positive breast cancer undergoing endocrine therapy. (Cited by: 0) (pmid: 38924035)

• Protocol: A pooled analysis of three parallel randomized controlled trials in the US, China, and South Korea compared immediate acupuncture (20 sessions over 10 weeks) to delayed acupuncture (usual care then reduced intensity acupuncture). 158 women with stage 0-III breast cancer participated.
• Outcome: Immediate acupuncture resulted in statistically and clinically significant improvements in hot flash severity, endocrine symptoms, and breast cancer-specific quality of life compared to delayed acupuncture. The effect varied by study site.

[5] Medical acupuncture for hot flashes in menopausal women. (Cited by: 34) (pmid: 17019380)

• Protocol: A randomized, single-blind, sham-controlled trial with 103 women experiencing hot flashes. Participants received biweekly acupuncture (real or sham) for 5 weeks, followed by 7 weeks of follow-up. Hot flash frequency was tracked daily.
• Outcome: The study found no significant difference in hot flash reduction between medical acupuncture and sham acupuncture at 6 or 12 weeks. Medical acupuncture was not more effective than sham acupuncture.

[6] True acupuncture versus sham acupuncture for hot flashes in breast cancer patients. (Cited by: 58) (pmid: 18065731)

• Protocol: A randomized controlled trial assigned 72 breast cancer patients with ≥3 hot flashes daily to true or sham acupuncture twice weekly for 4 weeks. Sham group crossed over to true acupuncture at week 7. Hot flash frequency was assessed at baseline, 6 weeks, and 6 months.
• Outcome: Acupuncture reduced hot flash frequency, but the difference compared to sham acupuncture wasn't statistically significant at 6 weeks. However, crossing over the sham group to true acupuncture showed further reduction, lasting 6 months. A longer, more intense intervention might yield greater benefit.

[7] Electroacupuncture for menopausal symptoms during menopause transition. (Cited by: 3) (pmid: 30125529)

• Protocol: A prospective, multicenter, randomized, participant-blinded trial in China. 360 women received either electroacupuncture at traditional acupoints or sham electroacupuncture for 8 weeks, with 24 weeks follow-up.
• Outcome: Electroacupuncture did not significantly relieve menopausal symptoms, although it showed a statistically significant, yet clinically insignificant, improvement in quality of life. The study suggests limited generalizability due to mild baseline symptoms.

[8] Acupuncture (integrated with diet and self-massage) for hot flushes and other menopausal symptoms. (Cited by: 5) (pmid: 24827469)

• Protocol: A randomized controlled trial of 100 women with frequent hot flushes compared acupuncture plus diet/massage to diet/massage alone. Acupuncture was administered twice weekly for 6 weeks.
• Outcome: Acupuncture significantly reduced hot flushes, night sweats, and other menopausal symptoms compared to the control group receiving only diet and self-massage.

[9] Acupuncture for vasomotor symptoms (VMS) in perimenopausal and postmenopausal women. (Cited by: 17) (pmid: 27023860)

• Protocol: A randomized controlled trial of 209 women (45-60 years) experiencing frequent VMS. The acupuncture group received up to 20 treatments in 6 months; the control group received treatment after 6 months.
• Outcome: Acupuncture significantly reduced VMS frequency and improved quality of life compared to the control group. Benefits persisted for at least 6 months post-treatment.

[10] Acupuncture for hot flashes in breast cancer patients receiving Tamoxifen. (Cited by: 46) (pmid: 18839306)

• Protocol: A randomized controlled trial of 59 breast cancer patients experiencing Tamoxifen-induced hot flashes received either 10 weeks of traditional acupuncture or sham acupuncture. Hot flash frequency and Kupperman index were assessed.
• Outcome: Acupuncture significantly reduced hot flashes (day and night) during and after treatment, with a sustained improvement in the Kupperman index, unlike sham acupuncture. The effect suggests acupuncture provides effective relief and improves overall health.

