Efficacy Comparison of Different Acupuncture Treatments for Hot Flashes: A Systematic Review with Network Meta-Analysis

The objective of this study was to conduct a systematic review and network meta-analysis to evaluate and compare the effectiveness of various types of acupuncture for menopausal hot flashes (HF). Randomized controlled trials (RCTs) were retrieved from 8 electronic databases, and the risk of bias was evaluated for the included studies. Pairwise meta-analysis and network meta-analysis were performed using Review Manager and R software for indirect comparison and ranking, respectively. In total, 23 RCTs (2,302 patients) were eligible for systematic review, of which 10 were included in network meta-analysis. Network meta-analysis showed manual acupuncture (MA) had the highest probability of reducing HF frequency and severity, followed by sham acupuncture (SA), electroacupuncture, usual care, or no treatment; furthermore, warm acupuncture significantly improved menopause-specific quality of life compared with MA or electroacupuncture. Compared with hormone replacement therapy, acupuncture had less efficacy in reducing HF frequency but enhanced menopause-specific quality of life. There was no significant difference between MA and SA in mitigating HF. The existing evidence showed that MA could be used for alleviating menopausal HF. However, it is recommended that more high-quality RCTs should be performed.