Parallel or cross over randomised controlled trials (RCTs) of real needle versus sham acupuncture in women with menopausal hot flushes (perimenopausal, menopausal or postmenopausal women or those with surgically induced menopause) were eligible for inclusion. Studies of women with radiation induced or chemotherapy induced menopause or with breast cancer were excluded.
The included studies were based in Sweden, USA and Korea. Studies involved women aged 43 to 65 years with (where reported) four or more moderate to severe hot flushes per day. Most studies included only postmenopausal women, although some studies included perimenopausal and postmenopausal women. Treatment ranged from nine to 16 sessions of either manual or electro acupuncture; sessions each lasted 20 to 30 minutes. Both classical Chinese and Western formula acupuncture were included. Control groups received either non-penetrating or minimally penetrating sham acupuncture, mostly at non-acupuncture points. Follow-up ranged from four to 24 weeks. The primary outcome measure was mean change in hot flush frequency, severity or an index (frequency x severity), assessed either subjectively (on a visual analogue scale), through a diary of symptoms or using validated scoring systems of generic vasomotor symptoms.
Two reviewers independently read all articles, and disagreements were resolved by consensus and discussion with a third reviewer.