[11] *Urtica dioica* (nettle) and acupuncture for menopausal hot flashes and quality of life in postmenopausal women. (Cited by: 6) (pmid: 31126551)

• Protocol: A double-blind, randomized controlled trial compared *Urtica dioica* (450mg/day), acupuncture, combined therapy, and placebo/sham acupuncture in 72 postmenopausal women with ≥20 hot flashes/week over 7 weeks with a 4-week follow-up.
• Outcome: *Urtica dioica* significantly reduced hot flashes and improved quality of life compared to placebo, similar to acupuncture. Combining *Urtica dioica* and acupuncture offered no additional benefit.

[12] Acupuncture (Traditional Chinese Medicine and sham) for menopausal hot flashes. (Cited by: 29) (pmid: 18528313)

• Protocol: A randomized controlled pilot study of 56 peri- and postmenopausal women with frequent hot flashes. Participants received either usual care, sham acupuncture, or Traditional Chinese Medicine acupuncture twice weekly for 8 weeks.
• Outcome: All groups showed a significant decrease in hot flash frequency, but acupuncture groups (both real and sham) showed a significantly greater reduction than the usual care group. No significant differences were found between the two acupuncture types. The results suggest a strong placebo effect or a genuine effect of acupuncture.

[13] Acupuncture plus enhanced self-care for hot flashes in women with breast cancer. (Cited by: 49) (pmid: 27022113)

• Protocol: A randomized controlled trial (RCT) compared acupuncture plus enhanced self-care versus enhanced self-care alone in 190 women with breast cancer. Participants received a self-care booklet; the acupuncture group received 10 acupuncture sessions.
• Outcome: Acupuncture plus enhanced self-care significantly reduced hot flash scores and improved quality of life compared to enhanced self-care alone, with benefits sustained at 3 and 6 months post-treatment.

[14] Acupuncture for hot flushes in perimenopausal and postmenopausal women. (Cited by: 18) (pmid: 21653660)

• Protocol: A randomized, single-blind, sham-controlled trial. 54 women with moderate to severe hot flushes received either real or sham acupuncture (11 treatments over 7 weeks) following a 4-week run-in period.
• Outcome: Acupuncture showed no statistically significant difference compared to sham acupuncture in reducing overall hot flush scores. However, a possible benefit on hot flush severity was observed, warranting further investigation to distinguish specific effects from non-specific ones.

[15] Acupuncture plus usual care for hot flashes and menopause-related symptoms in perimenopausal and postmenopausal women. (Cited by: 28) (pmid: 19907348)

• Protocol: A multicenter, randomized controlled trial compared acupuncture plus usual care (12 sessions over 4 weeks) to usual care alone in women with frequent hot flashes. Hot flashes and menopause symptoms were tracked via diaries and questionnaires.
• Outcome: Acupuncture significantly reduced hot flash severity and improved overall menopause symptoms compared to usual care alone, with effects sustained at 8 weeks.

[16] Electroacupuncture (EA) and Gabapentin (GP) for hot flashes in breast cancer survivors. (Cited by: 51) (pmid: 26304905)

• Protocol: A randomized, placebo-controlled trial (120 participants) comparing 8 weeks of EA or GP against sham acupuncture and placebo pills. Treatment administered once daily.
• Outcome: Electroacupuncture showed greater reduction in hot flash severity than gabapentin, with fewer side effects. Acupuncture demonstrated larger placebo and smaller nocebo effects compared to pills. Findings require confirmation in larger trials.

[17] Traditional Chinese Medicine (TCM) acupuncture and Chinese herbal medicine (CHM) for hot flushes and quality of life in postmenopausal women. (Cited by: 10) (pmid: 23676632)

• Protocol: A four-arm randomized controlled pilot trial involving 40 postmenopausal women with frequent hot flushes. Participants received either TCM acupuncture, sham acupuncture, verum CHM, or placebo CHM for 12 weeks.
• Outcome: TCM acupuncture significantly reduced hot flush frequency, severity, and overall menopausal symptoms compared to sham acupuncture and CHM. CHM showed no significant benefit over placebo.

[18] Moxibustion for menopausal hot flashes. (Cited by: 11) (pmid: 19293729)

• Protocol: A randomized controlled trial assigned 51 perimenopausal and postmenopausal women to three groups: two moxibustion treatment groups (differing protocols) and a waiting-list control. Treatment involved 14 sessions over 4 weeks.
• Outcome: Moxibustion significantly reduced hot flash frequency and severity compared to the control group. One moxibustion protocol also improved quality of life scores. Larger studies with placebo controls are recommended.

[19] Acupuncture for postmenopausal nocturnal hot flashes and sleep quality. (Cited by: 25) (pmid: 16952511)

• Protocol: A randomized, placebo-controlled trial of 29 postmenopausal women with frequent hot flashes received either active or placebo acupuncture for nine sessions over seven weeks.
• Outcome: Acupuncture significantly reduced the severity of nocturnal hot flashes compared to placebo. While frequency reduction was also observed in the active group, it wasn't statistically significant compared to placebo. Improvement in sleep quality correlated with reduced hot flash severity and frequency.

[20] Acupuncture for menopausal symptoms in postmenopausal women. (Cited by: 14) (pmid: 21383392)

• Protocol: A sham-controlled clinical trial randomized 53 postmenopausal women to receive either true acupuncture or sham acupuncture. Menopausal symptoms and hormone levels (estradiol, FSH, LH) were assessed before and after treatment.
• Outcome: Acupuncture significantly reduced menopausal symptoms (total MRS score, somatic and psychological subscales, hot flushes) compared to sham acupuncture. Acupuncture also resulted in higher estradiol and lower LH levels.

[21] Individualized acupuncture plus self-care versus self-care alone for hot flashes in postmenopausal women. (Cited by: 29) (pmid: 19423996)

• Protocol: A multicenter, randomized controlled trial compared acupuncture plus self-care to self-care alone in postmenopausal women experiencing ≥7 hot flashes daily. The acupuncture group received 10 sessions.
• Outcome: Acupuncture plus self-care significantly reduced hot flash frequency and intensity, and improved health-related quality of life compared to self-care alone. Calcitonin gene-related peptide levels were unchanged.

[22] Acupuncture for vasomotor symptoms (hot flashes) during menopausal transition. (Cited by: 0) (pmid: 32898024)

• Protocol: A crossover, single-blind, sham-controlled trial with 100 women. Participants received either real or sham acupuncture for 24 weeks, then crossed over to the other treatment for another 24 weeks.
• Outcome: Acupuncture significantly reduced hot flashes compared to sham acupuncture. The effect was observed primarily when acupuncture was administered.

[23] Acupuncture for hot flashes in breast cancer survivors. (Cited by: 2) (pmid: 32217888)

• Protocol: A randomized controlled trial (RCT) analyzed data from 108 breast cancer survivors. Participants received either acupuncture (electro or sham) or pharmacological treatment (gabapentin or placebo). Genetic analysis focused on SNPs in genes related to neurotransmission, thermoregulation, and inflammation.
• Outcome: Six specific genotypes were associated with a significantly higher response rate to acupuncture for hot flash reduction (70.3% vs 37.5%, P=0.035). This association was not observed in the pharmacological treatment group. The findings suggest potential for personalized acupuncture treatment.

[24] Acupuncture and phytoestrogens versus hormone therapy (estrogen plus progestin) for menopausal symptoms (hot flushes). (Cited by: 3) (pmid: 31142156)

• Protocol: A randomized controlled trial of 75 postmenopausal women with hot flushes, comparing 3-month treatments of conjugated estrogens/medroxyprogesterone acetate, weekly acupuncture, and soy isoflavones. Outcomes were measured using Greene's climacteric scale and Menopause Quality of Life (MenQoL) questionnaire.
• Outcome: Acupuncture and, to a lesser extent, phytoestrogens effectively reduced menopausal symptoms similarly to hormone therapy, as measured by Greene's scale and MenQoL. Acupuncture's benefits on MenQoL were more sustained after treatment cessation.

[25] Traditional acupuncture (TA) and sham acupuncture (SA) for vasomotor symptoms (VMS) and quality of life in perimenopausal and postmenopausal women. (Cited by: 18) (pmid: 21968279)

• Protocol: A pilot, randomized, single-blind, placebo-controlled trial comparing TA, SA, and a waiting control (WC) group. 33 women with frequent VMS received 3 weekly treatments for 12 weeks (TA & SA groups).
• Outcome: Both TA and SA improved VMS and quality of life compared to WC. TA showed a potential impact on the hypothalamic-pituitary-adrenal axis, warranting further investigation in a larger trial.

[26] Traditional acupuncture for breast cancer-related hot flashes and night sweats (HF&NS) in women taking tamoxifen. (Cited by: 20) (pmid: 20954961)

• Protocol: A single-arm observational study of 50 women with early breast cancer receiving eight weekly acupuncture treatments. Participants were ≥35 years old, ≥6 months post-treatment, on tamoxifen for ≥6 months, and experienced ≥4 HF&NS daily for ≥3 months.
• Outcome: Traditional acupuncture significantly reduced HF&NS frequency (49.8% reduction), improved physical and emotional well-being (7 WHQ domains), and lessened the perception of HF&NS as a problem. Benefits showed trends of persistence at 4 and 18 weeks post-treatment.

[27] Electro-acupuncture (EA) and hormone therapy (HT) for vasomotor symptoms (hot flushes) in breast cancer survivors. (Cited by: 32) (pmid: 18365859)

• Protocol: A prospective, randomized, controlled multicenter trial comparing EA (12 weeks) and HT (24 months) in 45 women with breast cancer experiencing hot flushes. Daily hot flush frequency and distress were recorded.
• Outcome: EA significantly reduced hot flushes at 12 weeks and maintained this reduction at 24 months in a subset of participants. HT also effectively reduced hot flushes at 12 weeks. The study suggests EA as a potential treatment warranting further investigation.

[28] Electro-acupuncture (EA) and gabapentin (GP) for sleep disturbances in breast cancer survivors with hot flashes. (Cited by: 23) (pmid: 27875389)

• Protocol: A randomized controlled trial (RCT) of 58 breast cancer survivors with frequent hot flashes received 8 weeks of either EA or 900mg/day GP. The primary outcome was change in Pittsburgh Sleep Quality Index (PSQI) score.
• Outcome: EA showed significantly greater improvement in total PSQI score, sleep latency, and sleep efficiency compared to GP at week 8. EA resulted in broader sleep improvements than GP. Larger trials are needed for confirmation.

[29] Needle acupuncture for menopausal vasomotor symptoms (hot flushes and night sweats). (Cited by: 6) (pmid: 24925094)

• Protocol: A stratified, parallel, randomized sham-controlled trial with 360 menopausal women experiencing frequent hot flushes. Participants received either true or sham acupuncture (10 treatments over 8 weeks). Blinding was used.
• Outcome: The abstract does not present results, only stating that the trial's results will contribute to the evidence on acupuncture's role in treating vasomotor symptoms. No conclusions on efficacy are provided.

[30] Acupuncture for postmenopausal hot flashes. (Cited by: 16) (pmid: 17182200)

• Protocol: A randomized, placebo-controlled pilot study of 29 postmenopausal women with frequent hot flashes received either active acupuncture or placebo acupuncture (sham) for seven weeks (nine sessions).
• Outcome: Active acupuncture resulted in a significantly greater reduction in hot flash severity compared to placebo, though not in frequency. Larger studies are needed.

[31] Acupuncture plus auricular acupressure (AA) versus hormone replacement therapy (Climen) for perimenopausal syndrome. (Cited by: 3) (pmid: 24886348)

• Protocol: A 1:1 randomized controlled trial (RCT) in 206 Chinese women with perimenopausal syndrome comparing AA (28 sessions over 12 weeks) to Climen (3 cycles). Primary outcome was Menopause Rating Scale (MRS).
• Outcome: The abstract only presents the study protocol; no results are reported. Results were expected to clarify acupuncture's effectiveness in relieving perimenopausal syndrome.

[32] Gua sha therapy for perimenopausal syndrome. (Cited by: 8) (pmid: 27760084)

• Protocol: A randomized controlled trial of 80 perimenopausal women compared Gua sha therapy (15-minute sessions once weekly for 8 weeks) plus conventional treatment to conventional treatment alone.
• Outcome: Gua sha therapy significantly reduced perimenopausal symptoms and improved quality of life compared to the control group, with no significant changes in serum hormone levels. The therapy was deemed safe and effective.

[33] Acupuncture for menopausal symptoms (hot flushes and Kupperman Menopausal Index score). (Cited by: 6) (pmid: 20497031)

• Protocol: A randomized, single-blind, placebo-controlled crossover trial with 81 postmenopausal women. Groups received either 12 months of acupuncture followed by 6 months of sham acupuncture, or vice versa. Acupuncture needles were inserted to a depth of 2cm for approximately 40 minutes per session.
• Outcome: Acupuncture significantly reduced hot flushes and KMI scores compared to sham acupuncture at 6 months. The effect was not sustained at 12 months but was observed again in the group that received acupuncture last, at 18 months. This suggests a potential benefit of acupuncture for managing menopausal symptoms.

[34] Acupuncture for hot flashes in men undergoing androgen ablation therapy (AAT). (Cited by: 14) (pmid: 20605360)

• Protocol: A prospective study of 14 men with AAT-induced hot flashes received acupuncture. Hot flash severity was measured before and at 2, 6 weeks, and 8 months post-treatment using a hot flash score (frequency x severity).
• Outcome: Acupuncture significantly reduced hot flash severity at all time points (p<0.01), with a durable effect at 8 months. No side effects were reported. A randomized controlled trial is recommended.

[35] TCM acupuncture and sham acupuncture for vasomotor symptoms in post-menopausal women. (Cited by: 12) (pmid: 20430288)

• Protocol: A randomized, single-blind trial involving 51 post-menopausal women randomly assigned to receive either 12 weeks of TCM acupuncture or sham acupuncture. Hot flashes were tracked daily, and questionnaires assessing climacteric symptoms and mood were administered at multiple time points.
• Outcome: Both TCM acupuncture and sham acupuncture groups showed significant improvement in vasomotor symptoms. No significant difference was found between the two groups, suggesting sham acupuncture may have therapeutic effects, limiting its usefulness as a placebo control.

[36] Individualized acupuncture plus self-care versus self-care alone for hot flashes in postmenopausal women. (Cited by: 12) (pmid: 20009958)

• Protocol: A pragmatic, multicenter randomized controlled trial followed 267 postmenopausal women with hot flashes for 12 months. The acupuncture group received 10 acupuncture treatments over 12 weeks, plus self-care advice; the control group received self-care advice only.
• Outcome: Initial significant differences in hot flash frequency and quality of life between groups at 12 weeks disappeared by 6 and 12 months. Acupuncture may offer short-term benefits but no long-term effects on hot flashes.

[37] Manual acupuncture and electroacupuncture for perimenopausal syndrome symptoms (hot flashes, hormone levels). (Cited by: 5) (pmid: 29231429)

• Protocol: A randomized controlled trial comparing manual acupuncture and electroacupuncture in 50 perimenopausal women. Treatments (at specific acupoints) were administered twice weekly for 8 weeks. Outcomes were assessed using questionnaires and hormone level testing at multiple time points.
• Outcome: Both manual acupuncture and electroacupuncture significantly improved hot flashes, menopausal symptoms, and serum follicle-stimulating hormone and estradiol levels. No significant difference was found between the two acupuncture techniques.

[38] Acupuncture with electrostimulation for hot flashes in prostate cancer patients undergoing hormonal therapy. (Cited by: 21) (pmid: 20494414)

• Protocol: A pilot study of 22 men experiencing hot flashes due to androgen deprivation therapy. Participants received bi-weekly acupuncture for 4 weeks, then weekly for 6 weeks. Hot flash scores were tracked daily.
• Outcome: 41% of patients experienced a >50% reduction in hot flash score after 4 weeks, and 55% at any point during the treatment. Improved hot flash scores correlated with better quality of life and sleep. Further research is recommended.

[39] Traditional Chinese Medicine (TCM) acupuncture plus self-care for hot flushes in postmenopausal women. (Cited by: 3) (pmid: 17324253)

• Protocol: A multi-center, randomized controlled trial comparing TCM acupuncture plus self-care versus self-care alone in 286 postmenopausal women experiencing ≥7 hot flushes daily. Intervention involved 10 acupuncture sessions over 12 weeks.
• Outcome: The abstract describes the study protocol; no outcomes are presented as the study was ongoing at the time of publication.

[40] Brief, standardized acupuncture for moderate to severe menopausal symptoms. (Cited by: 2) (pmid: 32517477)

• Protocol: A post-hoc analysis of a randomized controlled trial. 70 women received weekly acupuncture (CV3, CV4, LR8, SP6, SP9) for 5 weeks, with a delayed-treatment control group. Outcomes were assessed using the MenoScores Questionnaire at 26 weeks.
• Outcome: Acupuncture's positive effects on menopausal symptoms (hot flushes, sweats, sleep problems) persisted for up to 21 weeks post-treatment. A small pre-treatment effect was also observed.

Research Interpretation: Summary and Conclusion

Multiple randomized controlled trials (RCTs) have investigated acupuncture's efficacy in treating hot flashes, employing various acupuncture techniques (traditional, electroacupuncture, moxibustion), control groups (sham acupuncture, no treatment, usual care, placebo), and durations. While some studies demonstrated statistically significant reductions in hot flash severity and frequency, and improvements in quality of life, compared to controls, others found no significant difference between acupuncture and sham or control groups. Inconsistencies exist across studies, potentially due to variations in acupuncture protocols, patient populations, and outcome measures. Several studies suggest a possible placebo effect, while others highlight the potential for personalized acupuncture based on genetic factors. The collective evidence is inconclusive, with some studies indicating short-term benefits but limited long-term efficacy. Larger, well-designed, multi-center trials with standardized protocols are needed to definitively establish acupuncture's role in managing hot flashes.

Publications

[1] Ee C; Xue C; Chondros P; Myers SP; French SD; Teede H; Pirotta M (2016). Acupuncture for Menopausal Hot Flashes: A Randomized Trial Annals of internal medicine 164 (3) :146-54.

[2] Serra D; Fleishman SB; White C; Leung TM; Chadha M (2023). Acupuncture Reduces Severity of Hot Flashes in Breast Cancer: A Randomized Single-Blind Trial Holistic nursing practice 37 (6) :330-336.

[3] Jeong YJ; Choi HR; Kim KS; Shin IH; Park SH (2023). Impact of Acupuncture on Hot Flashes in Breast Cancer Patients Receiving Adjuvant Antiestrogen Therapy with Tamoxifen: A Randomized Controlled Trial Journal of integrative and complementary medicine 29 (4) :241-252.

[4] Lu W; Giobbie-Hurder A; Tanasijevic A; Kassis SB; Park SH; Jeong YJ; Shin IH; Yao C; Jung HJ; Zhu Z; Bao C; Bao T; Yang E; Bierer BE; Ligibel JA (2024). Acupuncture for hot flashes in hormone receptor-positive breast cancer: A pooled analysis of individual patient data from parallel randomized trials Cancer 130 (18) :3219-3228.

[5] Vincent A; Barton DL; Mandrekar JN; Cha SS; Zais T; Wahner-Roedler DL; Keppler MA; Kreitzer MJ; Loprinzi C (2007). Acupuncture for hot flashes: a randomized, sham-controlled clinical study Menopause (New York, N.Y.) 14 (1) :45-52.

[6] Deng G; Vickers A; Yeung S; D'Andrea GM; Xiao H; Heerdt AS; Sugarman S; Troso-Sandoval T; Seidman AD; Hudis CA; Cassileth B (2007). Randomized, controlled trial of acupuncture for the treatment of hot flashes in breast cancer patients Journal of clinical oncology : official journal of the American Society of Clinical Oncology 25 (35) :5584-90.

[7] Liu Z; Ai Y; Wang W; Zhou K; He L; Dong G; Fang J; Fu W; Su T; Wang J; Wang R; Yang J; Yue Z; Zang Z; Zhang W; Zhou Z; Xu H; Wang Y; Liu Y; Zhou J; Yang L; Yan S; Wu J; Liu J; Liu B (2018). Acupuncture for symptoms in menopause transition: a randomized controlled trial American journal of obstetrics and gynecology 219 (4) :373.e1-373.e10.

[8] Baccetti S; Da Fre M; Becorpi A; Faedda M; Guerrera A; Monechi MV; Munizzi RM; Parazzini F (2014). Acupuncture and traditional Chinese medicine for hot flushes in menopause: a randomized trial Journal of alternative and complementary medicine (New York, N.Y.) 20 (7) :550-7.

[9] Avis NE; Coeytaux RR; Isom S; Prevette K; Morgan T (2016). Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial Menopause (New York, N.Y.) 23 (6) :626-37.

[10] Hervik J; Mjaland O (2009). Acupuncture for the treatment of hot flashes in breast cancer patients, a randomized, controlled trial Breast cancer research and treatment 116 (2) :311-6.

[11] Kargozar R; Salari R; Jarahi L; Yousefi M; Pourhoseini SA; Sahebkar-Khorasani M; Azizi H (2019). Urtica dioica in comparison with placebo and acupuncture: A new possibility for menopausal hot flashes: A randomized clinical trial Complementary therapies in medicine 44 :166-173.

[12] Avis NE; Legault C; Coeytaux RR; Pian-Smith M; Shifren JL; Chen W; Valaskatgis P (2008). A randomized, controlled pilot study of acupuncture treatment for menopausal hot flashes Menopause (New York, N.Y.) 15 (6) :1070-8.

[13] Lesi G; Razzini G; Musti MA; Stivanello E; Petrucci C; Benedetti B; Rondini E; Ligabue MB; Scaltriti L; Botti A; Artioli F; Mancuso P; Cardini F; Pandolfi P (2016). Acupuncture As an Integrative Approach for the Treatment of Hot Flashes in Women With Breast Cancer: A Prospective Multicenter Randomized Controlled Trial (AcCliMaT) Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34 (15) :1795-802.

[14] Kim DI; Jeong JC; Kim KH; Rho JJ; Choi MS; Yoon SH; Choi SM; Kang KW; Ahn HY; Lee MS (2011). Acupuncture for hot flushes in perimenopausal and postmenopausal women: a randomised, sham-controlled trial Acupuncture in medicine : journal of the British Medical Acupuncture Society 29 (4) :249-56.

[15] Kim KH; Kang KW; Kim DI; Kim HJ; Yoon HM; Lee JM; Jeong JC; Lee MS; Jung HJ; Choi SM (2010). Effects of acupuncture on hot flashes in perimenopausal and postmenopausal women--a multicenter randomized clinical trial Menopause (New York, N.Y.) 17 (2) :269-80.

[16] Mao JJ; Bowman MA; Xie SX; Bruner D; DeMichele A; Farrar JT (2015). Electroacupuncture Versus Gabapentin for Hot Flashes Among Breast Cancer Survivors: A Randomized Placebo-Controlled Trial Journal of clinical oncology : official journal of the American Society of Clinical Oncology 33 (31) :3615-20.

[17] Nedeljkovic M; Tian L; Ji P; Deglon-Fischer A; Stute P; Ocon E; Birkhauser M; Ausfeld-Hafter B (2014). Effects of acupuncture and Chinese herbal medicine (Zhi Mu 14) on hot flushes and quality of life in postmenopausal women: results of a four-arm randomized controlled pilot trial Menopause (New York, N.Y.) 21 (1) :15-24.

[18] Park JE; Lee MS; Jung S; Kim A; Kang K; Choi J; Park J; Choi SM (2009). Moxibustion for treating menopausal hot flashes: a randomized clinical trial Menopause (New York, N.Y.) 16 (4) :660-5.

[19] Huang MI; Nir Y; Chen B; Schnyer R; Manber R (2006). A randomized controlled pilot study of acupuncture for postmenopausal hot flashes: effect on nocturnal hot flashes and sleep quality Fertility and sterility 86 (3) :700-10.

[20] Sunay D; Ozdiken M; Arslan H; Seven A; Aral Y (2011). The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial Acupuncture in medicine : journal of the British Medical Acupuncture Society 29 (1) :27-31.

[21] Borud EK; Alraek T; White A; Fonnebo V; Eggen AE; Hammar M; Astrand LL; Theodorsson E; Grimsgaard S (2009). The Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study, a randomized controlled trial Menopause (New York, N.Y.) 16 (3) :484-93.

[22] Soares JM Jr; Branco-de-Luca AC; da Fonseca AM; Carvalho-Lopes CM; Arruda-Veiga EC; Roa CL; Bagnoli VR; Baracat EC (2020). Acupuncture ameliorated vasomotor symptoms during menopausal transition: single-blind, placebo-controlled, randomized trial to test treatment efficacy Menopause (New York, N.Y.) 28 (1) :80-85.

[23] Romero SAD; Li QS; Orlow I; Gonen M; Su HI; Mao JJ (2020). Genetic predictors to acupuncture response for hot flashes: an exploratory study of breast cancer survivors Menopause (New York, N.Y.) 27 (8) :913-917.

[24] Palma F; Fontanesi F; Facchinetti F; Cagnacci A (2019). Acupuncture or phy(F)itoestrogens vs. (E)strogen plus progestin on menopausal symptoms. A randomized study Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology 35 (11) :995-998.

[25] Painovich JM; Shufelt CL; Azziz R; Yang Y; Goodarzi MO; Braunstein GD; Karlan BY; Stewart PM; Merz CN (2012). A pilot randomized, single-blind, placebo-controlled trial of traditional acupuncture for vasomotor symptoms and mechanistic pathways of menopause Menopause (New York, N.Y.) 19 (1) :54-61.

[26] de Valois BA; Young TE; Robinson N; McCourt C; Maher EJ (2010). Using traditional acupuncture for breast cancer-related hot flashes and night sweats Journal of alternative and complementary medicine (New York, N.Y.) 16 (10) :1047-57.

[27] Frisk J; Carlhall S; Kallstrom AC; Lindh-Astrand L; Malmstrom A; Hammar M (2008). Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial Climacteric : the journal of the International Menopause Society 11 (2) :166-74.

[28] Garland SN; Xie SX; Li Q; Seluzicki C; Basal C; Mao JJ (2017). Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial Menopause (New York, N.Y.) 24 (5) :517-523.

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